Ortiz-Cruz, J Bone Joint Surg Am 1997 - The Results of Transplantation of Intercalary Allografts after Resection of Tumors. A Long-Term Follow-Up Study
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The Results of Transplantation of Intercalary Allografts after Resection of Tumors. A Long-Term Follow-Up Study
Ortiz-Cruz, Mankin, et al.·J Bone Joint Surg Am·1997·296 citations
Ortiz‑Cruz and colleagues reviewed intercalary allografts placed after bone tumor resection to establish how often they succeeded and what predicted failure.
Massachusetts General Hospital series of 104 intercalary allografts in 100 patients (1974 to 1992), mean age 28, followed a mean 73 months (24 to 220).
Key Findings
Of 104 reconstructions, 84% had a good or excellent result. Most failures occurred in the first 3 to 4 years, after which results were generally stable.
Of the 15 failed grafts, 7 limbs were salvaged with another allograft or other reconstruction and 8 patients had amputation, 2 for recurrent tumor. Overall, 92 patients kept the limb.
Non‑union at 1 year affected 31 grafts (30%). Success was 71% with non‑union vs 89% without (p = 0.02).
Infection was the most damaging complication: 12 grafts (12%), all within 33 months. Success was 17% with infection vs 92% without, and 6 infections led to amputation.
Fracture occurred in 18 grafts, cutting success to 56% from 90%. Fewer grafts fractured with one long plate (7 of 56) than with two short plates (7 of 21).
Adjuvant chemotherapy or radiation lowered success to 60% from 91% (p = 0.008), and high‑grade tumors also did worse. Age, sex, site and graft length did not affect outcome.
Board pearl
Allograft non‑union was the most frequent but least consequential complication. On its own it never caused graft failure. Infection and fracture drove the failures.
Authors' conclusion
Despite the relatively high rate of non-union that necessitated additional operations, these data indicate that transplantation of allografts for the treatment of intercalary defects has a high rate of success and usually results in a functional limb.
Ortiz‑Cruz and colleagues reviewed intercalary allografts placed after bone tumor resection to establish how often they succeeded and what predicted failure.
Massachusetts General Hospital series of 104 intercalary allografts in 100 patients (1974 to 1992), mean age 28, followed a mean 73 months (24 to 220).
Key Findings
Of 104 reconstructions, 84% had a good or excellent result. Most failures occurred in the first 3 to 4 years, after which results were generally stable.
Of the 15 failed grafts, 7 limbs were salvaged with another allograft or other reconstruction and 8 patients had amputation, 2 for recurrent tumor. Overall, 92 patients kept the limb.
Non‑union at 1 year affected 31 grafts (30%). Success was 71% with non‑union vs 89% without (p = 0.02).
Infection was the most damaging complication: 12 grafts (12%), all within 33 months. Success was 17% with infection vs 92% without, and 6 infections led to amputation.
Fracture occurred in 18 grafts, cutting success to 56% from 90%. Fewer grafts fractured with one long plate (7 of 56) than with two short plates (7 of 21).
Adjuvant chemotherapy or radiation lowered success to 60% from 91% (p = 0.008), and high‑grade tumors also did worse. Age, sex, site and graft length did not affect outcome.
Board pearl
Allograft non‑union was the most frequent but least consequential complication. On its own it never caused graft failure. Infection and fracture drove the failures.
Authors' conclusion
Despite the relatively high rate of non-union that necessitated additional operations, these data indicate that transplantation of allografts for the treatment of intercalary defects has a high rate of success and usually results in a functional limb.