Surgical Difficulties Encountered With Use of Modular Endoprosthesis for Limb Preserving Salvage of Failed Allograft Reconstruction After Malignant Tumor Resection
Section snippets
Material and Methods
From our institution's tumor registry database, we identified 10 patients from 1994 to 2008 with allograft failure after malignant tumor resection who subsequently underwent limb preserving salvage surgery with modular endoprosthesis. Allograft failure was defined as local tumor recurrence, persistent infection not responding to intravenous antibiotic therapy and surgical drainage/debridement, allograft fracture, host-allograft junction nonunion not responding to autogenous cancellous bone
Results
Please refer to Table 1, Table 2 respectively for characteristics of the failed allograft reconstructions and results of the modular endoprosthesis revisions.
Half of the allograft reconstructions (5) failed because of fracture, making this the most frequent mode of allograft failure in this series of patients. The fractures occurred either through a screw hole (3) or at the clinically and radiologically healed host-allograft bone junction (2). In the 2 cases where the fracture occurred at the
Discussion
As patient survival rates continue to improve with systemic treatment, especially chemotherapy [22], more patients will start to present with failure of their primary reconstruction. While much literature has been published describing the outcomes of primary allograft reconstruction after malignant tumor resection1, 3, 7, 8, few papers have addressed the outcomes and specific difficulties faced with salvage of failed primary allograft reconstructions 15, 18, 23. In their article, Wang et al [15]
References (29)
- et al.
Primary bone osteosarcoma in the pediatric age: state of the art
Cancer Treat Rev
(2006) - et al.
Long-term results of allograft replacement in the management of bone tumours
Clin Orthop Relat Res
(1996) - et al.
Infection in massive bone allografts
Clin Orthop Relat Res
(2005) - et al.
Survival of massive allografts in segmental oncological bone defect reconstructions
Int Orthop
(2009) - et al.
Allograft fractures revisited
Clin Orthop Relat Res
(2001) - et al.
Fractures in large segment allografts
Clin Orthop Relat Res
(2000) - et al.
Factors affecting non-union of the allograft-host junction
Clin Orthop Relat Res
(2001) - et al.
Long-term results for limb salvage with osteoarticular allograft reconstruction
Clin Orthop Relat Res
(2009) - et al.
Survivorship and radiographic analysis of knee osteoarticular allografts
Clin Orthop Relat Res
(2000) - et al.
Free vascularized fibula graft salvage of complications of long bone allograft after tumor reconstruction
J Bone Joint Surg Am
(2008)
Results of free vascularised fibula grafting for allograft nonunon after limb salvage surgery for malignant bone tumors
J Pediatr Orthop
Allograft-allograft healing? Salvage of massive allografts after fracture
Clin Orthop Relat Res
Repairing bone and joint defect after tumor excision with allograft/prosthetic composite arthroplasty
Zhejiang Da Xue Xue Bao Yi Xue Ban
Allograft-prosthetic composite reconstruction of the proximal part of the tibia—an analysis of early results
J Bone Joint Surg Am
Cited by (14)
Proximal Femur Salvage in Revision Knee Arthroplasty Due to Oncologic Indications: Long-term Results of Onlay and Overlapping Allograft in Revision Surgeries
2023, CiOS Clinics in Orthopedic SurgeryRevision surgeries for tumor endoprostheses around the knee joint: a mid-long-term follow-up of 20 cases
2022, World Journal of Surgical OncologyWhat Are the Long-term Results of MUTARS <sup>®</sup> Modular Endoprostheses for Reconstruction of Tumor Resection of the Distal Femur and Proximal Tibia?
2017, Clinical Orthopaedics and Related Research
No benefits or funds were received in support of the study.