title: Hemicortical resection and inlay allograft reconstruction for primary bone tumors: a retrospective evaluation in the Netherlands and review of the literature.
abstract: BACKGROUND
  Selected primary tumors of the long bones can be adequately treated with hemicortical resection, allowing for optimal function without compromising the oncological outcome. Allografts can be used to reconstruct the defect. As there is a lack of studies of larger populations with sufficient follow-up, little is known about the outcomes of these procedures.
  
  
  METHODS
  In this nationwide retrospective study, all patients treated with hemicortical resection and allograft reconstruction for a primary bone tumor from 1989 to 2012 were evaluated for (1) mechanical complications and infection, (2) oncological outcome, and (3) failure or allograft survival. The minimum duration of follow-up was twenty-four months.
  
  
  RESULTS
  The study included 111 patients with a median age of twenty-eight years (range, seven to seventy-three years). The predominant diagnoses were adamantinoma (n = 37; 33%) and parosteal osteosarcoma (n = 18; 16%). At the time of review, 104 patients (94%) were alive (median duration of follow-up, 6.7 years). Seven patients (6%) died, after a median of twenty-six months. Thirty-seven patients (33%) had non-oncological complications, with host bone fracture being the most common (n = 20, 18%); all healed uneventfully. Other complications included nonunion (n = 8; 7%), infection (n = 8; 7%), and allograft fracture (n = 3; 3%). Of ninety-seven patients with a malignant tumor, fifteen (15%) had residual or recurrent tumor and six (6%) had metastasis. The risk of complications and fractures increased with the extent of cortical resection.
  
  
  CONCLUSIONS
  Survival of hemicortical allografts is excellent. Host bone fracture is the predominant complication; however, none of these fractures necessitated allograft removal in our series. The extent of resection is the most important risk factor for complications. Hemicortical resection is not recommended for high-grade lesions; however, it may be superior to segmental resection for treatment of carefully selected tumors, provided that it is possible to obtain adequate margins.
  
  
  METHODS
  Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, Leiden University Medical Center, Postzone J11-R70, P.O. Box 9600, 2300 RC Leiden, the Netherlands. E-mail address for M.P.A. Bus: M.P.A.Bus@lumc.nl.
authors.forename: M P A
authors.initials: MP
authors.lastname: Bus
authors.affiliation: Department of Orthopaedic Surgery, Academic Medical Center, P.O. Box 22660, 1100 DD Amsterdam, the Netherlands.
authors.forename: J A M
authors.initials: JA
authors.lastname: Bramer
authors.affiliation: Department of Orthopaedic Surgery, Academic Medical Center, P.O. Box 22660, 1100 DD Amsterdam, the Netherlands.
authors.forename: G R
authors.initials: GR
authors.lastname: Schaap
authors.affiliation: Department of Orthopaedic Surgery, Radboud University Medical Center, Nijmegen, Postzone 357, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands.
authors.forename: H W B
authors.initials: HW
authors.lastname: Schreuder
authors.affiliation: Department of Orthopaedic Surgery, University Medical Center Groningen, Groningen, P.O. Box 30.001, 9700 RB Groningen, the Netherlands.
authors.forename: P C
authors.initials: PC
authors.lastname: Jutte
authors.affiliation: Department of Orthopaedic Surgery, Radboud University Medical Center, Nijmegen, Postzone 357, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands.
authors.forename: I C M
authors.initials: IC
authors.lastname: van der Geest
authors.affiliation: Department of Orthopaedic Surgery, Leiden University Medical Center, Postzone J11-R70, P.O. Box 9600, 2300 RC Leiden, the Netherlands. E-mail address for M.P.A. Bus: M.P.A.Bus@lumc.nl.
authors.forename: M A J
authors.initials: MA
authors.lastname: van de Sande
authors.affiliation: Department of Orthopaedic Surgery, Leiden University Medical Center, Postzone J11-R70, P.O. Box 9600, 2300 RC Leiden, the Netherlands. E-mail address for M.P.A. Bus: M.P.A.Bus@lumc.nl.
authors.forename: P D S
authors.initials: PD
authors.lastname: Dijkstra
mesh_terms: D050398:Adamantinoma / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D064591:Allografts; D001859:Bone Neoplasms / Q000601:surgery*; D016025:Bone Transplantation; D002648:Child; D005260:Female; D050723:Fractures, Bone / Q000209:etiology; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009426:Netherlands; D012516:Osteosarcoma / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome