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Sarcoma
Volume 2017, Article ID 9710964, 9 pages
https://doi.org/10.1155/2017/9710964
Research Article

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

Department of Orthopedic Surgery, Korea Cancer Center Hospital, Seoul, Republic of Korea

Correspondence should be addressed to Dae-Geun Jeon; rk.er.hcck@noejgd

Received 12 February 2017; Revised 7 April 2017; Accepted 8 May 2017; Published 4 June 2017

Academic Editor: Valerae O. Lewis

Copyright © 2017 Seung Yong Lee et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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 , pasteurization length ≤ 10 cm , male sex , and locations in pelvis or tibia 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.