[Massive bone allografts in large bone defects after tumor surgery: a clinical long-term study].

Eleven patients with malignant bone tumor arising in femur and tibia treated by means of bone graft were followed for 25 months to 6 years. Histological diagnosis included 8 osteosarcomas, a chondrosarcoma, a malignant fibrous histiocytoma and a round-cell sarcoma. They had intensive adjuvant chemotherapy for a year after the operation. The drugs used were adriamycin and high-dose methotrexate. One patient died of pulmonary metastasis, two patients of local recurrence and another patient of infection requiring amputation. Seven cases were finally evaluated. Of these 7 cases, operative procedures included one segmental femoral resection with intercalary allograft, two segmental femoral resections with allograft and knee arthrodesis, three segmental tibial resections with allograft and knee arthrodesis and one eccentric resection of femur with allograft. There were three allograft resorptions which were successfully treated by additional autografts. Other complications were a septic fistula formation and two cases of breakage in internal securing metals due to non-union. They also healed without further problem. Bone healings of the grafts were evaluated on X-ray and one case was histologically examined. All of the primary segmental allografts after the wide resection of the tumor failed in the primary bone healing. However, additional autogenous bone graft led to healing within two years. Functional evaluation according to Enneking proved good in four and fair in three cases. Reconstructive surgery with massive bone grafts represents a successful alternative to prosthetic implant in young adults with long life expectancy.