Background: Limb salvaging surgeries are current surgical treatment of extremity bone sarcomas. Resected bone
replacement consists of two main methods; tumor prosthesis versus structural allograft. Biological reconstruction with
an allograft is an economic cheap method in young sarcoma patients, however, the surgeons are more convinced with
tumor prosthesis replacement.
Methods: We evaluated the short-term complications and functional results of 40 patients with aggressive extremity
tumors in a retrospective cohort study. The mean age of cases was 25 and we followed them for 24 months. 17
patients underwent tumor prosthesis replacement after wide resection of limb sarcomas. 16 cases had structural
allograft reconstruction and 7 patients treated with amputation. We matched confounders including age, sex, blood
cell count and chemotherapy treatment in the study groups.
Results: We found 15 major complications (45.5%) in limb salvage surgeries composing infection, allograft nonunion,
allograft fracture, prosthesis fracture, prosthesis loosening and device failure that needed another surgery to be
resolved. We had 10 major complications in allograft group (62%) and 5 in tumor prosthesis group (29.4%). Although
the rate of complications was higher in allograft group, it didn’t statistically indicate strong correlation (Fisher’s exact:
0.084). Mean Musculo-Skeletal tumor rating Scale (MSTS) score was 25.8(73.7%) and 22.3(63.7%) in allograft
group and prosthesis cases respectively. MSTS score had a normal distribution in the different groups with no
significant difference between them.
Conclusion: Although complications were higher in the allograft group, allograft could be offered to bone sarcoma
patients, whom are predicted to have short life expectancy.
Level of evidence: III