Background: As diagnostic and therapeutic techniques improve,
patients with a musculoskeletal sarcoma should expect longer survival, fewer
complications and side effects, and an improved quality of life. Functional
longevity of the reconstruction after resection of the tumor becomes a major
concern, especially in young and physically active patients. The purpose of
this study was to analyze the mid-term and long-term survival of
reconstructions with a distal femoral osteoarticular allograft in a series of
patients.
Methods: We retrospectively reviewed the results of eighty
reconstructions with a distal femoral osteoarticular allograft following
resection of a bone tumor in seventy-six patients. The mean duration of
follow-up was eighty-two months. The rates of survival of the allograft and
the joint surface were estimated with use of the Kaplan-Meier method. Cox
regression analysis was performed to determine whether age, gender, the
percentage of the femur that had been resected, and the use of chemotherapy
were independent prognostic factors. Functional and radiographic results were
documented according to the Musculoskeletal Tumor Society scoring system at
the time of the latest follow-up.
Results: Five patients were lost to follow-up, leaving seventy-five
allografts in seventy-one patients available for study. Thirteen patients
(thirteen allografts) died of tumor-related causes without allograft failure
before a two-year radiographic follow-up could be performed. Of the remaining
sixty-two allografts, fourteen failed: six failed as a result of infection;
four, because of local recurrence; one, because of massive resorption; and
three, as a result of fracture. At the time of final follow-up, at a mean of
125 months, forty-eight allografts were still in place. The overall rate of
allograft survival was 78% at both five and ten years, and the rate of
allograft survival without the need for resurfacing with a knee prosthesis was
71% at both five and ten years. With the numbers available, age, gender, the
percentage of the femur that had been resected, and the use of chemotherapy
were not found to have a significant effect on the overall allograft survival
rates. The patients who retained the original allograft had good or excellent
functional and radiographic results.
Conclusions: The life expectancy for most patients with a highly
aggressive or malignant tumor in the distal part of the femur is now several
decades. In this study, we found a high rate of survival of distal femoral
allograft reconstructions at both five and ten years.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.