Stringent patient selection in bulk allograft reconstructions

We hypothesized that stringent patient selection in the use of large bulk structural allografts for limb preservation would positively affect outcomes and decrease complication rates by eliminating certain comorbid or social factors known to contribute to the most detrimental sources of allograft failure: infection, fracture, and nonunion.Our selection criteria included patients who were younger than 50 years, nonsmokers, non-obese (body mass index <40), who did not receive radiation therapy to the recipient site perioperatively, and who underwent intercalary allograft reconstruction except in the upper extremity where osteoarticular allografts were permitted. Outcomes were assessed using the Musculoskeletal Tumor Society (MSTS) and Toronto Extremity Salvage Score (TESS) scoring systems. Twenty-three patients fulfilled our cohort inclusion criteria. The overall survival rate for the 23 allografts was 91% (21/23). Average MSTS and TESS scores were 76% and 87%, respectively. Eleven of 23 patients experienced at least 1 complication requiring a second procedure. Musculoskeletal Tumor Society scores among patients experiencing no complications averaged 83% vs 71% for patients experiencing at least 1 complication. Average TESS scores were 89% and 86%, respectively.The results of our early experience indicate there is no appreciable difference in complication rates among our series of patients stringently selected for bulk allograft reconstruction compared to other previously reported studies.