Osteoarticular allografts

Over the past eighty years, osteoarticular allografts have provided the possibility of limb-sparing procedures in tumor surgery. Several authors have now reported up to 80 per cent successful use of these types of grafts, and large well-documented series give evidence that limb reconstruction following extensive resection of bone and joints has been possible with their use. In conjunction with their successful applications, studies of the fate of osteoarticular allografts have provided useful information on their associated problems. Infection has been a major complication, affecting up to 12 per cent of recipients and frequently resulting in re-operations and occasionally amputations. Studies have suggested however that almost half of these infections are due to soft-tissue complications rather than to the allografts. Fractures and non-unions, affecting up to 10 per cent of recipients, have proven easier to treat, and few if any patients lose their grafts after fractures. A recent study of retrieved osteoarticular allografts has shown that incorporation of these massive bone segments is slow but progressive, and ultimate incorporation of the grafts can be expected in most patients. The fate of the cartilaginous portion of the grafts has also been evaluated. Our laboratory has suggested that although cryopreservation of the articular portion of the grafts appears feasible in vitro, the fate of transplanted cryopreserved cartilage is dependent on many factors, including accurate sizing and ligamentous reconstruction around the replaced joints. In determining indications for massive osteoarticular allografts, we have found that these grafts are not a panacea for all problems encountered in bone tumor resection, but should be used advisedly for the treatment of specific problems.(ABSTRACT TRUNCATED AT 250 WORDS)