Evaluation of Clinical Results and Complications of Structural Allograft Reconstruction after Bone Tumor Surgery

Document Type : RESEARCH PAPER

Authors

1 Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

2 Department of Orthopedic Surgery, Kamyab Hospital, Mashhad, Iran Department of Orthopedic Surgery, Emam Reza Hospital, Mashhad, Iran

3 Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

 
Background: Massive bone allograft is an option in cases of limb preservation and reconstruction after massive benign and malignant bone tumor resection. The purpose of this study was to analyze the outcome of these procedures at Imam Reza Hospital, Mashhad University of Medical Sciences.

Methods: In this study, 113 cases have been presented. Eleven cases were excluded (patients has a traumatic defect or they passed away before the completion of the study’s two-year follow up period). Each patient completed a questionnaire, went through a physical examination and, if indicated, X-ray information was collected. The patients were divided into three groups: chemotherapy, chemotherapy plus radiation therapy, and no-adjuvant-therapy.

Results: Fifty-four cases were male and the mean age was 24.5±5.39. The number of cases and indications for surgery were: 33 cases of aggressive benign tumors or low grade malignant bone tumors (large bone defects) including 16 germ cell tumors, eight aneurysmal bone cysts, five low grade osteosarcomas, and four chondrosarcomas. Another 69 cases were high-grade malignant bone tumors including 42 osteosarcomas, 21 Ewing’s sarcoma, and six other high grade osteosarcomas. Patients were divided into three groups: the first group received no adjuvant therapy, the second group received chemotherapy, and the third group received chemotherapy plus radiotherapy. The location of tumors were as follows: eight cases in the pelvic bone, 12 in the proximal femur, 18 in the femoral shaft, 36 in the distal femur, 12 in the proximal tibia, and 16 in the humeral bone. The 12 cases of proximal femoral defects were reconstructed by allograft composite prosthesis, 18 diaphyseal defects with intercalary allograft, and 36 distal femoral defects were reconstructed using osteoarticular allograft. The rate of deep infection was 7:8% (eight patients) and in this regard, we found a significant difference among the three groups, such that most cases of infection occurred in the adjuvant chemotherapy plus radiation therapy group. Allograft fracture occurred in six patients and prevalence was the same in all groups. Only in six cases of radio-chemotherapy nonunion occurred, so we used autogenous bone graft for union. Local recurrence was observed in six patients: three belonged to the adjuvant chemotherapy group and the other three were in the chemo-radiotherapy group; no significant difference was observed between these two groups. However, there was a significant difference between these two and the group that received no adjuvant therapy. Also, there were 11 cases of metastases and Restriction of knee joint motion occurred in 48 cases of osteo-cartilaginous grafts of the distal femur and proximal tibia.

Conclusion: Although structural allograft is an appropriate choice in limb reconstruction after massive resection of involved tissues in malignant and invasive bone tumors, the risk of complications such as nonunion and infection in massive allograft increases in cases of adjuvant (chemotherapy and radiotherapy) modalities of treatment. Whereas the rate of tumor recurrence, metastasis, and restrictions in range of motion during a short term follow up after implantation showed no significant difference among the evaluated groups. Consequently, further attention and constant periodic visits of the patients and checking for local recurrence and distant metastasis should be done after surgery.

Keywords

References

1. Jamshidi KH, Jabal Ameli M, Ameri Mahabadi E. The
results of limb-salvage procedures for high grade
osteosarcoma of the limbs. Razi J Med Sci. 2004;
10(38):835-43.
2. Anract P, Coste J, Vastel L, Jeanrot C, Mascard
E, Tomeno B. Proximal femoral reconstruction
with megaprosthesis versus allograft prosthesis
composite. A comparative study of functional results,
complications and longevity in 41 cases. Rev Chir
Orthop Reparatrice Appar Mot. 2000; 86(3):278-88.
3. Bullens PH, Minderhoud NM, de Waal Malefijt MC,
Veth RP, Buma P, Schreuder HW. Survival of massive
allografts in segmental oncological bone defect
reconstructions. Int Orthop. 2009; 33(3):757-60.
4. Tuominen T, JämsäT, Tuukkanen J, Nieminen P,
Lindholm TC, Lindholm TS, et al. Native bovine bone
morphogenetic protein improves the potential of
biocoral to heal segmental canine ulnar defects. Int
Orthop. 2000; 24(5):289-94.
5. Mankin HJ, Doppelt S, Tomford W. Clinical experience
with allograft implantation. The first ten years. Clin
Orthop Relat Res. 1983; 174:69-86.
6. Dick HM, Malinin TI, Mnaymneh WA. Massive
allograft implantation following radical resection of
high-grade tumors requiring adjuvant chemotherapy
treatment. Clin Orthop Relat Res. 1985; 197:88-95.
7. Glasser DB, Lane JM. Stage IIB osteogenic sarcoma.
Clin Orthop Relat Res. 1991; 270:29-39.
8. Deijkers RL, Bloem RM, Petit PL, Brand R, Vehmeyer
SB, Veen MR. Contamination of bone allografts:
analysis of incidence and predisposing factors. J
Bone Joint Surg Br. 1997; 79(1):161-6.
9. Farfalli GL, Aponte-Tinao L, Lopez-Millan L, Ayerza
MA, Muscolo DL. Clinical and functional outcomes
of tibial intercalary allografts after tumor resection.
Orthopedics. 2012; 35(3):e391-6.
10. Jamshidi K, Jabalameli M, Ameri E. The early results
of massive osteoarticular allograft in the surgical
treatment of lower limb bone tumors. J Kerman Univ
Med Sci. 1998; 5(3):117-22.
11. Mankin HJ, Gebhardt MC, Jennings LC, Springfield
DS, Tomford WW. Long-term results of allograft
replacement in the management of bone tumors. Clin
Orthop Relat Res. 1996; 324:86-97.
12. Nekouei A, Solouki S. The results of treatment of
bone allograft transplantation in the treatment of
primary malignant bone tumors in Namazi and
Chamran Hospital. Shiraz: Shiraz University of
Medical Sciences; 2013.
13. Donati D, Biscaglia R. The use of antibioticimpregnated
cement in infected reconstructions
after resection for bone tumours. J Bone Joint Surg
Br. 1998; 80(6):1045-50.
14. Rodl RW, Ozaki T, Hoffmann C, Bottner F, Lindner N,
Winkelmann W. Osteoarticular allograft in surgery
for high-grade malignant tumours of bone. J Bone
Joint Surg Br. 2000; 82(7):1006-10.
15. Donati D, Di Liddo M, Zavatta M, Manfrini M, Bacci G,
Picci P, et al. Massive bone allograft reconstruction in
high-grade osteosarcoma. Clin Orthop Relat Res. 2000;
377:186-94.
16. Vander Griend RA. The effect of internal fixation on
the healing of large allografts. J Bone Joint Surg Am.
1994; 76(5):657-63.
17. Masterson EL, Masri BA, Duncan CP, Rosenberg A,
Cabanela M, Gross M. The cement mantle in femoral
impaction allografting. A comparison of three
systems from four centres. J Bone Joint Surg Br. 1997;
79(6):908-13.
18. Friedlaender GE, Tross RB, Doganis AC, Kirkwood
JM, Baron R. Effects of chemotherapeutic agents on
bone. I. Short-term methotrexate and doxorubicin
(adriamycin) treatment in a rat model. J Bone Joint
Surg Am. 1984; 66(4):602-7.
19. Kumta SM, Leung PC, Griffith JF, Roebuck DJ, Chow
LT, Li CK. A technique for enhancing union of
allograft to host bone. J Bone Joint Surg Br. 1998;
80(6):994-8.
The Archives of Bone and Joint Surgery
Volume 4, Issue 3
July 2016
Pages 236-242

Files

History

  • Receive Date: 28 May 2015
  • Revise Date: 09 January 2016
  • Accept Date: 13 January 2016

Share

How to cite

Statistics