[Reconstruction of segmental bone defects using massive osseous and osteocartilaginous allograft]

The reconstruction of large segmental defects after the resection of malignant bone tumors is usually done with modular or custom-made endoprostheses, so far, they appear to work well. From the experience with other indications for endoprostheses it must be admitted that failures will be a matter of time only. With the improved prognosis for patients with primary malignant bone tumors with regard to relapse-free survival and increased chances for permanent cure, the trend for reconstruction procedures should be directed to more 'biological' techniques. The reconstruction of osseous and osteocartilaginous defects with massive allografts is somewhere between the use of autologous bone and artificial replacement. From the experience with 14 allograft reconstructions in primary malignant bone tumors (osteosarcoma, malignant fibrous histiocytoma, leiomyosarcoma, chondrosarcoma, lymphoma) or other aggressive lesions (aneurysmal bone cyst, recurring giant-cell tumor, solitary metastasis) of the humerus (one osteoligamentous graft in combination with an endoprosthesis, one intercalary graft), the femur (three intercalary grafts, two osteoarticular distal femurs, one combination with an endoprosthesis), and the proximal tibia (four osteocartilaginous, two intercalary grafts) in patients aged 10 to 64 years, we feel that this type of reconstruction allows for a reconstruction without sacrificing more bone and soft tissue than needed for the surgical margins. Fusion between the patient's bone and the allograft has been seen after 6 to 18 months. From this small series it is concluded that using allografts might allow for the preservation of joint structures that need to be resected for the implantation of an endoprosthesis, increasing the possibilities for salvage procedures.(ABSTRACT TRUNCATED AT 250 WORDS)