Allograft replacement in management of giant cell tumor of bone: a report of 77 cases / 中华外科杂志

ABSTRACT

<p><b>OBJECTIVE</b>To evaluate the functional outcome and the complications of allograft replacement in management of giant cell tumors of bone.</p><p><b>METHODS</b>Seventy-seven patients who underwent bone tumor resection and massive allograft reconstruction of bone defects between 1992 and 2002 were evaluated. The length of the resected part ranged from 5 to 11 centimeters. Fresh-frozen allografts were employed as osteoarticular grafts (n = 47), hemi-condylar (n = 12), massive (n = 14) or allograft-prosthesis composite (n = 4). Most of the lesions located in proximal and distal femur, proximal tibia and humerus. The oncological parameters that were evaluated including survival of the patient, local recurrence, and metastasis. The radiographic parameters included time to union, stability of the joint, fracture of the allograft. Mankin evaluation system was used to assess functional outcome.</p><p><b>RESULTS</b>At a median of 35 months (range from 12 to 135 months) after the operation, 76 of the patients in the study group were free of disease, and one had died of disease. Eleven (14.1%) patients had local recurrence and 12 (15.4%) nonunion. Late complications included 5 (6.4%) fractures of the allograft and 5 (6.4%) infections of the graft. Instability of the joint in the form of subluxation was noted in 5 (6.4%) patients. One extremity were amputated due to local recurrence. On the basis of Mankin functional evaluation, the total satisfied rate was 83.2 percent. Osteoarticular graft got the highest score (91.5%) and hemi-condylar got the lowest (66.6%). Massive grafts and composite were at the middle (ranges from 71.4% to 75%).</p><p><b>CONCLUSION</b>Allografts offer many types of reconstruction for bony defects after tumor resection. The functional results are comparable to other methods of reconstruction, and once incorporated by the host, offer the advantage of longevity. It is also a method with high complication, and decreasing the complications could improve the functional score. Less resection could get better reconstruction and better function, less margin resulted at the same time. The risk of recurrence increases when less surgical margin achieves. The main end-result-influencing factor is local recurrence.</p>