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Large segment allograft survival is improved with intramedullary cement
Author(s) -
Gerrand Craig H.,
Griffin Anthony M.,
Davis Aileen M.,
Gross Allan E.,
Bell Robert S.,
Wunder Jay S.
Publication year - 2003
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.10316
Subject(s) - medicine , intramedullary rod , surgery , arthrodesis , confidence interval , bone grafting , bone cement , cement , alternative medicine , pathology , archaeology , history
Background and Objectives The most common cause of failure in large segment bone allografts used for oncologic reconstruction is allograft fracture. Reinforcement with pressurized intramedullary cement may improve the mechanical properties of allografts. Methods We reviewed the prospectively collected records of 45 patients who underwent en bloc resection of an extremity bone tumor and reconstruction using an allograft with intramedullary cement. Results Seven allografts were used for arthrodesis, 20 were intercalary, and 18 were osteochondral. Twenty eight of 45 patients were alive at a mean 5.8 years (SD 1.9; range 3–11.2) with 24 allografts in situ. In these 45 patients, there were four allograft fractures and four infections. Six of these complications resulted in allograft removal. The estimated 5‐year allograft survival rate was 86% (95% confidence interval 74–98%). Seven patients required secondary autogenous bone grafting for non‐unions. Function measured by the Toronto Extremity Salvage Score and the 1987 and 1993 Musculoskeletal Tumor Society Rating Scales demonstrated a consistent pattern with worse function in patients with osteochondral allografts and best function with intercalary allografts. Conclusions These results suggest the addition of intramedullary cement to large segment bone allografts improves their survival by decreasing the fracture risk, particularly for allografts used for arthrodesis and intercalary reconstructions. J. Surg. Oncol. 2003;84:198–208. © 2003 Wiley‐Liss, Inc.