J Korean Orthop Assoc.  2015 Dec;50(6):462-473. 10.4055/jkoa.2015.50.6.462.

Bone Reconstruction: Structural Allograft and Autograft

• Chung YG

• KMID: 2185087
• DOI: http://doi.org/10.4055/jkoa.2015.50.6.462

Abstract

Structural allograft or recycled autograft bone transplantation has been performed for reconstruction of bone defects caused by bone tumor resection. Knowledge regarding advantages and disadvantages of bone reconstruction using an allograft or recycled autograft, other alternatives such as reconstruction with tumor prosthesis, the understanding of biologic characteristics and fate of transplanted bones, functional results, and complications of reconstruction are important. The surgeon should also be accustomed to the major technical points of allograft or recycled autograft transplantation. Proper indication, selection of an appropriate allograft or recycled autograft, rigid fixation, accurate surgical skills, preventive measures of infection and efficient rehabilitation are necessary in order to obtain long term survival of grafted bones and good functional outcome. Here, I will discuss the bone reconstruction methods using structural allograft or recycled autograft transplantation after bone tumor resection and their clinical results.

Keyword

bone neoplasm; bone transplantation; reconstruction; allografts; autografts

MeSH Terms

Allografts*
Autografts*
Bone Neoplasms
Bone Transplantation
Population Characteristics
Prostheses and Implants
Rehabilitation
Transplants

Figure

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  Figure 1 (A) An anteroposterior radiograph of the right humerus of a 12-year-old patient in whom an osteochondral allograft reconstruction was performed after wide near total resection of the humerus involved with osteosarcoma. (B) A lateral radiograph of a patient with osteosarcoma at the midshaft of the right femur treated with intercalary allograft reconstruction. Dual plate fixation was performed for stability of the construct. (C) An anteroposterior radiograph of the right distal femur of a patient with osteosarcoma in whom resected bone was reconstructed with an allograft-prosthesis composite.

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  Figure 2 Unicondylar osteochondral allograft. A 60-year-old male patient with metastatic carcinoma involving the medial condyle of right distal femur (A) was managed with a unicondylar osteoarticular allograft (B). After resection of the medial hemicondyle (C), a size- and shape-matched allograft hemicondyle was inserted and fixated with plate and screws (D). (E) Postoperative radiograph showed a well reconstructed articular surface.

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  Figure 3 A 55-year-old male patient with chondrosarcoma at the left humerus (A) was managed with an intercalary allograft combined with an onlay type vascularized fibular graft (B). (C) Six year follow-up radiograph showed solid bone union at both proximal and distal host-allograft bone junctions (Courtesy of Dr. Joo-Yup Lee, Department of Orthopedic Surgery, The Catholic University of Korea, St. Vincent Hospital, Suwon; with permission).

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  Figure 4 A 40-year-old female patient with parosteal osteosarcoma at the right distal femur (A-C) was managed with wide resection and reconstruction with a recycled pasteurized autograft combined with an inlay type vascularized fibular graft. (D) Twelve-year follow-up radiograph showed solid bone union at both proximal and distal host-allograft bone junctions. The patient recovered full limb function.

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