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. 2006 Dec;30(6):478-83.
doi: 10.1007/s00264-006-0223-7. Epub 2006 Sep 30.

Massive allografts in tumour surgery

Z Matejovsky Jr  1 , Z Matejovsky, I Kofranek
Affiliations

Massive allografts in tumour surgery

Z Matejovsky Jr et al. Int Orthop. 2006 Dec.

Abstract
in English, French

We offer our personal experience of the use of massive bone allografts after tumour resection. We demonstrate the long-term results from 71 patients (72 allografts) operated on between 1961 and 1990. The long-term survival rate in osteoarticular and intercalary grafts is around 60%. Fractures of the graft can be salvaged in most cases. Infection leads to the removal of the graft in almost all cases. Factors influencing the survival, remodelling and complications of the grafts are discussed. The regime of cryopreservation, fixation and loading of the graft influence these factors, as do the use of autologous bone chips around the allograft-host junction and the application of chemotherapy or radiation. Fracture of the graft can be salvaged in most cases, as opposed to infection which remains the most severe complication and can occur at any time. Even with the improvement of tumour endoprostheses, the use of allografts remains an option, especially in young patients.

Les auteurs rapportent leur expérience de l’utilisation des allogreffes massives après résection tumorale. Les résultats à long terme de 71 patients (73 allogreffes) opérés entre 1961 et 1990 sont rapportés avec un taux de survie dans les greffes articulaires et intercalaires voisin de 60%. Les fractures de greffes peuvent être rattrapées dans de nombreux cas, mais l’infection conduit à retirer la greffe dans la plupart des cas. Les facteurs influençant le remodelage et les complications des allogreffes sont discutés. Le régime de cryopréservation, la fixation et la remise en contrainte des greffes influencent ces facteurs ainsi que la disposition de lamelles d’autogreffe à la jonction hôte-allogreffe et l’aexistence de radio ou chimiothérapie. La rupture de la greffe peut être récupérée dans la plupart des cas, contrairement à l’infection qui demeure la complication la plus grave qui peut se produire à tout moment. Même avec le développement des prothèses massives pour tumeur l’utilisation des allogreffes reste une option interessante spécialement chez les patients jeunes.

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Figures

Fig. 1
Fig. 1
a Osteolytic lesion in the proximal tibia of a 23-year-old woman with a giant cell tumour; b After intralesional resection of the proximal tibia, preserving only the cortical bone on both sides, an osteocartilaginous allograft was fixed with two screws; c 24 years after surgery the patient walks symmetrically without support. Knee flexion is limited only by 15° in comparison with the healthy side
Fig. 2
Fig. 2
a Osteolytic lesion in the left acetabular region of the pelvis in a 21-year-old woman. Diagnosis from the biopsy was malignant fibrous histiocytoma. The final histological diagnosis was osteosarcoma with more then 90% tumour necrosis after preoperative chemotherapy.b Sixteen years after surgery the allograft is well integrated, with no tumour recurrence. Femoral head necrosis and limited range of motion are the only problems. The patient married and gave birth to two healthy children by caesarian section
See this image and copyright information in PMC

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