A comparison of osteoarticular allografts and allograft-prosthesis composites for reconstruction of the distal femur after resection of a bone tumour in childhood: a retrospective study. (1st October 2022)

• Record Type: Journal Article
• Authors: Jamshidi, Khodamorad; Bagherifard, Abolfazl; Mirzaei, Alireza
• Is Part Of: Bone & joint journal. Volume 104B:Number 10(2022)
• Page Start: 1174
• Page End: 1179
• Publication Date: 2022-10-01
• Subjects: ‎Resurfaced allograft-prosthesis composite‎ -- Osteoarticular allograft‎ -- Tumour -- Distal femur -- distal femoral -- composites -- allografts -- resection of a bone tumour -- Knee -- Osteoarthritic changes -- Musculoskeletal Tumor Society (MSTS) score -- malignant tumour -- retrospective analysis -- allograft reconstructions; Bones -- Surgery -- Periodicals; Joints -- Surgery -- Periodicals; Orthopedic surgery -- Periodicals; 617.47005
• DOI: 10.1302/0301-620X.104B10.BJJ-2022-0235.R1
• Languages: English
• ISSNs: 2049-4394

Abstract

Abstract : Aims: Osteoarticular reconstruction of the distal femur in childhood has the advantage of preserving the tibial physis. However, due to the small size of the distal femur, matching the host bone with an osteoarticular allograft is challenging. In this study, we compared the outcomes and complications of a resurfaced allograft-prosthesis composite (rAPC) with those of an osteoarticular allograft to reconstruct the distal femur in children. Methods: A retrospective analysis of 33 skeletally immature children with a malignant tumour of the distal femur, who underwent resection and reconstruction with a rAPC (n = 15) or osteoarticular allograft (n = 18), was conducted. The median age of the patients was ten years (interquartile range (IQR) 9 to 11) in the osteoarticular allograft group and nine years (IQR 8 to 10) in the rAPC group (p = 0.781). The median follow-up of the patients was seven years (IQR 4 to 8) in the osteoarticular allograft group and six years (IQR 3 to 7) in the rAPC group (p = 0.483). Limb function was evaluated using the Musculoskeletal Tumor Society (MSTS) score. Results: At final follow-up, the knee was unstable in 9/18 patients (50%) in the osteoarticular allograft group and 2/15 patients (13%) in the rAPC group (p = 0.026). The median range of motion (ROM) of the knee was 117° (IQR 115° to 120°) in the osteoarticular allograft group and 100° (IQR 95° to 105°) in the rAPC group (p < 0.001). The median MSTS score was 25 (IQR 23 to 26) in the osteoarticular allograft group and 28 (IQR 26 to 29) in the rAPC group (p = 0.007). Osteoarthritic change was detected in 11/18 patients (61%) in the osteoarticular allograft group and in 4/15 (26%) patients in the rAPC group (p = 0.048). Conclusion: In our series, a resurfaced allograft-prosthesis composite provided better knee stability and function, with a lower rate of osteoarthritis; an osteoarticular allograft was associated with better knee ROM. Cite this article: Bone Joint J 2022;104-B(10):1174–1179.