Massive osteoarticular allografts in the reconstruction of extremities following resection of tumors not requiring chemotherapy and radiation.

Since 1976, 70 osteoarticular allografts have been used to reconstruct extremities from which tumors not requiring chemotherapy or radiotherapy have been resected. Allografts excised from cadavers were stored in the vapor phase of liquid nitrogen in liquid nitrogen freezers (-150 degrees) after exposure to 15% glycerol. Prior to their use, the allografts were thawed rapidly in either tissue culture or balanced salt solutions. Following resection of the tumor, the excised bone was replaced with allografts that were rigidly internally fixed with plates and screws or, occasionally, with intramedullary rods. Patients were observed carefully for complications and were subjected to functional evaluations. Complications did not include alterations suggestive of a pronounced immunologic response to the graft. Five patients developed either local recurrences or distal metastasis. Of the remaining 65 patients, followed for one year or longer, osteochondral allografts performed satisfactorily in 55 (84.6%). This group included eight patients with initial complications that were successfully treated. The group of ten patients with unsatisfactory results included four patients with fractures of the grafts, one with fragmentation of the humeral head, three with infections, and two with joint instabilities. Since all patients had either hemi-joint or quarter joint replacements, the overall results achieved so far have been rewarding. However, continued long-term observations of patients with allografts are indicated, as are studies that would allow for the improvement of cartilage preservation, decrease the incidence of fractures, and improve rigidity of internal fixation. The incidence of infection can be reduced by the improvement in surgical technique, particularly with reference to the wound closure.