Effect of anatomic site and irradiation on the rates of revision and infection of allograft-prosthesis composites after resection of a primary bone tumor: a meta-analysis.

Abstract

Allograft-prosthesis composite reconstruction after resection of a primary bone tumor may have theoretical advantages, such as restoration of bone stock and soft tissue attachments. However, the reported results of APC of different anatomical sites differ widely. We conducted a meta-analysis to estimate the revision and infection rates associated with allograft-prosthesis composite (APC) reconstructions after resection of a primary bone tumor. We looked for variables, such as anatomic sites and irradiation of the allograft, associated with these outcomes. We searched Medline, EMBASE, and Cochrane Library. The primary outcome was the revision rate, and the secondary outcome was the infection rate. Random effects meta-analyses of single proportions were used to estimate pooled rates of events. Meta-regression models were built to assess the effect of moderators on relevant both outcomes. Thirty-one studies were included: 9 about acetabulum APC, 9 about proximal femur APC, 4 about proximal tibia APC, and 9 about proximal humerus APC. The revision rates ranged from 16% (95% CI 10-25%) for proximal humerus to 38% (95% CI 26-52%) for acetabulum, and were significantly different between anatomic sites (p=0.028). The infection rates ranged from 8% (95% CI 4-16%) for proximal humerus to 23% (95% CI 16-33%) for proximal tibia and 23% (95% CI 15-35%) acetabulum APCs, and were significantly different between anatomic sites (p=0.008). Finally, we found that irradiation of the allograft was significantly associated with revision rates (p=0.033) and infection rates (p<0.001). Results of an APC reconstruction after resection of a primary malignant bone tumor vary significantly between anatomic sites and after irradiation of the allograft.