Allograft versus Megaprosthesis

This chapter presents the case scenarios of a 13-year-old female who presents with a three-month history of left shoulder pain that awakens her at night, and a 45-year-old female who presents with a six-week history of knee pain. Open biopsy is consistent with high-grade dedifferentiated chondrosarcoma. Resection and reconstruction are planned. Three common means of reconstruction have been used after periarticular tumor resection: osteoarticular allograft, allograft-prosthetic composite (APC), and endoprosthesis. Amputation for any reason was required in 5.1% of patients with endoprostheses, in 10% of patients with osteoarticular allografts, and in 1.7% of APCs. Aseptic loosening is similar between endoprostheses and APCs. There is a higher risk for fracture in osteoarticular allografts compared to peri-prosthetic fractures for APCs and endoprostheses. The chapter provides recommendations for implementing evidence-based practice in the clinical setting.