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The effect of intramedullary cement on intercalary allograft reconstruction of bone defects after tumour resection: a
J S Wunder1, A M Davis, J S Hummel
1Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ont.
Objective:
A pilot study to evaluate the surgical and functional results of resection and reconstruction of diaphyseal bone tumours with cemented and uncemented intercalary allografts.
Design:
A retrospective case series.
Setting:
A quaternary care unit within a teaching hospital.
Patients:
Twenty-two patients with diaphyseal bone tumours treated between 1988 and 1992, with mean follow-up of 38 months (range from 20 to 70 months).
Interventions:
Diagnostic biopsy in all patients. Preoperative and postoperative chemotherapy in patients with high-grade sarcoma. En-bloc excision of all tumours. Reconstruction of the defect with cemented (15 patients) or uncemented (7 patients) intercalary allografts.
Main Outcome Measures:
Nonunion at one or both osteosynthesis sites, death from systemic disease, amputation.
Results:
Six of the 22 patients died of systemic disease with the graft intact, and 3 subsequently had amputation for either local recurrence (2 patients) or failure of free tissue transfer (1 patient), leaving 13 patients alive with the allograft in situ at an average of 36 months (range from 24 to 64 months). There were no revision procedures to remove or replace the original allograft. Five patients had nonunion at one or more osteosynthesis sites on plain radiographs 9 months after resection. Four patients with nonunion were in the cemented group of 13 patients available for assessment at 9 months, and 1 was in the uncemented group of 5 patients available for assessment at 9 months. There were two graft fractures, both in the uncemented group.
Conclusion:
The results of this pilot study offer guarded support for the use of pressurized cement in allografts prior to reconstruction of intercalary defects.