Intercalary allografts reliable for reconstruction after bone tumour excision
Intercalary allografts enhanced with intramedullary cement and compression plate fixation are reliable as a reconstruction method following primary diaphyseal bone tumour excision, a new single-centre study has found. Moreover, the method yields high satisfaction and functional outcomes.
Analysis of the 46 patients (mean age 32.8 years) who received intercalary allografts between 1989 and 2014 revealed a median graft survival time of 92 months and an overall intercalary allograft survival rate of 84.8 percent.
Complications were reported in 33 percent (n=15) of the patients; 13 required surgical interventions, while the remaining two were managed without operations. Three patients experienced nonunion of grafts, one of which was treated with an autograft. The mean time to union was 9 months. Fracture of the allograft was reported in two patients.
Local recurrence after treatment of bone sarcoma was reported in only 8.7 percent (n=4) of the patients. One of the patients also had recurrent tumour in the tibia and needed below-knee amputation.
In terms of functional outcomes, only 70 percent (n=32) of the patients had complete information. The mean Musculoskeletal Tumour Society (MSTS) 87 score of these patients was 29.1±4.5. By comparison, the mean MSTS 93 and Toronto Extremity Salvage Score (TESS) ratings were 82.2±15.7 and 81.2±16.8, respectively.
Functional outcomes were the best for patients who received humeral reconstruction. Similarly, functional scores were significantly better for the upper limbs based on the TESS scores (p=0.03). Differences in the MSTS 87 (p=0.11) and MSTS 93 (p=0.14) scores were only marginally significant.