Page 22 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

Chapter 1
well-preserved human grafts in the Netherlands was ensured by The Leiden Bone Bank Foundation, which was founded in 198895. In chapter 5, we evaluate the results of intercalary allograft reconstructions in treatment of primary bone tumors from the four appointed centers for orthopaedic oncology in the Netherlands84.
Orthopaedic surgeons later postulated that bone tumors with limited osseous and intramedullary involvement may be adequately treated by hemicortical (hemicylindrical) resection, leaving part of the cortical bone intact96, 97. Hemicortical defects may be reconstructed using allografts96, autografts98, or autologous iliac crest grafts99. Although autografts have favorable biological properties, allografts were the preferred technique in the Netherlands, because they allow for reconstruction of larger defects. Moreover, they avoid donor site morbidity, which occurrs in approximately 10% of patients and includes prolonged pain complaints, large hematomas, unsightly scars, and sensory loss100. In 2002, investigators from our center reported on the results of 22 hemicortical allograft reconstructions in treatment of low-grade malignant bone tumors96. The authors reported excellent results, with none of their patients experiencing local tumor relapse, fracture, or infection. Later, others reported comparable results, but all described small case series and most lacked long-term follow-up97-99, 101-103. In chapter 6, we present the results of a nationwide retrospective study on complications and oncological outcome after hemicortical resection of primary tumors of the musculoskeletal system104.
In the early 1990s, allografts were also commonly used for (partial) joint replacement following tumor resection105-107. It soon appeared that speci c problems of joint reconstruction with allografts were the high risks of joint instability, cartilage degeneration, and subchondral collapse108-110. However, large studies focusing on the long-term outcomes of these osteoarticular allografts were lacking. In chapter 7, we evaluate our own experiences with osteoarticular allograft reconstructions, and present a systematic review of the literature, in an attempt to quantify the risk of complications after osteoarticular allograft reconstruction.
One of the major complications of allograft reconstructions is nonunion of allograft-host junctions111, 112. Treatment of nonunion is often problematic because one side of the junction is comprised of nonvascular bone111. Nonunion is assumed to result from a complex interplay between biological and mechanical factors111. The in uence of many factors, including the use of adjuvant chemotherapy, osteosynthesis type and location of the junction, has been thoroughly evaluated84, 88, 111, 113. On the other hand, it has been stated that construct stability and contact
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