Incorporation and clinical results of large allografts of the extremities and pelvis

Abstract

The results of implantation of 37 large deep-frozen allografts with 29 osteoarticular grafts of the extremities and pelvis following the resection of malignant or aggressive benign bone tumors were evaluated at followup (mean, 6 years; range, 2.5-20 years). The patients had excellent or good results in 62% of all cases according to the Mankin-Waber functional rating score, and a corresponding rating of 81% in the Musculoskeletal Tumor Society Score. Benign versus malignant disease rated 83% and 76%, respectively, in the Musculoskeletal Tumor Society Score, and 67% and 46%, respectively, in the Mankin-Waber score. Radiological and nuclear medicine (single-photon emission computed tomography) studies and histological biopsies indicated that the incorporation, perfusion, and replacement with new bone was only partial and of a low degree. Late degenerative cartilage and sclerotic changes occurred in 20 of 29 cases with osteoarticular grafts. The best functional results were achieved with knee osteoarticular allografts (81%-88%) compared with modest results in the proximal humerus (69%) and hemipelvis (57%) according to the Musculoskeletal Tumor Society Score rating. Chemotherapy did not influence the union or infection rate of the allografts. In the 4 cases (11%) with infection, all grafts could be salvaged, but the functional results were only 63% in the Musculoskeletal Tumor Society Score. The overall complication rate was high (57%); graft-related complications occurred in 43%, including fatigue fractures in 27%. There were no cases of nonunion at the host graft junction. Clinical rejection did not occur. These clinical results may be improved in the future by new technology that uses bone substitutes, growth factors, and bone morphogenetic proteins.