Page 97 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

Introduction
Until the 1970s, the treatment of high-grade extremity sarcoma routinely consisted of the amputation of a ected limbs. Despite aggressive surgery, the ve-year survival rate was ≤20%1-3. Because of the introduction of chemotherapy and advances in imaging and surgical techniques, limb salvage became feasible in an increasing number of patients and ve-year survival rates increased to 55% to 70%4-11.
Most primary malignant bone tumors are localized in the epiphysis and/
or metaphysis of the long bones, often necessitating resection of joints. Still,
numerous tumors are located in the metaphysis or diaphysis10,12, in which case
it is desirable to save adjacent joints. Reconstruction with intercalary allografts is
a well-accepted surgical technique to reconstruct the osseous defect after such 5 resections. Intercalary allografts have been recommended as a reliable solution
with long-term success rates and good functional outcome in 82% to 84% of patients13,14. As intercalary allografts have relatively good stability compared with
autografts, the main advantage of using intercalary allografts is the opportunity
to biologically reconstruct a large long-bone de cit without donor site morbidity. Nevertheless, allografts are associated with high rates of infection (0% to 18%),
fracture (0% to 30%), and delayed union or nonunion (15% to 55%)13-20. Finally, widespread use might be restricted by limited availability in some countries and
by the minor possibility of transmission of infectious diseases.
In this multicenter study, we retrospectively evaluated (1) incidence of and risk factors for failure, (2) incidence of and risk factors for complications (with special emphasis on infection, fracture, and nonunion), (3) time to full weight-bearing, and (4) optimal xation methods for intercalary allograft reconstructions after bone tumor surgery.
Materials and Methods
In the Netherlands, primary bone tumors are treated in four appointed centers for orthopaedic oncology. To identify eligible patients, we assessed all massive allografts that were delivered to these centers by our national bone bank between 1989 and 2009. All consecutive whole-circumference resections of primary tumors in the long bones that were reconstructed with an intercalary allograft were included and retrospectively reviewed. The minimum follow-up was 24 months ( gure 1).
Intercalary allografts
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