Allograft Reconstruction for Bone Metastases

Abstract

One of the greatest challenges of limb salvage surgery is the reconstruction of skeletal defects left after the resection of bone tumors. The goal of restoring skeletal integrity and limb function in this situation can be accomplished by using autograft bone [1–3], prosthetic devices [4–6], or cadaveric allografts [7–10]. The choice among these modalities of treatment has been governed largely by the philosophy outlook rather than by factual evidence that proves one superior over the other. Clearly, each method has its advantages and disadvantages. We have been longtime subscribers to the school of thought that considers allografts as the method of choice for these complex reconstructions [11–14]. As a result of our experience with the use of these procedures in primary bone tumors, it occurred to us that they may be suitable for the treatment of metastatic bone disease. In many instances, metastatic disease causes extensive bone loss with or without pathological fracture. The two main goals of operative treatment in this situation are to increase the Patients’ mobility and to relieve their pain. We reasoned that allografts used in combination with internal fixation devices and/or prosthetic implants have advantages over more traditional techniques when aiming to attain these goals. This is because deep frozen cadaveric bones are readily available in a well-functioning bone bank, can be custom-tailored for any defects and thus allow the excision of large tumor areas and are generally strong and retain shape. This offers instant bone stability, restoration of joint function by the ability of attaching tendon/ligament structures to allografts and the possibility of union to host bone if time permits. This study presents our experience accumulated to date with what we think is a novel modality of surgical treatment of bone metastases, the use of allograft reconstruction.