Pasteurized Autograft-Prosthesis Composite Reconstruction May Not Be a Viable Primary Procedure for Large Skeletal Defects after Resection of Sarcoma

Abstract EN

Background.

Among various types of composite biological reconstruction, pasteurized autograft-prosthesis composite (PPC) is popular when allograft is unavailable.

Previous limited cohort study indicated result comparable to tumor prosthesis.

However, as case number and follow-up increase, we experienced more complications than anticipated.

We questioned the usefulness of PPC as a viable reconstructive option.

Methods.

We reviewed 142 PPCs and analyzed overall and location-related survival and factors associated with the failure of PPC.

Results.

Twenty-year survival rate of 142 PPCs was 39.8 ± 10.0%.

Fifty-two (36.6%) of 142 PPCs showed failure.

Among various locations, the proximal femur showed best survival: 78.0 ± 9.9%.

Final status of the 52 failed PPCs was modular tumor prosthesis in 23 (43%), arthrodesis in 11 (21%), pseudarthrosis in 7 (13%), amputation in 7 (13%), and allograft-prosthesis composite in 4 (8%).

Tumor volume > 200 cc (p=0.001), pasteurization length ≤ 10 cm (p=0.002), male sex (p=0.02), and locations in pelvis or tibia (p=0.029) were poor prognostic factors.

Conclusions.

Long-term survival of PPCs was below expectations.

Despite the complexity of the procedure, there is little survival gain over tumor prosthesis.

PPC may be indicated when a modular prosthesis is not readily available.