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Despite complication risks, allograft reconstruction can manage defects
A case series showed bone defects in children after tumoral resections can be managed effectively with allograft reconstruction.
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An allograft reconstruction for skeletally immature pediatric patients with malignant bone tumors may have a high rate of complications, but can effectively manage big bone defects and provide bone stock for future procedures, according to the results of a retrospective study.
In total, 14 of 18 patients treated with allograft developed some kind of complication, but two patients died prior to the final follow-up of the study and most displayed positive clinical outcomes, Alfonso Vaquero-Picado, MD, told Orthopaedics Today Europe.
“We can say that allograft reconstruction for resections of malignant tumors of long bone in children under 10 years old is a reliable technique, with good disease control and high rates of success, even if the complication rate is elevated,” Vaquero-Picado said.
The study has been accepted and will be available as a poster at the 17th Annual EFORT Congress.
High complication rate
Vaquero-Picado and colleagues included 18 patients with malignant bone tumors treated between 1994 and 2002 in their retrospective study. Only patients younger than 10 years old with primary malignant bone tumors of long bones, such as the femur, tibia or humerus, were included.
The median age at diagnosis was 7.6 years, and the retrospective study included 12 boys and six girls. Jorge de las Heras-Sotos, MD, the senior author of the study, performed wide resections in all cases. De las Heras-Sotos was chief of the pediatric musculoskeletal tumors unit at Hospital Universitario La Paz during the study period.
Images: Vaquero-Picado A
“The point with these patients is they have a long period of growth after the resection, so reconstruction with a conventional prosthesis is not a good option. There is no small prosthesis for a sarcoma affecting the hip of a 2-year-old child, and it would be necessary to change it several times until the end of growth and after that,” he said.
In all, 14 patients developed a complication after surgery. Three patients developed an infection, one developed a local recurrence, two developed graft fractures, three developed graft resorptions, two developed degenerative osteoarthritis, six developed pseudoarthrosis and two developed problems of soft tissue coverture, Vaquero-Picado said.
Provides good bone stock
Reoperations were needed on the same or contralateral side of 16 of the 18 patients and were done for leg-length discrepancy, pseudoarthrosis and other reasons, Vaquero Picado said.
“We have seen that the rates of incorporation of the allograft in children is superior to those communicated for allografts in adults. It is important, as it provides a solid, functional and reproducible reconstruction and it gives a good bone stock for future procedures, with an excellent rate of survivorship for allograft and patients. This is encouraging data,” he said.
Despite the high rate of complications, most patients can be effectively treated with small, simple procedures, Vaquero-Picado said. – by Robert Linnehan
- Reference:
- Vaquero-Picado A, et al. Poster #2429. Tentatively scheduled to be presented at: 17th EFORT Annual Congress – A combined programme in partnership with swiss orthopaedics; 1-3 June 2016; Geneva.
- For more information:
- Alfonso Vaquero-Picado, MD, can be reached at Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain; email: fonvaquero@yahoo.es.
Disclosure: Vaquero-Picado reports no relevant financial disclosures.