Aims To assess complications and failure mechanisms of osteoarticular allograft reconstructions for primary bone tumours.
Patients and Methods We retrospectively evaluated 38 patients (28 men, 74%) who were treated at our institution with osteoarticular allograft reconstruction between 1989 and 2010. Median age was 19 years (interquartile range 14 to 32). Median follow-up was 19.5 years (95% confidence interval (CI) 13.0 to 26.1) when 26 patients (68%) were alive. In addition, we systematically searched the literature for clinical studies on osteoarticular allografts, finding 31 studies suitable for analysis. Results of papers that reported on one site exclusively were pooled for comparison.
Results A total of 20 patients (53%) experienced graft failure, including 15 due to mechanical complications (39%) and three (9%) due to infection. In the systematic review, 514 reconstructions were analysed (distal femur, n = 184, 36%; proximal tibia, n = 136, 26%; distal radius, n = 99, 19%; proximal humerus, n = 95, 18%). Overall rates of failure, fracture and infection were 27%, 20%, and 10% respectively. With the distal femur as the reference, fractures were more common in the humerus (odds ratio (OR) 4.1, 95% CI 2.2 to 7.7) and tibia (OR 2.2, 95% CI 1.3 to 4.4); infections occurred more often in the tibia (OR 2.2, 95% CI 1.3 to 4.4) and less often in the radius (OR 0.1, 95% CI 0.0 to 0.8).
Conclusion Osteoarticular allograft reconstructions are associated with high rates of mechanical complications. Although comparative studies with alternative techniques are scarce, the risk of mechanical failure in our opinion does not justify routine employment of osteoarticular allografts for reconstruction of large joints after tumour resection.
Cite this article: Bone Joint J 2017;99-B:522–30.
M. P. A. Bus: Conception or design of the work, Data collection, Data analysis and interpretation, Drafting the article, Critical revision of the article, Final approval of the version to be published.
M. A. J. van de Sande: Critical revision of the article, Final approval of the version to be published.
A. H. M. Taminiau: Critical revision of the article, Final approval of the version to be published.
P. D. S. Dijkstra: Conception or design of the work, Critical revision of the article, Final approval of the version to be published.
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
This article was primary edited by G. Scott.
Supplementary material. The search strategy and a table showing an overview of the literature can be found alongside the online version of this article at www.bjj.boneandjoint.org.uk
- Received May 16, 2016.
- Accepted November 11, 2016.
- ©2017 The British Editorial Society of Bone & Joint Surgery