Resection arthrodesis of the knee for tumor: large intercalary allograft and long intramedullary nail technique.
Twenty-five patients had a procedure consisting of resection of the distal femur or proximal tibia for aggressive or malignant neoplasms.  The resulting bony gap was bridged by allografts averaging 18 cm in length.  Fixation was achieved using a long fluted intramedullary nail.  The average follow-up time and time to union were 3 years (range, 0.25 to 9 years) and 13 months (range, 6 to 28 months), respectively.  Eleven patients had nononcologic complications related to the index surgical procedure, including two patients with allograft nonunion.  There were no infections.  Three patients had amputations for local recurrence of their tumor.  Twenty patients (80%) had no evidence of tumor at the time of follow-up. According to the Evaluation System of the Musculoskeletal Tumor Society, 80% of patients had a satisfactory result.  No patient had a nononcologic complication resulting in total failure or amputation.  The procedure of resection-arthrodesis of the knee using a large allograft with a long intramedullary nail provides patients with a stable, durable biological reconstruction that allows early weight-bearing, and the procedure carries a low incidence of infection.
Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine and Musculoskeletal Tumor Center, University Hospitals of Cleveland, OH.
J
J
Benevenia
J T
JT
Makley
M
M
Locke
A
A
Gentili
J
J
Heiner
D000293:Adolescent; D000328:Adult; D000368:Aged; D001174:Arthrodesis / Q000379:methods*; D001858:Bone Nails; D001859:Bone Neoplasms / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D006085:Graft Survival; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009372:Neoplasms, Connective Tissue / Q000601:surgery*; D011183:Postoperative Complications; D014184:Transplantation, Homologous / Q000379:methods; D016896:Treatment Outcome