What Are the Long-Term Clinical and Functional Outcomes After Hemicortical Allograft Reconstruction for Primary Bone Tumors?

Background: Hemicortical allograft reconstruction is associated with low short-term complication rates and excellent functional outcomes. However, data on their long-term complication profile and patient-reported outcomes is scarce to non-existent.

Methods: Patients with hemicortical resection and allograft reconstruction for primary bone tumors were included. The Henderson classification for biologic reconstruction was used to classify allograft failures. Functional outcomes at a minimum of 10 years postoperatively were assessed.

Results: Twenty-four patients with femur hemicortical allograft and 20 with tibia allograft were included. Allograft failure and reoperation occurred in 39% and 52% of patients, respectively. The main causes of allograft failure were infection, soft-tissue failure, and structural failure (9% each). Tibia allografts had a higher rate of failure due to infection (p = 0.02) and nonunion (p = 0.049) compared to femur allografts. There were no differences in allograft failure-free survival based on bone (tibia vs. femur) and osteosynthesis type (plate vs. screw and plates). Median TESS-LE and LEFS scores were 98.8% and 87.5% for tibia allografts, and 98.1% and 97.5% for femur allografts, respectively.

Conclusion: Long-term allograft failure-free survival was excellent, with infection and soft-tissue failures as the main failure mechanisms. At last follow-up, patients who still had the hemicortical allograft displayed excellent functional outcomes.

Level of evidence: Level IV.