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Are Pasteurized Autografts Durable for Reconstructions After Bone Tumor Resections?
Seung Yong Lee1, Dae-Geun Jeon, Wan Hyeong Cho
1Seung Yong Lee MD, Dae-Geun Jeon MD, Wan Hyeong Cho MD, Won Seok Song MD, Bum Suk Kim MD, Department of Orthopedic Surgery, Korea Cancer Center Hospital, Seoul, Korea.
Clinical Orthopaedics and Related Research
|February 23, 2019
Summary
Long-term outcomes reveal disappointing survival rates for pasteurized autografts in bone defect reconstruction after tumor resection. This method should be used cautiously, especially in pediatric patients and pelvic reconstructions, due to high failure rates.
Area of Science:
- Orthopedic Surgery
- Oncology
- Biomaterials
Background:
- Pasteurized autografts are a biologic option for bone defects post-tumor resection, but long-term data from large series are limited.
- Previous reports suggested favorable outcomes, yet this study observed significant failure rates, particularly with extended follow-up.
Purpose of the Study:
- To evaluate graft survival, union rates, complications, and factors influencing outcomes of pasteurized autografts in a large patient cohort.
- To analyze failure causes and survival rates across different types of pasteurized autograft reconstructions.
Main Methods:
- A 26-year retrospective review of 353 patients reconstructed with pasteurized autografts after tumor resection.
- Data collected included patient demographics, tumor characteristics, graft type, fixation, union rates, complications, and oncologic outcomes.
- Kaplan-Meier survival analysis and log-rank tests were used to assess graft survival and intergroup differences.
Main Results:
- Five, 10-, and 20-year graft survival rates were 73%, 59%, and 40%, respectively, with 38% of grafts removed due to complications.
- Common causes for graft removal included infection (13%), nonunion (7%), and graft fracture (6%).
- Factors associated with increased graft removal included younger age (≤15 years), male sex, and pelvic location. Osteoarticular and hemicortical grafts showed better survival than intercalary, fusion, or pasteurized autograft-prosthesis composite (PPC) types.
Conclusions:
- Long-term survival of pasteurized autografts in this large cohort was disappointing compared to previous reports.
- Caution is advised when using pasteurized autografts in children, adolescents, pelvic reconstructions, and PPC forms.
- This method may be considered for minimal bone destruction cases, particularly for small intercalary or distal long bone reconstructions, and is best indicated after hemicortical resection.
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