Osteoarticular allograft versus prosthetic allograft composites: which reconstruction method results in superior outcomes following the resection of proximal femur tumor in adolescent and preadolescent patients?
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BACKGROUND: Primary malignant tumors of the proximal femur in children are rare, and there is no consensus about the optimal reconstruction method for this condition. While methods for biological reconstruction-such as vascularized fibular allograft and rotationplasty-and nonbiological options like expandable endoprosthesis exist as reconstructive choices, each method has its distinct advantages and disadvantages. In this study, we compared the outcomes of osteoarticular allograft (OAA) with allograft-prosthetic component (APC) in reconstructing the proximal femur in a cohort of adolescent and preadolescent patients. PATIENTS AND METHODS: Twenty patients aged between 8 and 13 years with primary malignant bone tumors of the proximal femur who were managed with either OAA or APC reconstruction were included. The median follow-up was 71 months (range 24-140). The primary outcome of interest was limb function evaluated by the Musculoskeletal Tumor Society (MSTS) score. Secondary outcomes of interest were surgical complications. RESULTS: The median MSTS score of the patients was 23 (range 20-25) in the OAA group and 26 (range 23-27) in the APC group (P = 0.003). Postoperative complications in the OAA group included two nonunions (18.1%), two infections (18.1%), six degenerative joint diseases (54.5%), and one allograft fracture (9.1%). The postoperative complications in the APC group included one nonunion (11.1%), one dislocation (11.1%), and two allograft fractures (22.2%). Allograft fractures were managed with revision and replacement with a tumor prosthesis. No revision was done to address the DJD in the OAA group. CONCLUSION: OA and APC reconstructions of the proximal femur following tumor resection in adolescent and preadolescent patients each have their benefits and associated complications. However, APC reconstruction appears to provide superior limb function and a lower incidence of postoperative complications.