Human leukocyte antigen matching, radiographic score, and histologic findings in massive frozen bone allografts.

Forty-six patients receiving frozen bone allografts, preoperatively tissue typed for human leukocyte antigen and ABO antigens, were radiographically evaluated according to the Musculoskeletal Tumor Society scoring system at a mean followup of 55 months. Patients who matched for 1 or 2 Class I human leukocyte antigens with the donor scored higher than patients totally mismatched, but differences were not significant. Matching for Class II human leukocyte antigen and ABO antigens seemed not to influence radiographic outcome of allografts. In sixteen patients histologic specimens were obtained. Five of 16 patients who showed histologic parameters of an immune response scored significantly lower than those who did not. Processed frozen bone allografts, because of their lack of viable donor cells, most likely trigger an indirect pathway of alloantigen recognition in the recipient. This type of recognition may generate in the recipient either a chronic type of rejection or an immunologic state of tolerance to grafted antigens that cannot be measured with human leukocyte antigen blood tests. This may explain difficulties in correlating human leukocyte antigen mismatches between the donor and recipient with frozen bone allograft performances.

Osteoid osteoma of the hip. Percutaneous resection guided by computed tomography.

Seven patients with a presumptive diagnosis of osteoid osteoma located at the hip were treated with percutaneous resection of the nidus through computed tomography guidance. Histologic confirmation was obtained in 5 of the 7 patients. The average hospital stay was 27 hours. At followup, from 12 to 40 months, all patients remain asymptomatic. This procedure presents potential advantages that traditional open surgery techniques do not have.

The use of a bone allograft for reconstruction after resection of giant-cell tumor close to the knee.

The results of bone-allograft reconstruction after the resection of giant-cell tumor close to the knee were reviewed in fifty-two patients (fifty-five allografts), who had been followed for a mean of seven years (range, two to twenty-four years). One giant-cell tumor was graded as stage 1; twenty, as stage 2; and thirty-one, as stage 3. Three reconstructions were repeated transplants that were done after the failure of a previous transplant. Ten allograft reconstructions were intercalary and were combined with an arthrodesis of the knee, and forty-five were osteoarticular. Major complications included infection (after three reconstructions), resorption of the graft (six), collapse of the articular surface (two), fracture (two), and recurrence (one). According to the criteria described by Mankin et al. for functional analysis, forty-two (76 per cent) of the extremities had a result that was considered to be excellent or good. Radiographic evaluation according to the system of the Musculoskeletal Tumor Society showed a mean score of 72 per cent for osteoarticular reconstructions, and of 86 per cent for intercalary reconstructions.

Massive femoral allografts followed for 22 to 36 years. Report of six cases.

Six massive femoral allografts followed up for 22 to 36 years are described. Three were intercalary, two were osteoarticular and one was a total femoral replacement. Their functional rating according to the Musculoskeletal Tumor Society System (Enneking 1987) averaged 82% (56 to 100). The radiographic score averaged 75% (48 to 100). Four allografts had suffered fractures, but three of these had later united to give good final scores. Our study shows that massive femoral allografts can function well for as long as 36 years.