Long-term Results of Osteoarticular Allograft Reconstruction in Children with Distal Femoral Bone Tumors

Background: There is no consensus regarding the best method of reconstruction in pediatric population following the wide resection of malignant bone tumors. More exploration of the complications of osteoarticular reconstruction leads to less existing controversy of this type of reconstruction, which is the main point of this article. Methods: Long-term outcomes and complications of osteoarticular allograft reconstruction of primary distal femoral bone sarcomas in 22 children with mean age of 10.7 years old were reviewed in this study. Musculoskeletal Tumor Society (MSTS) scoring system was used for functional evaluation of the allografts. Results: With an average follow-up time of 81 months, the outcomes of 16 patients with allografts at the final follow up were evaluated. As expected, Limb length discrepancy (LLD) was observed in all patients (mean LLD= 2.73cm), which was significantly correlated to allograft survival time (P 0.001). Degenerative joint disease (DJD) was also seen in all patients and its grade was also significantly correlated to allograft survival time (P 0.001). The mean MSTS-score was 74% at the latest follow-up, ranging from 60% to 90%. Five and 10 year survival rate of allografts were found to be 93.3% and 62.2%, respectively. Conclusion: Osteoarticular allograft reconstruction could result in several complications including DJD. Despite its considerable biologic advantage over endoprosthesis, osteoarticular allograft reconstruction is a long-lasting but still a temporary solution before performing megaprosthesis. This allows patients to preserve their remaining physis for limb growth and become old enough for an adult megaprosthesis.