This single-center retrospective study followed 198 patients who received massive segmental allografts (femur or tibia) after bone tumor resection, asking whether these reconstructions remain durable beyond 10 years. It is the largest series to report long-term complications and survivorship with minimum 10-year follow-up, with no patients lost to follow-up.
Prior to this series, the accepted wisdom was that massive allograft complications cluster in the first 3 years — after that, the graft was considered stable. The authors provide the largest dataset with minimum 10-year follow-up to test that assumption directly.
When choosing between allograft and endoprosthesis for a young patient with a distal femoral osteosarcoma who responds to chemotherapy, an allograft is a reasonable option: the 10-year failure rate is 40%, but survivors function at MSTS 26/30 and walk unaided. For a proximal tibial tumor in an adult, the calculus is different. A 58% failure rate dominated by early infection makes this reconstruction hard to justify.
Counsel femoral allograft patients that fracture risk does not plateau: keep them under long-term surveillance and discuss the progressive fracture risk explicitly, especially for intercalary femoral reconstructions where the 20-year failure rate reaches 51%.
The authors themselves acknowledge they cannot directly compare allografts to endoprostheses in this dataset. The selection bias (higher-risk patients received prostheses) means these numbers represent a best-case allograft population.
Do Massive Allograft Reconstructions for Tumors of the Femur and Tibia Survive 10 or More Years after Implantation?
Radiological Assessment of Osteo-Arthrosis.
Mesenchymal Stem Cells.
Traumatic Arthritis of the Hip after Dislocation and Acetabular Fractures: Treatment by Mold Arthroplasty. an End-Result Study Using a New Method of Result Evaluation.
Bone: Formation by Autoinduction.
Treatment of Deep Cartilage Defects in the Knee with Autologous Chondrocyte Transplantation.
Interrater Reliability of a Modified Ashworth Scale of Muscle Spasticity
Osteoclast Differentiation Factor Is a Ligand for Osteoprotegerin/osteoclastogenesis-Inhibitory Factor and Is Identical to Trance/rankl.
Comparison of Upper Gastrointestinal Toxicity of Rofecoxib and Naproxen in Patients with Rheumatoid Arthritis. Vigor Study Group.
Magnetic Resonance Classification of Lumbar Intervertebral Disc Degeneration.
Novel Regulators of Bone Formation: Molecular Clones and Activities.
The Diagnosis of Osteoporosis.
"modes of Failure" of Cemented Stem-Type Femoral Components: a Radiographic Analysis of Loosening.
Biomechanical Measures of Neuromuscular Control and Valgus Loading of the Knee Predict Anterior Cruciate Ligament Injury Risk in Female Athletes: a Prospective Study.
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Prevention of Infection in the Treatment of One Thousand and Twenty-Five Open Fractures of Long Bones: Retrospective and Prospective Analyses.
The Variation in Isometric Tension with Sarcomere Length in Vertebrate Muscle Fibres.
Osteoarthritis: a Disease of the Joint as an Organ.
Radiological Demarcation of Cemented Sockets in Total Hip Replacement.
Ectopic Ossification Following Total Hip Replacement. Incidence and a Method of Classification.
The Operation of the Century: Total Hip Replacement.
Fatty Muscle Degeneration in Cuff Ruptures. Pre- and Postoperative Evaluation by CT Scan.
Osseointegrated Titanium Implants. Requirements for Ensuring a Long-Lasting, Direct Bone-To-Implant Anchorage in Man.
The Etiology of Chondromalacia Patellae.
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Problems in the Management of Type III (severe) Open Fractures: a New Classification of Type III Open Fractures.
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Vacuum-Assisted Closure: a New Method for Wound Control and Treatment: Animal Studies and Basic Foundation.
A System for the Functional Evaluation of Reconstructive Procedures after Surgical Treatment of Tumors of the Musculoskeletal System.
A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee
The Stabilizing System of the Spine. Part I. Function, Dysfunction, Adaptation, and Enhancement.
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Hip Morphology Influences the Pattern of Damage to the Acetabular Cartilage: Femoroacetabular Impingement as a Cause of Early Osteoarthritis of the Hip.
Porosity of 3D Biomaterial Scaffolds and Osteogenesis.
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Clinician's Guide to Prevention and Treatment of Osteoporosis.
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Epidemiology of Adult Fractures: a Review.
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A Joint Coordinate System for the Clinical Description of Three-Dimensional Motions: Application to the Knee.
Consensus Statement on Concussion in Sport-The 5th International Conference on Concussion in Sport Held in Berlin, October 2016.
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Estimating the Prevalence of Limb Loss in the United States: 2005 to 2050.
Metastasis to Bone: Causes, Consequences and Therapeutic Opportunities.
Role of Proinflammatory Cytokines in the Pathophysiology of Osteoarthritis.
The Basic Science of Articular Cartilage: Structure, Composition, and Function.
Osteoporosis: Now and the Future.
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Transfusion of Plasma, Platelets, and Red Blood Cells in a 1:1:1 vs. a 1:1:2 Ratio and Mortality in Patients with Severe Trauma: the Proppr Randomized Clinical Trial
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Diagnosis and Management of Prosthetic Joint Infection: Clinical Practice Guidelines by the Infectious Diseases Society of America.
The Amazing Osteocyte.
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Metastatic Bone Disease: Clinical Features, Pathophysiology and Treatment Strategies.
Diagnosis and Treatment of Hip and Knee Osteoarthritis
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This single-center retrospective study followed 198 patients who received massive segmental allografts (femur or tibia) after bone tumor resection, asking whether these reconstructions remain durable beyond 10 years. It is the largest series to report long-term complications and survivorship with minimum 10-year follow-up, with no patients lost to follow-up.
Prior to this series, the accepted wisdom was that massive allograft complications cluster in the first 3 years — after that, the graft was considered stable. The authors provide the largest dataset with minimum 10-year follow-up to test that assumption directly.
When choosing between allograft and endoprosthesis for a young patient with a distal femoral osteosarcoma who responds to chemotherapy, an allograft is a reasonable option: the 10-year failure rate is 40%, but survivors function at MSTS 26/30 and walk unaided. For a proximal tibial tumor in an adult, the calculus is different. A 58% failure rate dominated by early infection makes this reconstruction hard to justify.
Counsel femoral allograft patients that fracture risk does not plateau: keep them under long-term surveillance and discuss the progressive fracture risk explicitly, especially for intercalary femoral reconstructions where the 20-year failure rate reaches 51%.
The authors themselves acknowledge they cannot directly compare allografts to endoprostheses in this dataset. The selection bias (higher-risk patients received prostheses) means these numbers represent a best-case allograft population.