Clinical and functional outcomes of tibial intercalary allograft reconstructions
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Published:
Dec 12, 2012
Keywords:
Intercalary allografts, Tibia, Tibia Reconstruction
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Abstract
BackgroundThe purpose of this study was to evaluate the survival, the complications and the functional outcome of intercalary tibial allografts reconstructions following tumor resections.MethodsIntercalary tibia segmental allografts were implanted in 26 consecutive patients after segmental resections. Average follow-up was 6 years. Allograft survival was determined with the Kaplan-Meier method. Function was evaluated with the Musculoskeletal Tumor Society scoring system (MSTS). Results The rate of survival was 84% (CI 95%: 90%- 70%) at 5 years and 79% at 10 years (CI 95%: 95%-63%). Allografts were removed in 5 patients (3 due to infections and 2 due to local recurrences). Two patients showed diaphyseal nonunion and 3 had an incomplete fracture, but it was not necessary to remove the allografts. Average MSTS functional score was 29 points (range 27 to 30).ConclusionsDespite the incidence of complications, this analysis showed an acceptable survival with excellent functional scores. The use of intercalary allograft clearly has a place in the reconstruction of a segmental defect created by the resection of a tumor in the diaphyseal and/or metaphyseal portion of the tibia.
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López Millán, L., Aponte Tinao, L., Farfalli, G. L., Ayerza, M. A., & Muscolo, D. L. (2012). Clinical and functional outcomes of tibial intercalary allograft reconstructions. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 77(3), 192-196. https://doi.org/10.15417/141
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Clinical Research
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15. San-Julian M, Aquerreta JD, Benito A, Canadell J. Indications for epiphyseal preservation in metaphyseal malignant bone tumors of children: relationship between image methods and histological findings. J Pediatr Orthop 1999;19:543-8.
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17. Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res 1993;286:241-46.
18. Abudu A, Carter SR, Grimer RJ. The outcome and functional results of diaphyseal endoprostheses after tumour excision. J Bone Joint Surg Br 1996;78(4):652-7.
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21. Makley JT. The use of allografts to reconstruct intercalary defects of long bones. Clin Orthop Relat Res 1985;197:58-75.
22. Ortiz-Cruz EJ, Gebhardt MC, Jennings LC, Springfield DS, Mankin HJ. The results of transplantation of intercalary allografts after resection of tumors: A long-term follow-up study. J Bone Joint Surg Am 1997;79:97-106.
23. Canadell J, Forriol F, Cara JA. Removal of metaphyseal bone tumours with preservation of the epiphysis: physeal distraction before excision. J Bone Joint Surg Br 1994;76:127-32.
24. Berrey BH, Lord CF, Gebhardt MC, Mankin HJ. Fractures of allograft: Frequency, treatment, and end-results. J Bone Joint Surg Am 1990;72:825-33.
25. Gitelis S, Heligman D, Quill G, Piasecki P. The use of large allografts for tumor reconstruction and salvage of the failed total hip arthroplasty. Clin Orthop Relat Res 1988;231:62-70.
26. Hornicek FJ, Gebhardt MC, Tomford WW, Sorger JI, Zavatta M, Menzner JP, Mankin HJ. Factors affecting nonunion of the allograft-host junction. Clin Orthop Relat Res 2001;382:87-98.
27. Mankin HG, Springfield DS, Gebhardt MC, Tomford WW. Current status of allografting for bone tumors. Orthopedics 1992;15:1147-54.
28. Thompson RC, Pickvance EA, Garry D. Fractures in large segment allografts. J Bone Joint Surg Am 1993;75(11):1663-73.
29. Mnaymneh W, Malinin TI, Lackman RD, Hornicek FJ, Ghandur-Mnaymneh L. Massive distal femoral osteoarticular allografts after resection of bone tumors. Clin Orthop Relat Res 1994;303:103-115.
30. Vander Griend RA. The effect of internal fixation on the healing of large allografts. J Bone Joint Surg Am 1994;76(5):657-63.
31. Mankin HG, Gebhardt MC, Jennings LC, Springfield DS, Tomford WW. Long term results of allografts replacement in the management of bone tumors. Clin Orthop 1996;324:86-97.
2. Paulussen M, Ahrens S, Dunst J, Winkelmann W, Exner GU, Kotz R, et al. Localized Ewing tumor of bone: final results of the cooperative Ewing’s Sarcoma Study CESS 86. J Clin Oncol 2001;19:1818-29.
3. Hermanek P, Wittekind C. The pathologist and the residual tumor (R) classification. Pathol Res Pract 1994;190:115-23.
4. Ham SJ, Schraffordt Koops H, Veth RP, Horn JR, Molenaar WM, Hoekstra HJ. Limb salvage surgery for primary bone sarcoma of the lower extremities: long-term consequences of endoprosthetic reconstructions. Ann Surg Oncol 1998;5:423-36.
5. Hillmann A, Hoffmann C, Gosheger G, Krakau H, Winkelmann W. Malignant tumor of the distal part of the femur or the proximal part of the tibia: endoprosthetic replacement or rotationplasty: functional outcome and quality-of-life measurements. J Bone Joint Surg Am 1999;81(4):462-8.
6. Neel MD, Wilkins RM, Rao BN, Kelly CM. Early multicenter experienced with a noninvasive expandable prosthesis. Clin Orthop 2003;415:72-81.
7. Unwin PS, Walker PS. Extendible endoprostheses for the skeletally immature. Clin Orthop 1996;322:179-93.
8. Hardes J, Gebert C, Hillmann A, Winkelmann W, Gosheger G. Rotationplasty in the surgical treatment plan of primary malignant bone tumors: possibilities and limits. Orthopade 2003;32:965-70.
9. Exner GU, Hauser R. Reconstruction of large segmental defects of the lower extremities following resection of malignant and locally aggressive bone tumors. Schweiz Rundsch Med Prax 1991;44:1214-24.
10. Hennen J, Sabo D, Martini AK, Bernd L. Mantel transplant for defect reconstruction after resection of malignant bone tumors of the lower extremity. Unfallchirurg 2002;105:120-7.
11. Manfrini M, Gasbarrini A, Malaguti C, Ceruso M, Innocenti M, Bini S, et al. Intraepiphyseal resection of the proximal tibia and its impact on lower limb growth. Clin Orthop Relat Res 1999;358:111-9.
12. Ozaki T, Hillmann A, Wuisman P, Winkelmann W. Reconstruction of tibia by ipsilateral vascularized fibula and allograft: 12 cases with malignant bone tumors. Acta Orthop Scand 1997;68:298-301.
13. Muscolo DL, Ayerza MA, Aponte-Tinao L, Ranalletta M, Abalo E. Intercalary femur and tibia segmental allografts provide an acceptable alternative in reconstructing tumor resections. Clin Orthop 2004;426:97-102.
14. Donati D, Capanna R, Campanacci D, Del Ben M, Ercolani C, Masetti C, et al. The use of massive bone allografts for intercalary reconstruction and arthrodeses after tumor resection: A multicentric European study. Chir Organi Mov 1993;78:81-94.
15. San-Julian M, Aquerreta JD, Benito A, Canadell J. Indications for epiphyseal preservation in metaphyseal malignant bone tumors of children: relationship between image methods and histological findings. J Pediatr Orthop 1999;19:543-8.
16. San-Julian M, Dölz R, Garcia-Barrecheguren E, Noain E, Sierrasesumaga L, Cañadell J, et al. Limb salvage in bone sarcomas in patients younger than age 10: a 20-year experience. J Pediatr Orthop 2003;23:753-62.
17. Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res 1993;286:241-46.
18. Abudu A, Carter SR, Grimer RJ. The outcome and functional results of diaphyseal endoprostheses after tumour excision. J Bone Joint Surg Br 1996;78(4):652-7.
19. Cara JA, Laclériga A, Cañadell J. Intercalary bone allografts: 23 tumor cases followed for 3 years. Acta Orthop Scand 1994;65:42-6.
20. Gebhardt MC, Flugstad DI, Springfield DS, Mankin HJ. The use of bone allografts for limb salvage in high-grade extremity osteosarcoma. Clin Orthop Relat Res 1991;270:181-96.
21. Makley JT. The use of allografts to reconstruct intercalary defects of long bones. Clin Orthop Relat Res 1985;197:58-75.
22. Ortiz-Cruz EJ, Gebhardt MC, Jennings LC, Springfield DS, Mankin HJ. The results of transplantation of intercalary allografts after resection of tumors: A long-term follow-up study. J Bone Joint Surg Am 1997;79:97-106.
23. Canadell J, Forriol F, Cara JA. Removal of metaphyseal bone tumours with preservation of the epiphysis: physeal distraction before excision. J Bone Joint Surg Br 1994;76:127-32.
24. Berrey BH, Lord CF, Gebhardt MC, Mankin HJ. Fractures of allograft: Frequency, treatment, and end-results. J Bone Joint Surg Am 1990;72:825-33.
25. Gitelis S, Heligman D, Quill G, Piasecki P. The use of large allografts for tumor reconstruction and salvage of the failed total hip arthroplasty. Clin Orthop Relat Res 1988;231:62-70.
26. Hornicek FJ, Gebhardt MC, Tomford WW, Sorger JI, Zavatta M, Menzner JP, Mankin HJ. Factors affecting nonunion of the allograft-host junction. Clin Orthop Relat Res 2001;382:87-98.
27. Mankin HG, Springfield DS, Gebhardt MC, Tomford WW. Current status of allografting for bone tumors. Orthopedics 1992;15:1147-54.
28. Thompson RC, Pickvance EA, Garry D. Fractures in large segment allografts. J Bone Joint Surg Am 1993;75(11):1663-73.
29. Mnaymneh W, Malinin TI, Lackman RD, Hornicek FJ, Ghandur-Mnaymneh L. Massive distal femoral osteoarticular allografts after resection of bone tumors. Clin Orthop Relat Res 1994;303:103-115.
30. Vander Griend RA. The effect of internal fixation on the healing of large allografts. J Bone Joint Surg Am 1994;76(5):657-63.
31. Mankin HG, Gebhardt MC, Jennings LC, Springfield DS, Tomford WW. Long term results of allografts replacement in the management of bone tumors. Clin Orthop 1996;324:86-97.