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
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.
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.
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.
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.
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* 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: firstname.lastname@example.org