Autograft and Biologic Living Bone Reconstructions in Orthopaedic Oncology

There are numerous approaches to reconstruction of skeletal defects after surgical resection of benign and malignant tumors of bone. Limb-salvage surgery can be successfully performed in more than 90% of patients with aggressive bone neoplasms. Endoprosthetic arthroplasties, bulk allografts, and composite reconstructions successfully restore limb stability and demonstrate encouraging early functional outcomes but are limited in the long term by rates of failure that increase over time and increase the rate of secondary amputation. Biological reconstructions with viable bone autograft can provide more durable long-term reconstructions, as well as growing reconstructions in the pediatric population at the expense of high short-term complication rates and donor-site morbidity. Such reconstructions can take up to a year for successful and stable union. Nonvascularized autograft, pedicled bone transfer, and free vascularized bone transfer are available biologic options for addressing postresection bone defects. Ultimately, the manner of skeletal reconstruction depends on the location and size of the defect, the anticipated growth and functional needs of the patient, and the weighed risks of each procedure as tolerated by the patient.