International Orthopaedics - 2026-04-23 - Journal Article
Long-term clinical outcomes of allograft-prosthetic reconstruction for tumours of the extremities.
Sanders PTJ, van de Vusse SF, Simonis G, Fiocco M, van de Sande MAJ, Dijkstra PDS, Bus MPA
Topics
Key Takeaway
APC reconstruction for extremity tumors carries a cumulative mechanical failure rate of 28.6% at 25 years, with allograft collapse (20%) and non-union (14%) as dominant complications.
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Summary
This study evaluated long-term complications and failure rates of APC reconstruction in 64 extremity tumor resections (40% osteosarcoma, 28% chondrosarcoma) across proximal femur, distal femur, proximal tibia, and proximal humerus. Cumulative mechanical failure was 15.6% at 5 years, 21.9% at 10 years, and 28.6% at 25 years. Early failures were driven by non-union (14%) and infection (8%), while late failures were dominated by aseptic loosening (11%, median onset 14 years) and allograft collapse (20%, median onset 3 years).
Key Limitation
Heterogeneous cohort combining four anatomic locations and multiple tumor diagnoses without stratified failure analysis prevents site-specific or histology-specific risk quantification.
Original Abstract
PURPOSE
Allograft-prosthetic composites (APC) are used to reconstruct large periarticular defects following tumour resection, with potential advantages especially restoration of bone stock and ligamentous reattachment. While short- and mid-term outcomes have been reported on extensively, long-term clinical results remain limited. This study evaluated the incidence of mechanical and non-mechanical complications, risk factors for complications, and the cumulative incidence of reconstruction failure following APC reconstruction for extremity tumours with a minimum follow-up of ten years.
METHODS
We retrospectively reviewed 64 APC with at least ten years follow-up in our centre. Predominant diagnoses were osteosarcoma (40%) and chondrosarcoma (28%). Reconstructions involved the proximal femur (39%), distal femur (22%), proximal tibia (23%) and proximal humerus (16%). Median follow-up was 24.5 years (95%CI 23.6-25.4).
RESULTS
Instability occurred in nine reconstructions (14%). Non-union was observed in nine reconstructions (14%). Implant loosening occurred in seven reconstructions (11%) after a median of 14 years (range 2-18 years). Allograft collapse occurred in 13 reconstructions (20%) after a median of three years (range 1-15). Infection developed in five reconstructions (8%). Cumulative incidence of mechanical failure at five, ten and 25 years was 15.6% (95%CI 6.6-24.6), 21.9% (95%CI 11.6-32.1) and 28.6% (95%CI 17.2-39.9), respectively.
CONCLUSIONS
APC are associated with a considerable risk of both early and late complications. Non-union and infection predominate in the early postoperative period, whereas aseptic loosening and fractures are the main causes of late failure, occurring up to 18 years after surgery. These findings suggest that the routine use of APC for periarticular reconstruction after tumour resection should be reconsidered.