J Korean Orthop Assoc.  2018 Jun;53(3):264-270. 10.4055/jkoa.2018.53.3.264.

Complications of Allograft Reconstruction following Wide Resection of Malignant Bone Tumors in Long Bones

• Kim KJ
• Lee SK
• Jeon CY
• Ma CH
• Kim SM

• KMID: 2429175
• DOI: http://doi.org/10.4055/jkoa.2018.53.3.264

Abstract

PURPOSE
We evaluated the results of allograft reconstruction following wide resection of malignant bone tumors in long bone, retrospectively.
MATERIALS AND METHODS
Seven patients were included. The mean age was 44 years old. Male was 4 cases, and female was 3 cases. Mean follow-up period was 38 months. The mean Musculoskeletal Tumor Society (MSTS) score at final follow-up was evaluated. Postoperative complications were evaluated via periodic radiologic follow-up. Oncologic results were analyzed at final follow-up.
RESULTS
The primary malignancies occurred at femur in 5 cases, humerus in 1 case and tibia in 1 case. Pathologic diagnoses were osteosarcoma in 4 cases, multiple myeloma in 2 cases and adamantinoma in 1 case. Mean length of allograft was 165 mm. Fixations of allograft were intramedullary nailing with additional plate in 4 cases, intramedullary nailing in 2 cases, and screw fixation in 1 case. Mean time to union was 14.5 weeks. Mean MSTS score at final follow-up was 20 (67%). Postoperative complications were nonunion in 3 cases, implant failure in 1 case, and infection in 1 case. Oncologic outcomes were continuous disease free in 5 cases and alive with disease in 2 cases at final follow-up. Autologous bone graft and hemi-cortical onlay graft were performed in 2 cases of nonunion.
CONCLUSION
Allograft reconstruction following wide resection of malignant bone tumors in long bone was effective surgical option. However, the possibility of nonunion between host bone and allograft should be considered.

Keyword

malignant bone tumor; wide resection; allografts

MeSH Terms

Adamantinoma
Allografts*
Diagnosis
Female
Femur
Follow-Up Studies
Fracture Fixation, Intramedullary
Humans
Humerus
Inlays
Male
Multiple Myeloma
Osteosarcoma
Postoperative Complications
Retrospective Studies
Tibia
Transplants

Figure

• 

  Figure 1 (A) A 24-year-old male with ovoid to round osteolytic lesion at distal one third of left femur. Osteoblastic osteosarcoma was confirmed by incisional biopsy. (B) Radiograph showing allograft reconstruction following wide resection of malignant bone tumor, then internal fixation was done with retrograde intramedullary nail. (C) Radiograph showing nonunion (arrow) at proximal host bone-allograft interface at postoperative 12 months. (D) Radiograph showing nail fracture at nonunion site (arrow) at postoperative 18 months. (E) Radiograph showing that broken nail was removed, then conversion to antegrade intramedullary nail. (F) Photograph showing hemi-cortical allograft preparation for augmentation of nonunion site. (G) Radiograph showing autologuous bone graft and hemi-cortical onlay allograft was performed for augmenting nonunion site. Complete union was obtained.

• 

  Figure 2 (A) A 19-year-old male with intra-cortical round lesion at anterior cortex of right tibial shaft. Adamantinoma was confirmed via incisional biopsy. (B) Intraoperative photograph showing hemi-cortical resection of tumor site. (C) Photograph showing preparation of hemi-cortical allograft with accurate size with excised tumor. (D) Radiograph showing hemi-cortical allograft reconstruction with screw fixation. (E) Radiograph showing complete and sound union at host bone-allograft interface at postoperative 12 months.

• 

  Figure 3 (A) A 62-year-old female with elongated osteolytic lesion with cortical thinning at mid shaft of right humerus. Multiple myeloma was confirmed via incisional biopsy. (B) Computered tomography scan showing elongated osteolytic lesion with cortical thinning and breakage (between two arrows). (C) Radiograph showing allograft reconstruction following wide resection of myeloma lesion, then internal fixation was done with intramedullary nail and additional plates. (D) Radiograph showing allograft was well maintained and union was obtained at both proximal and distal host bone-allograft interfaces at postoperative 12 months.

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