Evaluation of the allograft-prosthesis composite technique for proximal femoral reconstruction after resection of a primary bone tumour.

OBJECTIVE: To evaluate clinical and functional outcomes resulting from the allograft-composite technique used for proximal femoral osteoarticular reconstruction in patients who had limb salvage surgery for primary bone tumours.
DESIGN: A retrospective review of a prospectively gathered database to provide a descriptive study.
SETTING: A tertiary care musculoskeletal oncology unit in a university hospital. PATIENTS AND
INTERVENTIONS: Patients treated between 1987 and 1993 were eligible for inclusion in this study if they met the following criteria: they were treated surgically for a primary malignant bone tumour; and a proximal femoral allograft-implant composite technique was used for the reconstruction. MAIN OUTCOME MEASURES: Major postoperative complications with emphasis on mechanical complications in the reconstructive composite implant. Functional outcome in a subset of patients using the 1987 and 1994 versions of the Musculoskeletal Tumor Society instrument, the Short-Form-36 and the Toronto Extremity Salvage Score.
RESULTS: There were 5 mechanical and 2 infectious complications requiring surgical intervention. Functional scores were generally low.
CONCLUSIONS: Our results suggest that the perceived benefits of the composite technique may accrue only to a few patients, partly owing to the risk of mechanical complications. Although these can be reduced by avoiding the use of cement in the host femur, the generally poor functional outcomes suggest that this technique needs to be studied further in this group of patients and compared with other reconstructive techniques, particularly the prosthetic implant.