THE EFFECT OF INTRAMEDULLARY CEMENT ON INTERCALARY ALLOGRAFT RECONSTRUCTION OF BONE DEFECTS AFTER TUMOR RESECTION - A PILOT-STUDY

OBJECTIVE: A Pilot study to evaluate the surgical and functional resul ts of resection and reconstruction of diaphyseal bone rumours with cem ented and uncemented intercalary allografts. DESIGN: A retrospective c ase series. SETTING: A quaternary care unit within a teaching hospital . PATIENTS. Twenty-two patients with diaphyseal bone tumours treated b etween 1988 and 1992, with mean follow-up of 38 months (range from 20 to 70 months). INTERVENTIONS: Diagnostic biopsy in all patients. Preop erative and postoperative chemotherapy in patients with high-grade sar coma. En-bloc excision of all rumours. Reconstruction of the defect wi th cemented (15 patients) or uncemented (7 patients) intercalary allog rafts. MAIN OUTCOME MEASURES: Nonunion at one or both osteosynthesis s ites, death from systemic disease, amputation. RESULTS: Six of the 22 patients died of systemic disease with the graft intact, and 3 subsequ ently had amputation for either local recurrence (2 patients) or failu re of free tissue transfer (1 patient), leaving 13 patients alive with the allograft in situ at an average of 36 months (range from 24 to 64 months). There were no revision procedures to remove or replace the o riginal allograft. Five patients had nonunion at one or more osteosynt hesis sites on plain radiographs 9 months after resection. Four patien ts with nonunion were in the cemented group of 13 patients available f or assessment at 9 months, and 1 was in the uncemented group of 5 pati ents available for assessment at 9 months. There were two graft fractu res, both in the uncemented group. CONCLUSION: The results of this pil ot study offer guarded support for the use of pressurized cement in al lografts prior to reconstruction of intercalary defects.