Salvage of the proximal femur following pathological fractures involving benign bone tumors

Analysis of mechanical complications for patients with extremity sarcoma after biological reconstruction

BACKGROUND

Biological reconstruction after tumor resection is significant for restoration of limb integrality. However, it is unclear what risk factors influence mechanical complications of patients after extremity sarcoma resection and biological reconstruction. The objective of study was (1) to compare complications between patients receiving inactivated autograft and allograft, (2) to analyze influence of graft type, nonunion and fixation method on mechanical complications for patients after biological reconstruction.

HYPOTHESIS

We hypothesized allograft, nonunion and fixation method influence occurrence of mechanical complications after biological reconstruction.

MATERIALS AND METHODS

We retrospectively reviewed 71 patients with sarcomas at the extremity receiving biological reconstruction from January 1999 to November 2015. Eight patients were lost at last follow-up. Sixty-three patients with complete clinical data were recruited into the present study. There were 32 males and 31 females with a mean age of 20.5±14.9 years (median, 17 years; range, 2-72 years). Sixty-one cases had tumors at lower extremity and two at upper extremity. Histological diagnosis was confirmed as forty-five with osteosarcoma, thirteen with Ewing sarcoma and five with chondrosarcoma.

RESULTS

Forty-four patients were free of disease, sixteen died of disease and three lived with pulmonary metastasis at last follow-up. Twenty-one out of 63 patients (33.3%) had local recurrence requiring surgical treatment. Reconstruction choice (mechanical complications rates were 38.9% for allograft (14/36) versus 14.8% for inactivated autograft (4/27)) and nonunion occurrence (yes 58.8% (10/17); no 17.4% (8/46)) had the close relationship with mechanical complication in the univariate analysis. The multivariate analysis revealed fixation method (p=0.041) and nonunion (p=0.008) were prognostic factors for mechanical complication of sarcoma resection and biological reconstruction at the extremity. Fourteen of 36 patients receiving massive allograft had a second surgery due to mechanical complication compared to 4 of 27 patients with massive inactivated autograft (38.9%, 14/36 vs. 14.8%, 4/27 (p=0.05)). Time to union for diaphysis and metaphysis was not significantly different between allograft and inactivated autograft groups.

DISCUSSION

Patients receiving massive allograft are prone to suffer from the mechanical complications. Extramedullary plate and nonunion have the tendency of increasing occurrence of mechanical complications of biological reconstruction.

LEVEL OF EVIDENCE

IV; retrospective study.