J Korean Orthop Assoc.  2013 Feb;48(1):9-15. 10.4055/jkoa.2013.48.1.9.

Intercalary Allograft Reconstruction after Malignant Tumor Resection around the Knee

• Choi ES
• Han I
• Cho HS
• Kang HG
• Kim JH
• Kim HS

• KMID: 2106657
• DOI: http://doi.org/10.4055/jkoa.2013.48.1.9

Abstract

PURPOSE
We aimed to assess the treatment outcomes and factors affecting bone union of intercalary allograft reconstruction after primary malignant bone tumor resection around the knee.
MATERIALS AND METHODS
Twenty-one patients who underwent intercalary allograft reconstruction after resection of a malignant tumor of femur or tibia were retrospectively reviewed. The average follow-up period was 46.4 months. Location of the tumor was as follows: femur in 12 cases and tibia in 9. Osteosarcoma was the most common tumor (12 cases). Intercalary allograft was internally fixed with an intramedullary (IM) nail in 3 cases, with a plate in 12 cases and with an IM nail combined with a plate in 6 cases. The survival of the grafts and functional outcomes were evaluated. Factors affecting bone union and complications were assessed.
RESULTS
All allografts survived without removal. The average Musculoskeletal Tumor Society functional score was 27. The mean length of the allograft was 16.7 cm and bony union took 10.9 months, in average. Nonunion occurred in 6 cases: at the diaphyseal side in 3, and the remaining 3 at the metaphyseal side. The graft length was shorter than average in all the diaphyseal side nonunion cases and longer than average in all the metaphyseal side nonunion cases. All cases of nonunion obtained bone union after additional operations (autologous bone graft alone: 1, bone graft with hardware change: 5).
CONCLUSION
Survival and functional outcomes of intercalary allograft were satisfactory. Long allograft showed a tendency of fracture or nonunion at the metaphyseal side. Nonunion could be managed with additional operation without allograft removal.

Keyword

osteosarcoma; intercalary reconstruction; allograft reconstruction

MeSH Terms

Femur
Follow-Up Studies
Humans
Knee
Nails
Osteosarcoma
Retrospective Studies
Tibia
Transplantation, Homologous
Transplants

Figure

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  Figure 1 (A, B) This patient underwent wide excision and intercalary reconstruction with allograft due to ewing's sarcoma. (C) Nonunion of diaphyseal junction and screw breakage (arrow) were noted at 9 months postoperatively. (D) Removal of plates, autogenous bone graft and intramedullary nailing were performed. (E) Bony union was identified after 12 months.

• 

  Figure 2 (A, B) This patient underwent intercalary resection and reconstruction with allograft and intramedullary nail due to parosteal osteosarcoma. (C) Nounion (arrow) was noted at 10 months postoperatively. (D) Bony union was achieved by autologous bone graft at 12 months.

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