Allograft and Recycled Autograft Reconstruction Following Resection of Bone Due to Osteosarcoma: A Systematic Review of Time to Union and Complications

Abstract

Abstract Background: Osteosarcoma is the most common primary malignant bone tumor, predominantly affecting the femur, tibia, and humerus. Despite advances in surgical oncology, comprehensive evaluations of biological reconstruction methods remain limited, with existing literature primarily consisting of small retrospective cohort studies. Objectives: This systematic review aimed to assess the outcomes and prognostic factors associated with allograft and recycled autograft reconstruction techniques following tumor resection. Materials and Methods: Six studies comprising 368 patients were included after a systematic search of PubMed, Embase, and Scopus. Pooled descriptive statistics were used to assess time to bone union and postoperative complications. Separate meta-analyses were conducted for each outcome. Results: Among the patients, 160 (43.5%) underwent allograft reconstruction and 208 (56.5%) received recycled autografts. Allograft reconstruction showed a trend toward shorter time to union (9.01 vs. 11.23 months; mean difference (MD): −0.92 months [−1.89, 0.05]; P = 0.06), though not statistically significant. There were no significant differences in rates of nonunion (risk ratio [RR]: 0.99), fracture (RR: 1.00), soft tissue failure (RR: 0.42), infection (RR: 1.52), or recurrence (RR: 1.10). Conclusions: Although both allograft and recycled autograft reconstructions demonstrated comparable effectiveness in terms of union time and postoperative complications, our analysis revealed a trend toward shorter time to union in the allograft group compared with the recycled autograft group, without reaching statistical significance. Therefore, the current evidence suggests that both reconstruction methods are viable options following wide resection of osteosarcoma.