Radical resection and allograft replacement in the treatment of bone tumors.

Resection and allograft transplantation in the treatment of bone tumors was introduced in the United States by Parrish in the mid 1960's, based on the demonstration by several investigators that fresh frozen allografts were well tolerated by the host. Since 1971, we have performed 63 such procedures in 60 patients who have had segmental resections for malignant and aggressive bone tumors. Analysis of the results in 46 patients who have been followed longer than 1 year (mean followup of 2.7 years) show that none of the patients have an identifible immunologic reaction to the graft. Twenty-five (53.5%) of the patients had an uneventful recovery and achieved functional status without complication ("good" resuls). An additional eleven patients (23.9%) who exhibited late complications of allograft fracture, infection, or nonunion required further surgery to achieve the same degree of functional restoration as the former group ("satisfactory" results), thus raising the total of good and satisfactory results to 78.2%. Seven of the patients (15.2%) were gross failures in that two required amputation, two had the grafts removed and three have died. Although these data suggest that the procedure is a successful one for treatment of certain types of bone tumors, continued follow-up is required to ascertain the long term results. The technique should be reserved for patients with aggressive or low grade tumors, in which resection can be performed without excessive tissue sacrifice and who will not require adjuvant chemotherapy.