CORR Insights(®): What Are the Risk Factors and Management Options for Infection After Reconstruction With Massive Bone Allografts?

Abstract

M assive allografts remain an important reconstructive alternative in the armamentarium of musculoskeletal oncologists, adult reconstruction, and other orthopaedic surgeons. Allografts replace osseous defects with like-tissue, restore bone stock for eventual revision reconstructions in younger patients, and offer anatomic tendon attachments and resulting muscle function (for example, in knee extensor, hip abductor, and shoulder rotator cuff grafts) not yet achievable by tendon-to-metal interfaces. When a flawless allograft or allograft-prosthesis composite reconstruction is performed, and the all-too-frequent complications (namely, infection, fracture, and nonunion) are avoided, the functional outcomes achievable frequently surpass those possible by other means, with these other means generally being limited to megaprosthesis reconstruction, resection arthroplasty variants, or some form of amputation. Unfortunately, infection following massive allograft reconstruction is common. The crude infection rate of 9% at 10 years of followup found in the study by Aponte-Tinao and colleagues [1] remains consistent with previously published estimates in patients treated with bulk allograft infection, which range from 8.5% to 13% [5, 6]. Infections frequently coexist with, or predispose to, the other dreaded allograft complications of This CORR Insights is a commentary on the article ‘‘What Are the Risk Factors and Management Options for Infection After Reconstruction With Massive Bone Allografts?’’ by Aponte-Tinao and colleagues available at: DOI: 10.1007/s11999-0154353-3. The author certifies that he, or anymember of his immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. All ICMJEConflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors andboardmembers are onfile with the publication and can be viewed on request. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR or The Association of Bone and Joint Surgeons. This CORR Insights comment refers to the article available at DOI: 10.1007/s11999-0154353-3. The views expressed in this article are those of the author and do not necessarily reflect the official policy or position of the Department of the Army, the Department of the Navy, Department of Defense, nor the U.S. Government. The author is a military service member. This work was prepared as part of his official duties. Title 17 U.S.C. 105 provides that ‘Copyright protection under this title is not available for any work of the United States Government.’ Title 17 U.S.C. 101 defines a U.S. Government work as a work prepared by a military service member or employee of the US Government as part of that person’s official duties.