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.
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.