Effect of anatomic site and irradiation on the rates of revision and infection of allograft-prosthesis composites after resection of a primary bone tumor: a meta-analysis

Introduction Allograft-prosthesis composite reconstruction after resection of a primary bone tumor may have theoretical advantages, such as restoration of bone stock and soft tissue attachments. However, the reported results of APC of different anatomical sites differ widely. We conducted a meta-ana...

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Published in:Archives of orthopaedic and trauma surgery 2016-10, Vol.136 (10), p.1371-1380
Main Authors: Aurégan, Jean-Charles, Pietton, Raphaël, Bégué, Thierry, Anract, Philippe, Biau, David
Format: Article
Language:English
Subjects:
Acetabulum - surgery
Bone cancer
Bone Neoplasms - radiotherapy
Bone Neoplasms - surgery
Bone Transplantation - methods
Femur - surgery
Humans
Humerus - surgery
Infections
Medicine
Medicine & Public Health
Meta-analysis
Models, Statistical
Orthopaedic Surgery
Orthopedics
Prostheses
Prosthesis Implantation - methods
Prosthesis-Related Infections - epidemiology
Prosthesis-Related Infections - etiology
Reoperation - statistics & numerical data
Tibia - surgery
Transplantation, Homologous
Treatment Outcome
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Summary:Introduction Allograft-prosthesis composite reconstruction after resection of a primary bone tumor may have theoretical advantages, such as restoration of bone stock and soft tissue attachments. However, the reported results of APC of different anatomical sites differ widely. We conducted a meta-analysis to estimate the revision and infection rates associated with allograft-prosthesis composite (APC) reconstructions after resection of a primary bone tumor. We looked for variables, such as anatomic sites and irradiation of the allograft, associated with these outcomes. Materials and methods We searched Medline, EMBASE, and Cochrane Library. The primary outcome was the revision rate, and the secondary outcome was the infection rate. Random effects meta-analyses of single proportions were used to estimate pooled rates of events. Meta-regression models were built to assess the effect of moderators on relevant both outcomes. Results Thirty-one studies were included: 9 about acetabulum APC, 9 about proximal femur APC, 4 about proximal tibia APC, and 9 about proximal humerus APC. The revision rates ranged from 16 % (95 % CI 10–25 %) for proximal humerus to 38 % (95 % CI 26–52 %) for acetabulum, and were significantly different between anatomic sites ( p  = 0.028). The infection rates ranged from 8 % (95 % CI 4–16 %) for proximal humerus to 23 % (95 % CI 16–33 %) for proximal tibia and 23 % (95 % CI 15–35 %) acetabulum APCs, and were significantly different between anatomic sites ( p  = 0.008). Finally, we found that irradiation of the allograft was significantly associated with revision rates ( p  = 0.033) and infection rates ( p  
ISSN:0936-8051
1434-3916
DOI:10.1007/s00402-016-2549-y