Long-term outcomes of intercalary allograft reconstruction for primary malignant bone tumors in lower extremities

Abstract

Abstract Purpose The aim of this study was to analyze the long-term clinical outcomes of intercalary allograft reconstruction for primary malignant bone tumors in lower extremities. Methods A retrospective study was conducted on 29 patients (16 males, 13females) who underwent intercalary allograft reconstruction for primary malignant bone tumors in lower extremities between September 2007 and December 2012. The average age were 23.4 ± 15.1 years (range, 9–64) and the most common pathological type was osteosarcoma (17) followed by Ewing’s sarcoma (4), adamantinoma (4), chondrosaroma in 2, angiosarcoma of bone in 1 and undifferentiated pleomorphic sarcoma in 1. The tumor locations were in the femur in 13 and the tibius in 16. All complications and allograft failures occuered were recorded in this study. The oncological outcomes included local control, metastasis, progression-free survival and overall survival. The functional outcomes were evaluated by Musculoskeletal Tumor Society Score (MSTS-93). Results 29 patients was included in this retrosepective study and there were no patients lost in the follow-up period. The mean follow-up time was 149.8 ± 42.1 months (43–194). Three patients (10.3%) deceased in the last follow-up due to distant metastasis. The average diaphyseal bone resection length was 172.7 ± 29.2 mm (range, 130 to 240mm). The average allograft survival time was 134.4 ± 53.7 months (range, 6 to 194 months). The mean union time was 16.3 (6–29) months and overall survivorship of the allograft was 82.7% (24/29) at an average 12.5 years follow-up. The average MSTS-93 score was 86% (range, 70–100%). Ninteen patients (66.5%) had at least one complication in the follow-up time. The common unoncological complications were bone non-union (8), fracture (3), infection (2) and leg length discrepancy (LLD, 2). Conclusions The intercalary allograft reconstruction is a reliable technique to resolve the massive bone defects after primary diaphyseal bone tumor resection in lower extremities with acceptable long-term function and satisfaction. Level of evidence: level IV Therapeutic.