Are Fibula Strut Allografts a Reliable Alternative for Periarticular Reconstruction after Curettage for Bone Tumors?

Bone tumors occurring in periarticular locations may cause a substantial risk of subchondral fracture and collapse. Poly-methylmethacrylate has been used for reconstruction in these instances because of its immediate structural stability. Allogeneic graft allows for biologic incorporation and remodeling, but it takes longer. Adding a fibula strut graft to the construct seems to provide structural stability during incorporation of the particulate graft. Seventeen of 22 (77.3%) patients returned to their full preoperative level of function after this procedure. We believe adding fibula strut to particulate allograft when using the buttress technique provides structural integrity and biologically active reconstruction, while maintaining a recurrence rate similar to those described for other reconstruction techniques. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

[1]  K. Jaffe,et al.  Use of a fibular allograft strut in the treatment of benign lesions of the proximal femur. , 2002, American journal of orthopedics.

[2]  T. Yamashita,et al.  Complications associated with bone cementing for the treatment of giant cell tumors of bone , 2002, Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association.

[3]  W. Enneking,et al.  Retrieved Human Allografts: A Clinicopathological Study , 2001, The Journal of bone and joint surgery. American volume.

[4]  L. White,et al.  Treatment of giant-cell tumors of long bones with curettage and bone-grafting. , 1999, The Journal of bone and joint surgery. American volume.

[5]  R. Hsu,et al.  Treatment of fibrous dysplasia involving the proximal femur. , 1998, Orthopedics.

[6]  R. Hsu,et al.  Semistructural allografting in bone defects after curettage , 1998, Journal of surgical oncology.

[7]  P. Choong The role of allografts in tumour surgery. , 1997, Acta orthopaedica Scandinavica. Supplementum.

[8]  R. Hsu,et al.  Treatment of the Femoral Neck and Trochanteric Benign Lesions , 1996, Clinical orthopaedics and related research.

[9]  H J Mankin,et al.  Long-Term Results of Allograft Replacement in the Management of Bone Tumors , 1996, Clinical orthopaedics and related research.

[10]  S. Bini,et al.  Giant cell tumor of bone. Curettage and cement reconstruction. , 1995, Clinical orthopaedics and related research.

[11]  Steven B. Lippitt,et al.  Thermal aspects of the use of polymethylmethacrylate in large metaphyseal defects in bone. A clinical review and laboratory study. , 1993, Clinical orthopaedics and related research.

[12]  R. Wilkins,et al.  Giant cell tumor of bone treated by curettage, cementation, and bone grafting. , 1992, Orthopedics.

[13]  W. Enneking,et al.  Observations on massive retrieved human allografts. , 1991, The Journal of bone and joint surgery. American volume.

[14]  K. Jaffe,et al.  Treatment of benign lesions of the femoral head and neck. , 1990, Clinical orthopaedics and related research.

[15]  W. Enneking,et al.  Fibrous dysplasia of the femoral neck. Treatment by cortical bone-grafting. , 1986, The Journal of bone and joint surgery. American volume.

[16]  C. Perka,et al.  Treatment of stages 2 and 3 giant-cell tumor , 2001, Archives of Orthopaedic and Trauma Surgery.

[17]  R. Eilert,et al.  Autograft versus allograft for benign lesions in children. , 1991, Clinical orthopaedics and related research.