Autograft and biologic living bone reconstructions in orthopaedic oncology: A systematic review.
DOI:
https://doi.org/10.51168/sjhrafrica.v4i6.2442Keywords:
Orthopaedic oncology, ; Autograft;Biologic reconstruction, Vascularized fibular graft, Limb salvage, Bone tumorsAbstract
Background
Reconstruction of large skeletal defects after oncologic bone resection remains challenging. Autograft and biologic living bone techniques aim to restore skeletal continuity while preserving long-term function.
Objective: To systematically review clinical outcomes of autograft and biologic living bone reconstructions in orthopaedic oncology, focusing on union rates, functional outcomes, complications, and durability.
Methods
A systematic review of Google Scholar and peer-reviewed databases identified ten relevant studies, including systematic reviews, meta-analyses, and retrospective cohorts. Evaluated techniques included vascularized and non-vascularized autografts, recycled tumor-bearing bone, and composite constructs. Outcomes assessed were graft union, functional scores, complications, and limb salvage.
Results
Biologic reconstructions demonstrated high union rates (up to ~90%) and good-to-excellent functional outcomes, with Musculoskeletal Tumor Society (MSTS) scores typically ranging from 80% to 90%. Vascularized and composite grafts showed faster biological incorporation and improved mechanical stability in large segmental defects. Common complications included infection (approximately 20%), non-union, and graft fracture. Chemotherapy was identified as a significant risk factor for reconstruction failure. Despite complications, limb salvage and long-term graft survival were frequently achieved.
Conclusion
Autograft and biologic living bone reconstructions offer durable, biologically sound solutions for skeletal reconstruction in selected orthopaedic oncology patients. While associated with higher complication rates and prolonged rehabilitation compared with endoprostheses, these techniques provide favorable long-term functional outcomes and bone stock preservation, particularly in young patients.
Future research
High-quality prospective multicenter studies with standardized outcome measures and stratification based on chemotherapy exposure are required. Comparative effectiveness research between biologic reconstruction and endoprosthetic replacement in age-stratified cohorts will further clarify optimal patient selection.
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Copyright (c) 2024 Dr. Karthik Shunmugavelu, Dr . Evangeline Cynthia Dhinakaran, Dr. Manigandan Dhatchnamoorthy
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