Intercalary allograft reconstruction following femoral tumour resection: mid- and long-term results and benefits of adding a vascularised fibula autograft

• Published in: World journal of surgical oncology 2022-06, Vol.20 (1), p.195-195, Article 195
• Main Authors: Crenn, Vincent, Quinette, Yonis, Bouthors, Charlie, Missenard, Gilles, Viard, Brice, Anract, Philippe, Boisgard, Stéphane, Mascard, Eric, Gouin, François
• Format: Article
• Language: English
• Subjects: Allografts; Antibiotics; Autografts; Bone cancer; Bone grafts; Bone healing; Bone reconstruction; Bone tumour; Cancer; Context; Ethics; Femur; Fibula; Fractures; Health aspects; Intercalary allograft; Long bone; Methods; Multivariate analysis; Nonunion; Oncology, Experimental; Orthopedics; Patient outcomes; Prostheses; Reconstruction; Revisions; Risk analysis; Risk factors; Skin & tissue grafts; Surgery; Survival; Tumors; Vascularised fibula graft; X-rays
• ISSN: 1477-7819; 1477-7819
• DOI: 10.1186/s12957-022-02650-x

Bone healing in femoral reconstructions using intercalary allografts can be compromised in a tumour context. There is also a high revision rate for non-union, infection, and fractures in this context. The advantages and disadvantages of an associated vascularised fibula graft (VFG) are still a matter of debate. In a multicentre study, we retrospectively analysed 46 allograft reconstructions, operated on between 1984 and 2017, of which 18 were associated with a VFG (VFG+) and 28 without (VFG-), with a minimum follow-up of 2 years. We determined the cumulative probability of bone union as well as the mid- and long-term revision risks for both categories by Kaplan-Meier survival analysis and a multivariate Cox model. We also compared the MSTS scores. Significant differences in favour of VFG+ reconstruction were observed in the survival analyses for the probability of bone union (log-rank, p = 0.017) and in mid- and long-term revisions (log-rank, p = 0.032). No significant difference was observed for the MSTS, with a mean MSTS of 27.6 in our overall cohort (p = 0.060). The multivariate Cox model confirmed that VFG+ was the main positive factor for bone union, and it identified irradiated allografts as a major risk factor for the occurrence of mid- and long-term revisions. Bone union was achieved earlier in both survival and Cox model analyses for the VFG+ group. It also reduced the mid- and long-term revision risk, except when an irradiated allograft was used. In case of a tumour, we thus recommend using VFG+ from a fresh-frozen allograft, as it appears to be a more reliable long-term option.