The Use of Allografts in Orthopaedic Surgery - Part I: The Use of Allografts in Musculoskeletal Oncology

As a result of the advances in imaging modalities, adjuvant treatment, surgical techniques, and reconstruction implants in the last few decades, limb salvage has become the standard of care for most patients with a malignant bone tumor. Because of an improved overall treatment approach, patients are now surviving longer and in greater numbers, which places greater demands on the reconstructive aspect of this care. First used by Lexer1 in the early 1900s, allografts were reintroduced as a reconstructive option following tumor resection, with successful results reported by Parrish2, Volkov3, Ottolenghi4, and Mankin et al.5. Nonstructural allografts are morselized cancellous or corticocancellous bone chips used to fill cavitary defects in host bone following curettage of a skeletal lesion. They are most commonly used in the management of lesions that simulate neoplasms (aneurysmal and unicameral bone cysts), benign bone neoplasms (giant-cell tumors and chondroblastomas), and occasionally even low-grade malignant bone lesions (grade-I chondrosarcomas) ( Figs. 1-A and 1-B ). An alternative to autografts, allografts are readily available and obviate the need for harvesting an autograft with its associated morbidity. Figs. 1-A and 1-B: Fig. 1-A Anteroposterior radiograph of the right ankle of an eleven-year-old girl, showing an expansile lytic lesion in the distal aspect of the fibula. An aneurysmal bone cyst was diagnosed on open biopsy. Fig. 1-B Six weeks following curettage and grafting with allograft cancellous bone chips. In a retrospective study, Glancy et al.6 compared the use of autograft and allograft in small ( 60-cm3 ) benign lesions in children, with respect to the success of graft incorporation. With smaller defects, both grafts were similarly efficient in achieving incorporation. With larger lesions, the rate of complete or partial healing was higher with autografts (100%) than with allografts (67%). To …