Complications following allograft reconstruction for primary bone tumors: Considerations for management

• Published in: Journal of orthopaedics 2019-01, Vol.16 (1), p.49-54
• Main Authors: Ippolito, Joseph A, Martinez, Maximilian, Thomson, Jennifer E, Willis, Alexander R, Beebe, Kathleen S, Patterson, Francis R, Benevenia, Joseph
• Format: Article
• Language: English
• Subjects: Allograft; Musculoskeletal oncology; Orthopedics; Reconstruction
• ISSN: 0972-978X; 0972-978X
• DOI: 10.1016/j.jor.2018.12.013

Abstract Introduction The aim of this study was to investigate complication rates and types following allograft reconstruction and discuss unique considerations for management. Methods Seventy-four consecutive patients underwent large segment allograft reconstruction following resection of primary musculoskeletal tumors from 1991 to 2016. Mean patient age was 32 ± 20 years (range, 5–71 years). Minimum follow-up was 2 years unless patients were lost to disease prior. Mean follow-up was 105 months. Results Thirty-five patients had complications requiring subsequent surgery at a mean of 30 months (range, 1–146 months) post-operatively. Individual complication rates were 29%, 50%, and 42% for Allograft Prosthetic Composite, Intercalary, and Osteoarticular allograft reconstruction, respectively. Risk factors for complication included age less than 30 (OR 4.5; p = 0.002), male gender (OR 2.8; p = 0.031), chemotherapy (OR 4.4; p = 0.003), lower extremity disease (OR 3.4; p = 0.025). In patients with complications, limb-retention rate was 91% and mean MSTS scores were 23.6. Conclusion Despite considerable complication rates, management with a systematic approach results in successful outcomes with limb-retention greater than 90% and mean MSTS scores of 79%. In carefully selected patients, allografts provide a reliable method of reconstruction with treatable complications occurring at a mean of 30 months.