Abstract
Background: Limb preservation in musculoskeletal tumor surgery has largely replaced amputation. Biologic reconstructions are now performed as preferred choice; if not feasible options are “megaprostheses”, allografts or composites. Endoprosthetic reconstructions usually provide immediate function, but fail at long term. Osteochondral allografts allow for one-to-one restoration and have potential for incorporation; however degeneration of the cartilage requiring revision almost inevitably will occur. In most cases, revision is then done by endoprosthetic replacement. Aim: In our patients, resurfacing of retained allografts failed. Problems encountered are presented and solutions proposed. Case Presentation: Resurfacing over retained allografts in the 2 index cases has resulted in failures related to fractures and instability. Revision with massive constrained endoprostheses was needed. Based on the experience with these failures, primary endoprosthetic replacement anchored in vital bone in a following case resulted in stable function. Conclusion: Knee replacement for advanced degeneration of the osteochondral allograft apparently needs choosing increased femoro-tibial constraint systems and stem extensions anchored to vital host bone.
Highlights
Allografts allow us to reconstruct defects of tumor resection one-to-one and are especially an option to be considered in growing children and young adults, preserving durable limb function [1]
Two of them were initially treated with standard resurfacing knee arthroplasties that failed within three years due to fracture of the allograft and instability of the non-hinged joints
In a third patient treated with a hemicondylar osteoarticular allograft needing knee replacement 24 years after initial reconstruction, based on the experience with the patients reported before, a fully constrained resurfacing knee arthroplasty system with stem extensions was implanted giving initial stable contact to the vital host bone
Summary
Allografts allow us to reconstruct defects of tumor resection one-to-one and are especially an option to be considered in growing children and young adults, preserving durable limb function [1]. A study comparing outcome of proximal tibia reconstructions with either osteoarticular allografts or endoprosthetic replacement showed separate advantages, not significantly different overall failure rates (at 10 years 44% for endoprostheses and 32% for allografts [4]). Case Presentation: Resurfacing over retained allografts in the 2 index cases has resulted in failures related to fractures and instability. Based on the experience with these failures, primary endoprosthetic replacement anchored in vital bone in a following case resulted in stable function. Conclusion: Knee replacement for advanced degeneration of the osteochondral allograft apparently needs choosing increased femoro-tibial constraint systems and stem extensions anchored to vital host bone
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