Page 96 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

Chapter 5
Abstract
Background: Favorable reports on the use of massive allografts to reconstruct intercalary defects underline their place in limb-salvage surgery. However, little is known about optimal indications as reports on failure and complication rates in larger populations remain scarce. We evaluated the incidence of and risk factors for failure and complications, time to full weight-bearing, and optimal xation methods for intercalary allografts after tumor resection.
Methods: A retrospective study was performed in all four centers of orthopaedic oncology in the Netherlands. All consecutive patients reconstructed with intercalary (whole-circumference) allografts after tumor resection in the long bones during 1989 to 2009 were evaluated. The minimum follow-up was 24 months. Eighty-seven patients with a median age of 17 years (1.5 to 77.5) matched inclusion criteria. The most common diagnoses were osteosarcoma, Ewing sarcoma, adamantinoma, and chondrosarcoma. The median follow-up period was 84 months (25 to 262). Ninety percent of tumors were localized in the femur or the tibia.
Results: Fifteen percent of our patients experienced a graft-related failure. The major complications were nonunion (40%), fracture (29%), and infection (14%). Complications occurred in 76% of patients and reoperations were necessary in 70% of patients. The median time to the latest complication was 32 months (0 to 200). The median time to full weight-bearing was nine months (1 to 80). Fifteen grafts failed, 12 of which failed in the rst four years. None of the 34 tibial reconstructions failed. Reconstruction site, patient age, allograft length, nail-only xation, and non- bridging osteosynthesis were the most important risk factors for complications. Adjuvant chemotherapy and irradiation had no e ects on complication rates.
Conclusions: We report high complication rates and considerable failure rates for the use of intercalary allografts; complications primarily occurred in the rst years after surgery, but some occurred much later after surgery. To reduce the number of failures, we recommend reconsidering the use of allografts for reconstructions of defects that are ≥15 cm, especially in older patients, and applying bridging osteosynthesis with use of plate xation.
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