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[Massive bone allografts in large bone defects after tumor surgery: a clinical long-term study]
N Shinohara1, K Yokoyama, H Chuman
1Dept. of Orthopedic Surgery, National Fukuoka Central Hospital.
Gan to Kagaku Ryoho. Cancer & Chemotherapy
|April 1, 1989
Summary
Bone reconstruction using massive bone grafts is a viable alternative to prosthetic implants for young adults with malignant bone tumors. While initial allografts may fail, autografts ensure successful bone healing and good functional outcomes.
Area of Science:
- Orthopedic oncology
- Surgical reconstruction
- Adjuvant chemotherapy
Context:
- Malignant bone tumors in the femur and tibia present significant reconstructive challenges.
- Limb salvage surgery aims to preserve function while eradicating disease.
- Prosthetic implants have limitations, especially in young patients with long life expectancy.
Purpose:
- To evaluate the efficacy of massive bone allografts in reconstructing large bone defects after tumor resection.
- To assess complication rates, bone healing, and functional outcomes in patients treated with bone grafts.
Summary:
- Eleven patients with malignant bone tumors underwent resection and reconstruction with massive bone grafts, followed by adjuvant chemotherapy (adriamycin and high-dose methotrexate).
- Seven cases were evaluated, with procedures including segmental resections and allograft reconstruction with or without knee arthrodesis.
- Initial allograft resorption occurred in three cases, successfully treated with autografts. Complications included septic fistula and hardware failure, which resolved.
- Primary bone healing of allografts failed in all cases, but subsequent autografting led to healing within two years.
- Functional outcomes (Enneking criteria) were good in four patients and fair in three.
Impact:
- Massive bone grafting is a successful reconstructive option for malignant bone tumors, offering an alternative to prosthetic implants in young adults.
- This approach can achieve good functional results, even after initial allograft complications, highlighting the importance of autografting for definitive healing.