The results of transplantation of intercalary allografts after resection of tumors. A long-term follow-up study.
We reviewed the results of 104 intercalary allograft procedures that had been performed, between April 1974 and August 1992, in 100 patients, usually after resection of a segment of bone because of an osseous neoplasm. The median duration of follow-up was 5.6 years. Retention of the graft and return to essentially normal function were the measures of success and, on that basis, eighty-seven (84 per cent) of the 104 reconstructions were successful. Of the fifteen limbs in which the reconstruction failed, four were salvaged with insertion of a second allograft and three, with use of some other technique. Of the 104 allograft procedures, eight (including two in patients who had a recurrent tumor) were followed by an amputation; thus, the ultimate rate of salvage was 92 per cent for the entire series. Thirty-one grafts failed to unite at one junction with the host or both, within one year after the operation, and this necessitated eighty-one additional operative procedures to achieve a good result. Life-table regression analysis showed that age, gender, anatomical site, and length of the graft were not associated with significant differences in the over-all outcome. Infection (p = 0.0001); fracture (p = 0.002); stage of the lesion (p = 0.007); and use of adjuvant chemotherapy or radiation, or both (p = 0.008), all had an adverse effect on the survival of the allograft. Despite the relatively high rate of non-union that necessitated additional operations, these data indicate that transplantation of allografts for the treatment of intercalary defects has a high rate of success and usually results in a functional limb.
Ortiz-Cruz
E
E
Paseo de la Florida, Madrid, Spain.
Gebhardt
M C
MC
Jennings
L C
LC
Springfield
D S
DS
Mankin
H J
HJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000564:Ameloblastoma / Q000601:surgery; D001859:Bone Neoplasms / Q000601:surgery*; D016025:Bone Transplantation; D002648:Child; D002675:Child, Preschool; D002813:Chondrosarcoma / Q000601:surgery; D005260:Female; D006085:Graft Survival; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D012516:Osteosarcoma / Q000601:surgery; D012189:Retrospective Studies; D012512:Sarcoma, Ewing / Q000601:surgery; D014184:Transplantation, Homologous; D016896:Treatment Outcome