[Total or partial iliac reconstruction using allografts from the bone bank]

The reconstruction of massive pelvic defects following resection for tumour or damage from major trauma presents great technical difficulty. We have used cryopreserved allografts in patients to restore the normal anatomy and avoid major resection, such as a hemipelvectomy. This method avoids major limb shortening and impairment of function which occurs after trochantero-iliac or trochantero-sacral arthrodesis. Resection of tumour must be meticulous and complete in order to achieve a sound bed for the allograft. No problems were encountered in reattaching muscle insertions to the allograft, and skin healing was achieved without difficulty in all cases but one. In 2 patients involvement of nerve roots by tumour required their resection, with paralysis of the affected limb, but the overall function was satisfactory. In 10 patients removal of the hip joint was needed, and a total replacement was undertaken with cementing of the acetabular component into the allograft. Only one patient required a further operation because of partial necrosis of the allograft. Demineralisation was noted in some parts of the allograft between 18-20 months, but did not appear to affect function.