title: Effect of anatomic site and irradiation on the rates of revision and infection of allograft-prosthesis composites after resection of a primary bone tumor: a meta-analysis.
abstract: BACKGROUND
  Allograft-prosthesis composite reconstruction after resection of a primary bone tumor may have theoretical advantages, such as restoration of bone stock and soft tissue attachments. However, the reported results of APC of different anatomical sites differ widely. We conducted a meta-analysis to estimate the revision and infection rates associated with allograft-prosthesis composite (APC) reconstructions after resection of a primary bone tumor. We looked for variables, such as anatomic sites and irradiation of the allograft, associated with these outcomes.
  
  
  METHODS
  We searched Medline, EMBASE, and Cochrane Library. The primary outcome was the revision rate, and the secondary outcome was the infection rate. Random effects meta-analyses of single proportions were used to estimate pooled rates of events. Meta-regression models were built to assess the effect of moderators on relevant both outcomes.
  
  
  RESULTS
  Thirty-one studies were included: 9 about acetabulum APC, 9 about proximal femur APC, 4 about proximal tibia APC, and 9 about proximal humerus APC. The revision rates ranged from 16 % (95 % CI 10-25 %) for proximal humerus to 38 % (95 % CI 26-52 %) for acetabulum, and were significantly different between anatomic sites (p = 0.028). The infection rates ranged from 8 % (95 % CI 4-16 %) for proximal humerus to 23 % (95 % CI 16-33 %) for proximal tibia and 23 % (95 % CI 15-35 %) acetabulum APCs, and were significantly different between anatomic sites (p = 0.008). Finally, we found that irradiation of the allograft was significantly associated with revision rates (p = 0.033) and infection rates (p < 0.001).
  
  
  CONCLUSIONS
  Results of an APC reconstruction after resection of a primary malignant bone tumor vary significantly between anatomic sites and after irradiation of the allograft.
authors: Department of Orthopedic Surgery and Traumatology, Antoine Béclère Hospital, AP-HP, Paris Sud University, 157 rue de la Porte de Trivaux, 92140, Clamart, France. aureganjc@yahoo.fr.
authors: Jean-Charles
authors: JC
authors: Aurégan
authors: Department of Orthopedic Surgery and Traumatology, Antoine Béclère Hospital, AP-HP, Paris Sud University, 157 rue de la Porte de Trivaux, 92140, Clamart, France.
authors: Raphaël
authors: R
authors: Pietton
authors: Department of Orthopedic Surgery and Traumatology, Antoine Béclère Hospital, AP-HP, Paris Sud University, 157 rue de la Porte de Trivaux, 92140, Clamart, France.
authors: Thierry
authors: T
authors: Bégué
authors: Department of Orthopedic Surgery and Traumatology, Cochin Teaching Hospital, AP-HP, Paris Descartes University, INSERM U1153, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France.
authors: Philippe
authors: P
authors: Anract
authors: Department of Orthopedic Surgery and Traumatology, Cochin Teaching Hospital, AP-HP, Paris Descartes University, INSERM U1153, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France.
authors: David
authors: D
authors: Biau
mesh_terms: D000077:Acetabulum / Q000601:surgery; D001859:Bone Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods*; D005269:Femur / Q000601:surgery; D006801:Humans; D006811:Humerus / Q000601:surgery; D015233:Models, Statistical; D019919:Prosthesis Implantation / Q000379:methods*; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000209:etiology*; D012086:Reoperation / Q000706:statistics & numerical data*; D013977:Tibia / Q000601:surgery; D014184:Transplantation, Homologous; D016896:Treatment Outcome
keywords: Allograft prosthesis composite; Infection, irradiation; Malignant bone tumor; Revision