The Journal of Bone and Joint Surgery, Vol 77, Issue 1 54-64, Copyright © 1995 by Journal of Bone and Joint Surgery, Inc
Massive allografts in the treatment of osteosarcoma and Ewing sarcoma in children and adolescents
BA Alman, A De Bari and JI Krajbich
Hospital for Sick Children, Toronto.
A retrospective review was performed of the results of all allograft
reconstructions that had been done after the resection of an osteosarcoma
or an Ewing sarcoma in a skeletally immature patient between 1982 and 1989
at The Hospital for Sick Children in Toronto. There were twenty-six
patients. Six reconstructions were intercalary, sixteen were resection
arthrodeses, three followed resection of a bone segment including the
epiphysis (osteoarticular reconstruction), and one was a replacement of the
entire humerus. Resection arthrodesis about the knee was performed with a
smooth intramedullary rod and with one growth plate left intact. Six
procedures were performed in the upper extremity. Excluding the patients
who died, the average duration of follow-up was five years and three
months. Twenty-one of the twenty-six patients had reached skeletal maturity
at the time of follow-up. Eighteen (69 per cent) of the patients had a good
or excellent result, four (15 per cent) had a fair result, and four had a
failure. Twenty patients (77 per cent) had at least one complication (other
than a limb-length discrepancy), and fourteen (54 per cent) sustained at
least one fracture of the allograft. Fifteen patients who had had a
reconstruction in the lower extremity had survived with survival of the
allograft at the time of the latest follow-up. A limb-length discrepancy of
at least two centimeters developed in nine of the fifteen patients. Five
were managed with a contralateral epiphyseodesis, and one of them had an
unsuccessful attempt at limb-lengthening as well. The patients who had a
limb-length discrepancy of more than three centimeters at the time of
follow-up had been significantly younger (p < 0.05) at the time of the
reconstruction than those who had a smaller discrepancy. Three allografts
(12 per cent), two of which were implanted early in the series, became
infected. Soft-tissue coverage is of paramount importance for the
prevention of infection, and we now routinely perform primary muscle
(gastrocnemius or latissimus dorsi) transfers when dealing with an
inadequate muscle envelope. Twelve patients were followed for more than
four years (average, six years and seven months); they had no complications
other than increased limb-length discrepancy and one subluxation of the
shoulder after the first four years following the reconstruction. Although
the rate of complications is higher than in adults, allograft
reconstruction remains a useful option for the management of skeletally
immature individuals.(ABSTRACT TRUNCATED AT 400 WORDS)
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