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The Journal of Bone and Joint Surgery 79:97-106 (1997)
© 1997 The Journal of Bone and Joint Surgery, Inc.

The Results of Transplantation of Intercalary Allografts after Resection of Tumors. A Long-Term Follow-Up Study*

EDUARDO ORTIZ-CRUZ, M.D.{dagger}, MARK C. GEBHARDT, M.D.{ddagger}, L. CANDACE JENNINGS, M.D.{ddagger}, DEMPSEY S. SPRINGFIELD, M.D.§ and HENRY J. MANKIN, M.D.{ddagger}

Investigation performed at the Orthopaedic Oncology Unit, Massachusetts General Hospital and Children's Hospital, Harvard Medical School, Boston

We reviewed the results of 104 intercalary allograft procedures that had been performed, between April 1974 and August 1992, in 100 patients, usually after resection of a segment of bone because of an osseous neoplasm. The median duration of follow-up was 5.6 years. Retention of the graft and return to essentially normal function were the measures of success and, on that basis, eighty-seven (84 per cent) of the 104 reconstructions were successful. Of the fifteen limbs in which the reconstruction failed, four were salvaged with insertion of a second allograft and three, with use of some other technique. Of the 104 allograft procedures, eight (including two in patients who had a recurrent tumor) were followed by an amputation; thus, the ultimate rate of salvage was 92 per cent for the entire series. Thirty-one grafts failed to unite at one junction with the host or both, within one year after the operation, and this necessitated eighty-one additional operative procedures to achieve a good result. Life-table regression analysis showed that age, gender, anatomical site, and length of the graft were not associated with significant differences in the over-all outcome. Infection (p = 0.0001); fracture (p = 0.002); stage of the lesion (p = 0.007); and use of adjuvant chemotherapy or radiation, or both (p = 0.008), all had an adverse effect on the survival of the allograft. Despite the relatively high rate of non-union that necessitated additional operations, these data indicate that transplantation of allografts for the treatment of intercalary defects has a high rate of success and usually results in a functional limb.


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