OUTCOME OF PELVIC ALLOGRAFT TRANSPLANTATION

F.J. Hornicek, MC Gebhardt, H.J. Mankin. Orthopaedic Oncology Unit, Massachusetts General Hospital, Boston, MA

From 1977 until present 63 pelvic allografts were transplanted in patients with bone tumors. Patient survival and graft performance were assessed in 59 of these patients with greater than two years follow-up (mean 50 mo, range 24-263 mo). There were 36 males (56%) and 28 females (44%) with an average age was 40% (range from 10 to 74%). The most common diagnoses included giant cell tumor, osteosarcoma, chondrosarcoma, and metastatic carcinoma. There were a total of 37 patients with high grade sarcomas who had 20 deaths (54%), 23 metastases (62%), and 16 recurrences (43%). The allograft complications for the 59 procedures included 13 infections (22%), 8 fractures (14%), and 3 non-unions (5%). Some of the patients had more than one complication, and eleven patients (19%) had neither tumor or allograft complications.

There were 27 patients who had one surgical procedure while the rest underwent multiple surgical procedures. Nineteen of these underwent only one further procedure and only 2 had and external hemipelvectomy. Adjuvant therapy was given in the majority of the cases (49 patients). Chemotherapy and radiation together resulted in a poor allograft outcome and patient survival. Those patients who had received chemotherapy alone had a 38% (11/29) satisfactory allograft result. This is in comparison to 60% (18/30) in the nonchemotherapy group. Likewise in the radiation group only 35% (9/26) had a satisfactory result as compared to 64% (20/33) in the group without radiation.

When the 16 oncologic failures are deleted from the group, the overall percentage of satisfactory results is 68% (29/43) in the remaining 43 patients. Infection had a detrimental effect on allograft outcome (p< 0.0001) whereas age was not a significant factor in outcome. The high grade tumors had worse allograft results as compared to the low grade tumors (p<0.002), and recurrence nearly always resulted in death (p<0.0001). Those grafts that did not involve the joint did better than the osteoarticular and alloprothesis groups.

Pelvic allograft transplantation has a higher rate of complications as compared to the extremity sites due to a variety of reasons. However, this type of allograft transplantation still serves as an option for the reconstruction of massive pelvic defects.