Structural allograft reconstruction of the foot and ankle after tumor resections.
BACKGROUND
Structural allografts have been used to correct deformities or to fill bone defects secondary to tumor excisions, trauma, osteochondral lesions, or intercalary arthrodesis. However, the quality of published evidence supporting the use of allograft transplantation in foot and ankle surgery has been reported as fair. The purpose of this study was to report the overall survival of structural allograft in the foot and ankle after tumor resection, and the survival according to the type of allograft and the complication rates in the medium to long term.


METHODS
From January 1989 to June 2011, 44 structural allograft reconstructions of the foot and ankle were performed in 42 patients (28 men and 14 women) due to musculoskeletal tumor resections. Mean age at presentation was 27 years. Mean follow-up was 53 months. Demographic data, diagnosis, site of the neoplasm, operations performed, operative complications, outcomes after surgery, date of last follow-up evaluation, and local recurrences were reviewed for all patients. Regarding the type of 44 allograft reconstructions, 16 were hemicylindrical allografts (HA), 12 intercalary allografts (IA), 10 osteoarticular allografts (OA), and 6 were total calcaneal allograft (CA).


RESULTS
The overall allograft survival rate, as calculated with the Kaplan-Meier method, at 5 and 10 years was 79 % (95 % CI 64-93 %). When allocated by type of allograft reconstruction the specific allograft survival at 5 and 10 years was: 83 % for CA, 80 % for HA, 77 % for OA, and 75 % for IA. The complications rate for this series was 36 % including: articular failure, local recurrence, infection, fracture and nonunion.


CONCLUSIONS
This study showed that structural allograft reconstruction in the foot and ankle after tumor resection may be durable with a 79 % survival rate at 5 and 10 years. The two types of allografts that showed better survival rate were hemicylindrical allografts (80 %) and calcaneus allografts (83 %). The highest complication rates occurred after calcaneus allografts and osteoarticular allografts.


METHODS
IV.
Institute of Orthopedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Potosi 4247, CIP: 1199, Buenos Aires, Argentina. miguel.ayerza@hospitalitaliano.org.ar.
M A
MA
Ayerza
Institute of Orthopedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Potosi 4247, CIP: 1199, Buenos Aires, Argentina.
N S
NS
Piuzzi
Institute of Orthopedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Potosi 4247, CIP: 1199, Buenos Aires, Argentina.
L A
LA
Aponte-Tinao
Institute of Orthopedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Potosi 4247, CIP: 1199, Buenos Aires, Argentina.
G L
GL
Farfalli
Institute of Orthopedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Potosi 4247, CIP: 1199, Buenos Aires, Argentina.
D L
DL
Muscolo
D000293:Adolescent; D000328:Adult; D000368:Aged; D064591:Allografts; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D001859:Bone Neoplasms / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods* / Q000706:statistics & numerical data; D002111:Calcaneus / Q000637:transplantation; D002648:Child; D002675:Child, Preschool; D015925:Cryopreservation; D005260:Female; D005531:Foot Deformities, Acquired / Q000000981:diagnostic imaging / Q000601:surgery*; D005534:Foot Diseases / Q000601:surgery*; D006085:Graft Survival; D006801:Humans; D007223:Infant; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D009926:Organ Preservation; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012983:Soft Tissue Neoplasms / Q000601:surgery*; D055815:Young Adult
Bone transplantation; Fresh-frozen structural allografts; Limb salvage; Tumor of bone; Tumors foot and ankle