INCORPORATION AND CLINICAL-RESULTS OF LARGE ALLOGRAFTS OF THE EXTREMITIES AND PELVIS

The results of implantation of 37 large deep-frozen allografts with 29 osteoarticular grafts of the extremities and pelvis following the res ection of malignant or aggressive benign bone tumors were evaluated at followup (mean, 6 years; range, 2.5-20 years). The patients had excel lent or good results in 62% of all cases according to the Mankin-Waber functional rating score, and a corresponding rating of 81% in the Mus culoskeletal Tumor Society Score. Benign versus malignant disease rate d 83% and 76%, respectively, in the Musculoskeletal Tumor Society Scor e, and 67% and 46%, respectively, in the Mankin-Waber score. Radiologi cal and nuclear medicine (single-photon emission computed tomography) studies and histological biopsies indicated that the incorporation, pe rfusion, and replacement with new bone was only partial and of a low d egree. Late degenerative cartilage and sclerotic changes occurred in 2 0 of 29 cases with osteoarticular grafts. The best functional results were achieved with knee osteoarticular allografts (81%-88%) compared w ith modest results in the proximal humerus (69%) and hemipelvis (57%) according to the Musculoskeletal Tumor Society Score rating. Chemother apy did not influence the union or infection rate of the allografts. I n the 4 cases (11%) with infection, all grafts could be salvaged, but the functional results were only 63% in the Musculoskeletal Tumor Soci ety Score. The overall complication rate was high (57%); graft-related complications occurred in 43%, including fatigue fractures in 27%. Th ere were no cases of nonunion at the host graft junction. Clinical rej ection did not occur. These clinical results may be improved in the fu ture by new technology that uses bone substitutes, growth factors, and bone morphogenetic proteins.