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Intercalary Femur Allografts Are an Acceptable Alternative After Tumor Resection

Abstract

Background

With the improved survival for patients with malignant bone tumors, there is a trend to reconstruct defects using biologic techniques. While the use of an intercalary allograft is an option, the procedures are technically demanding and it is unclear whether the complication rates and survival are similar to other approaches.

Questions/purposes

We evaluated survivorship, complications, and functional scores of patients after receiving intercalary femur segmental allografts.

Patients and Methods

We retrospectively reviewed 83 patients who underwent an intercalary femur segmental allograft reconstruction. We determined allograft survival using the Kaplan-Meier method. We evaluated patient function with the Musculoskeletal Tumor Society scoring system. Minimum followup was 24 months (median, 61 months; range, 24–182 months).

Results

Survivorship was 85% (95% confidence interval: 93%–77%) at 5 years and 76% (95% confidence interval: 89%–63%) at 10 years. Allografts were removed in 15 of the 83 patients: one with infection, one with local recurrence, and 13 with fractures. Of the 166 host-donor junctions, 22 (13%) did not initially heal. Nonunion rate was 19% for diaphyseal junctions and 3% for metaphyseal junctions. We observed an increase in the diaphysis nonunion rate in patients fixed with nails (28%) compared to those fixed with plates (15%). Fracture rate was 17% and related to areas of the allograft not adequately protected with internal fixation. All patients without complications had mainly good or excellent Musculoskeletal Tumor Society functional results.

Conclusions

Diaphyseal junctions have higher nonunion rates than metaphyseal junctions. The internal fixation should span the entire allograft to avoid the risk of fracture. Our observations suggest segmental allograft of the femur provides an acceptable alternative in reconstructing tumor resections.

Level of Evidence

Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Author information

Correspondence to Luis Aponte-Tinao MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Supplementary material 1 (MPG 5163 kb)

Supplementary material 1 (MPG 12815 kb)

Supplementary material 1 (MPG 11097 kb)

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Aponte-Tinao, L., Farfalli, G.L., Ritacco, L.E. et al. Intercalary Femur Allografts Are an Acceptable Alternative After Tumor Resection. Clin Orthop Relat Res 470, 728–734 (2012). https://doi.org/10.1007/s11999-011-1952-5

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Keywords

  • Distraction Osteogenesis
  • Nonunion Rate
  • Allograft Failure
  • Musculoskeletal Tumor Society
  • Segmental Bone Defect