title: Allograft reconstruction after proximal tibial resection for bone tumors. An analysis of function and outcome comparing allograft and prosthetic reconstructions.
abstract: Seventeen patients (age, 12-63 years; median, 22 years) treated with proximal tibial allografts were identified. Nine cases were intercalary and eight were osteoarticular allografts. Complications, number of operations, and oncologic and functional results were reviewed. The functional results of the allografts were compared with a prior cohort of patients who had endoprosthesis at the same institution by the same surgeons. There were 14 malignant tumors, two benign aggressive tumors, and one sclerosing osteomyelitis mimicking osteosarcoma. Twelve of 17 patients had complications, the most common being fracture, deformity, and infection. Six patients required more than one procedure, and three had amputations after allograft reconstruction. The ultimate function was excellent in three patients, good in seven, fair in six, and poor in one. There were 14 patients with endoprosthetic reconstruction. Wound problems followed by prosthetic loosening were the most common complications. Of the eight patients requiring a second procedure, three had an amputation. Three had excellent, seven good, and four fair functional results at the final evaluation. No patient in either group had a local recurrence. Allograft provides an alternative to endoprosthetic reconstruction; however, the high incidence of complications makes the outcome unpredictable. Allograft or prosthetic reconstruction provides better functional results than amputation without sacrificing oncologic results.
authors.affiliation: Department of Orthopaedics, Orthopaedic Hospital, Los Angeles, California.
authors.forename: E W
authors.initials: EW
authors.lastname: Brien
authors.forename: R M
authors.initials: RM
authors.lastname: Terek
authors.forename: J H
authors.initials: JH
authors.lastname: Healey
authors.forename: J M
authors.initials: JM
authors.lastname: Lane
mesh_terms: D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods*; D017024:Chemotherapy, Adjuvant; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016916:Joint Deformities, Acquired / Q000209:etiology; D007719:Knee Joint / Q000502:physiology; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology; D016059:Range of Motion, Articular; D013530:Surgical Wound Infection / Q000209:etiology; D013977:Tibia / Q000601:surgery*; D013978:Tibial Fractures / Q000209:etiology; D014184:Transplantation, Homologous / Q000379:methods