INTRAMEDULLARY, ANTIBIOTIC-LOADED CEMENTED, MASSIVE ALLOGRAFTS FOR SKELETAL RECONSTRUCTION - 26 CASES COMPARED WITH 19 UNCEMENTED ALLOGRAFTS

We compared the outcomes of 26 intramedullary cemented massive allogra fts with 19 allografts without cementation; all allografts were used f or reconstruction after excision of bone sarcomas. In the cementation group, 12 allografts were used as osteochondral grafts (proximal humer us 4, proxima[ tibia 4, and distal femur 4), 7 as intercalary diaphyse al allografts of the femur, and 7 for a knee arthrodesis. In the uncem ented allografts, 3 allografts were used as osteochondral grafts (prox imal humerus 2, proximal tibia 1), 2 as intercalary diaphyseal allogra ft of the femur, and 14 for a knee arthrodesis. The average length of follow-up was 40 (25-60) months. 14 of 26 cemented allografts had an e xcellent (osteotomy line: not visible) or good (fusion greater than or equal to 75% of the cortical thickness) healing of the junction site. Infection developed in 1 allograft. Fracture occurred in 4 of 12 ceme nted osteochondral[ allografts due to a subchondral collapse (all in t he proximal tibia). Fractures at the junction site in the lower extrem ity developed in 4 of 22 cemented allografts. In 19 allografts without cementation, 11 had excellent or good healing of the junction. Late i nfection developed in 4 allografts, fracture of the allograft in 3 cas es, and junction fracture in 3 of 17 patients with reconstruction of t he lower extremity. Intramedullary graft cementation seems to reduce t he fracture and infection rates.