RESEARCH ARTICLE


Allograft Reconstruction for Sarcomas of the Tibia



Vincent Y. Ng1, *, Philip Louie2, Stephanie Punt3, Ernest U. Conrad3
1 Department of Orthopaedics, University of Maryland Medical Center, 110 S. Paca St, 6th Floor, Baltimore, Maryland 21201, United States
2 Department of Orthopaedics, Rush University, Chicago, United States
3 Department of Orthopedics and Sports Medicine, University of Washington, 1959 NE Pacific Street, Seattle, Washington 98195, United States


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© 2017 Vincent et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the University of Maryland Medical Center - Orthopaedics, 110 S. Paca St, 6th Floor, Baltimore, Maryland 21201, United States; Tel: 443-462-5903; E-mail: vng@umoa.umm.edu


Abstract

Background:

Allograft reconstruction of oncologic resections involving the tibia can have unpredictable results. Prior studies have reported a high rate of complications and a long recovery period involving prolonged bracing, repeated procedures and extended periods of antibiotics.

Methods:

The case details of 30 tibial allografts (12 adults, 18 children; 20 intercalary, 7 hemicortical, 3 other) were reviewed retrospectively. Based on factors including function, pain, healing and infection, clinical outcomes were stratified into three categories: excellent, moderate, and poor.

Results:

The overall survival rate of the allografts was 66% at a mean follow-up of 42 mos (adults) and 63 mos (children). Healing for metaphyseal junctions was successful in 73% at a mean of 44 weeks and for diaphyseal junctions, 64% at 41 weeks. Intercalary allografts in adults (4 of 20) all became infected and none had excellent results. All hemicortical allografts were performed in adults and 6 of 7 had excellent results. Distal intercalary allografts in children (6 of 20) had either excellent or moderate results with no infections, but had 3 nonunions and 2 fractures. Proximal intercalary allografts in children (8 of 20) had 2 excellent results, but had 6 infections requiring a cement spacer. Five of the six spacers were ultimately revised to another allograft or an arthroplasty.

Conclusion:

For tibial allograft reconstruction, surgeons and patients should prepare for a prolonged treatment course that may include multiple complications and surgeries. Excellent or moderate results can be achieved eventually in most, but amputation may be necessary in 15-20% of cases.

Keywords: Tibia, Allograft, Reconstruction, Complication, Sarcoma, Function.