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.
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
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.
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.