We propose a surgical technique for structural allograft reconstitution of the diaphysis of long bones, maximizing surface
contact between host and allograft bone. This method, analogous to a telescope, overlaps the graft and host bone, theoretically
increasing bone surface contact substantially. We report the outcome of 22 telescoped allograft junction sites in 19 patients
who lacked sufficient host bone to accommodate a regular-length stemmed implant. This joint-sparing reconstruction preserved
15 of 16 adjacent joints at risk for replacement. Five patients needed additional surgery, but none for nonunion. The diaphyseal
length could be reconstructed enough so that a short prosthesis (less than the critical 40% of total bone length) could be
used. This biologic method to reconstruct major segments of the diaphysis is best suited for patients with quantitatively
or qualitatively deficient residual bone stock after tumor resection or prosthetic revision. We believe it is an excellent
technique for revision knee megaprostheses when there is a short remnant of proximal femur.
Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
One or more of the authors (JHH) have received funding from the Sullivan Fellowship in Musculoskeletal Oncology and the Biomet
Fellowship in Orthopedic Oncology Research.
Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations
were conducted in conformity with ethical principles of research, and that informed consent for participation in the study
was obtained.