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Friday, March 17, 2000

Better results with allographic composites

A study presented in scientific exhibit 407 found that allograft-prosthetic composites had significantly better functional results than osteoarticular allografts and metal prostheses in proximal humeral reconstruction after tumor resection.

Furthermore, osteoarticular allograft and metal failures were successfully salvaged with composite reconstructions, said H. Thomas Temple, MD, associate professor of orthopaedic surgery and pathology, chief, musculoskeletal oncology section, department of orthopaedic surgery, University of Miami, Miami, Fla., who presented the study.

"All patients with shoulder reconstructions using osteoarticular allografts, metal devices and allograft-prosthetic composites were identified from our institutional database," said Dr. Temple. "We compared functional results and graft success using the MSTS and Mankin grading systems." Minimum follow-up was two years. Nine osteoarticular, five metal prostheses and 12 composite grafts were analyzed. The mean ages for each group were 32, 58 and 57 years, respectively. There were no gender differences between groups.

There were six fractures in the osteoarticular group (66 percent) and none in the metal or composite groups. There were no infections in the osteoarticular or metal groups and one in the composite group (8 percent). The mean MSTS score in the osteoarticular allograft group was 60 percent, five grafts were rated good, one fair, and three failures due to fracture. All failures were successfully converted to a composite graft.

The MSTS score for patients with metal prostheses was 49 percent with four fair results and one failure. The allograft composite group MSTS score was 74 percent; five excellent, five good, one fair and one failure. The patient with a failed reconstruction due to infection was treated with resection arthroplasty.

Co-authors of the study, are Christopher J. Bashore, MD, chief, tumor service, National Naval Medical Center, Bethesda, Md; Theodore I. Malinin, professor, University of Miami School of Medicine and director, Miami Tissue Bank; and Walid Mnaymeh, MD, professor, University of Miami School of Medicine.

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Last modified 23/February/2000 by IS