Revista de la Asociación Argentina de Ortopedia y Traumatología
versión On-line ISSN 1852-7434
LOPEZ MILLAN, Lucas et al. Reconstruction of segmental defects of the femur with intercalary allografts. Rev. Asoc. Argent. Ortop. Traumatol. [online]. 2011, vol.76, n.4, pp. 309-315. ISSN 1852-7434.
Background: The purpose of this study was to evaluate survival, complications and functional scores of intercalary femur segmental allografts. Methods: We performed a survivorship analysis of 83 consecutive patients who underwent reconstruction with an intercalary femur segmental allograft. The mean follow-up was 5 years and allograft survival was determined with the Kaplan-Meier method. Patients' functions were evaluated with the Musculoskeletal Tumor Society Scoring System (MSTS). Results: Survivorship was 85% (CI 95%: 93% - 77%) at 5 years and 76% at 10 years (CI 95%: 89% - 63%). Allografts had to be removed in 15 patients due to 1 infection, 1 local recurrence and 13 fractures. From a total number of 166 host-donor junctions, 22 did not initially heal (13%). Nonunion rate for diaphyseal junctions was 19%, and 3% for metaphyseal junctions (p > 0.05). An increase in the diaphyseal nonunion rate was noted in patients fixed with nails (27%), compared to those fixed with plates (13%). The fracture rate was 16% and related to areas of the allograft inadequately protected with internal fixation. All uncomplicated patients had mainly good or excellent MSTS functional results. Conclusions: Allograft survival was 85% at 5 years and 76% at 10 years in this series. Diaphyseal junctions showed higher nonunion rates than metaphyseal junctions. The internal fixation should span the entire length of the allograft to avoid the risk of fracture. Results from this series of patients suggest that segmental allograft of the femur provides an acceptable alternative in reconstructing tumor resections.
Palabras clave : Allograft; Intercalary; Femur.