Allograft-Prosthetic Composite Reconstruction of the Proximal Part of the Tibia: An Analysis of the Early Results

Gilbert, Nathan F.; Yasko, Alan W.; Oates, Scott D.; Lewis, Valerae O.; Cannon, Christopher P.; Lin, Patrick P.
July 2009
Journal of Bone & Joint Surgery, American Volume;Jul2009, Vol. 91-A Issue 7, p1646
Academic Journal
Background: Allograft-prosthetic composite reconstruction of the proximal part of the tibia is one option following resection of a skeletal tumor. Previous studies with use of this technique have found a high prevalence of complications, including fracture, infection, extensor mechanism insufficiency, and loosening. To address some of these problems, we adopted certain measures, including muscle flap coverage, meticulous tendon reconstruction, rigid implant fixation, and careful rehabilitation. The goal of the present study was to evaluate the functional outcome and complications in patients undergoing allograft-prosthetic composite reconstruction of the proximal part of the tibia. Methods: Twelve patients who underwent allograft-prosthetic composite reconstruction of the proximal part of the tibia after tumor resection were retrospectively evaluated at a median follow-up of forty-nine months. Clinical records and radiographs were reviewed to evaluate patient outcome, healing at the allograft-host junction, function, construct survival, and complications. Results: Nine patients had no extensor lag, and three patients had 5° to 15° of extensor lag. The mean amount of knee flexion was 103° (range, 60° to 120°). The mean Musculoskeletal Tumor Society score was 24.3 (81%) of a maximum of 30. Complete bone union occurred in nine patients, and partial union occurred in three patients. At the time of writing, no secondary bone-grafting procedures had been required to achieve union, and no revision or removal of the reconstruction had been performed. Rotational or free flaps provided satisfactory wound coverage in all patients. A deep infection occurred in one patient whose allograft and prosthesis were successfully retained after treatment with surgical débridement and intravenous antibiotics. Conclusions: After osteoarticular resection of destructive tumors of the proximal part of the tibia, an allograft-prosthetic composite reconstruction can provide consistently good functional results with an acceptably low complication rate. Technical aspects of the procedure that may favorably affect outcome include soft-tissue coverage with muscle flaps and rigid fixation with a long-stemmed implant.


Related Articles

  • Donor-Site Morbidity After Osteochondral Autologous Transplantation for Lesions of the Talus. Paul, J.; Sagstetter, A.; Kriner, M.; Imhoff, A. B.; Spang, J.; Hinterwimmer, S. // Journal of Bone & Joint Surgery, American Volume;Jul2009, Vol. 91-A Issue 7, p1683 

    Background: Autologous osteochondral transplantation is accepted as one of the major treatment options for cartilage defects of the talus. One disadvantage of this technique is the need to harvest a donor graft from a normal knee. The potentially detrimental effect of graft harvest on knee...

  • Adamantinoma of the tibia: a clinicoradiologic study of four cases. Bouaziz, Mouna Chelli; Meherzi, Mohamed Hedi; Jlassi, Helmi; Nouri, Habib; Chaabane, Skander; Daghfous, Mohamed Samir; Karray, Slaheddine; Ladeb, Mohamed Fethi // European Journal of Orthopaedic Surgery & Traumatology;Aug2009, Vol. 19 Issue 6, p427 

    Adamantinoma of long bones is a malignant primitive bone tumor with epithelial origin, involving the tibia in a great majority of cases. It is a rare neoplasm with less than 200 cases reported in the world literature. The authors report four cases of tibial adamantinoma and describe the...

  • An atypical aneurysmal bone cyst of the head of the humerus, arthroscopic treatment: a case report. Saccomanni, B. // Archives of Orthopaedic & Trauma Surgery;Nov2008, Vol. 128 Issue 11, p1279 

    Curettage and bone grafting are the accepted methods of treatment of aneurysmal bone cysts. Unfortunately, recurrence is common. We treated a patient with atypical aneurysmal bone cyst of the head of the humerus that lacked aneurysmal dilatation by arthroscopic curettage without bone grafting....

  • Opening wedge high tibial osteotomy using 3D biomodelling Bonelike® macroporous structures: case report. Gutierres, M.; Dias, A. G.; Lopes, M. A.; Hussain, N. Sooraj; Cabral, A. T.; Almeida, L.; Santos, J. D. // Journal of Materials Science: Materials in Medicine;Dec2007, Vol. 18 Issue 12, p2377 

    Two synthetic calcium phosphates in porous wedge shape, Bonelike® and a commercial HA/β-TCP biphasic material, were used as an alternative to bone autografts and allografts in the treatment of medial compartment osteoarthritis of varus knees. The structure of Bonelike® has a 3D...

  • Use of non-vascularized autologous fibula strut graft in the treatment of segmental bone loss. Lawal, Y. Z.; Garba, E. S.; Ogirima, M. O.; Dahiru, I. L.; Maitama, M. I.; Abubakar, K.; Ejagwulu, F. S. // Annals of African Medicine;2011, Vol. 10 Issue 1, p25 

    Background: Fractures resulting in segmental bone loss challenge the orthopedic surgeon. Orthopedic surgeons in developed countries have the option of choosing vascularized bone transfers, bone transport, allogenic bone grafts, bone graft substitutes and several other means to treat such...

  • Cubitus varus: problem and solution. Jain, A. K.; Dhammi, I. K.; Arora, A.; Singh, M. P.; Luthra, J. S. // Archives of Orthopaedic & Trauma Surgery;Jul2000, Vol. 120 Issue 7/8, p420 

    A lateral closing wedge osteotomy was performed in 39 children with cubitus varus deformity resulting from a supracondylar fracture. All had a deformity of 15° or more, with 5 having more than 30° of varus. The osteotomy was fixed by three different methods. In 8 cases the osteotomy was...

  • Aneurysmatic bone cyst of the second metacarpal: en-block resection and bicortical iliac crest graft replacement. Ertem, Kadir; Karadag, Nese; Altinok, Tayfun; Karakas, H. Muammer // European Journal of Orthopaedic Surgery & Traumatology;Jan2007, Vol. 17 Issue 1, p89 

    Hand is an unusual location for aneurysmal bone cysts. A case in whom the second metacarpal of the left hand was presented. Because of its rapidly growing nature, a radical excision was performed. The resected segment was replaced by a bicortical iliac crest graft. The graft healed without...

  • Survival of massive allografts in segmental oncological bone defect reconstructions. P. Bullens; N. Minderhoud; M. de Waal Malefijt; R. Veth; P. Buma; H. Schreuder // International Orthopaedics;Jun2009, Vol. 33 Issue 3, p757 

    Abstract  Reconstructions of large segmental bone defects after resection of bone tumours with massive structural allografts have a high number of reported complications including fracture, infection and non-union. Our goal is to report the survival and complications of massive allografts...

  • Orthopaedic applications of bone graft & graft substitutes: a review. Nandi, S. K.; Roy, S.; Mukherjee, E; Kundu, B.; De, D. K.; Basu, D. // Indian Journal of Medical Research;Jul2010, Vol. 132 Issue 1, p15 

    Treatment of delayed union, malunion, and nonunion is a challenge to the orthopaedic surgeons in veterinary and human fields. Apart from restoration of alignment and stable fixation, in many cases adjunctive measures such as bone-grafting or use of bone-graft substitutes are of paramount...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics