International Orthopaedics

, Volume 42, Issue 5, pp 1175–1181 | Cite as

Implant and limb survival after resection of primary bone tumors of the lower extremities and reconstruction with mega-prostheses fifty patients followed for a mean of forteen years

  • Christina Enciso Holm
  • Christian Bardram
  • Anja Falk Riecke
  • Peter Horstmann
  • Michael Mørk Petersen
Original Paper



Previous studies reported variable outcome and failure rates after mega-prosthetic reconstructions in the lower extremities. The purpose of this study was to make a long-term single-center evaluation of patients treated with limb-sparing surgery and reconstruction with mega-prostheses in the lower extremities.


We identified 50 patients (osteosarcoma (n = 30), chondrosarcoma (n = 9), osteoclastoma (n = 6), Ewing sarcoma (n = 4), angiosarcoma (n = 1)), who underwent limb-sparing reconstruction of the lower extremities (proximal femur (n = 9), distal femur (n = 29), proximal tibia (n = 9), and the entire femur (n = 3)) between 1985 and 2005. Surviving patients not lost to follow-up were evaluated using the MSTS score. Causes of failure were classified according to the Henderson classification. Kaplan-Meier survival analysis was used for evaluation of patient, prosthesis, and limb survival.


Twenty-eight patients were alive at follow-up. Fifty-four percent had revision surgery (n = 27). The ten year patient survival was 60% (95%CI 46–74%); the ten year implant survival was 24% (95%CI 9–41%), and the ten year limb survival rate was 83% (95%CI 65–96%). Type 1 failure occurred in 9%, type 2 in 16%, type 3 in 28%, type 4 in 18%, and type 5 in 3%. Mean MSTS score was 21 (range, 6–30), representing a median score of 71%.


Our long-term results with mega-prostheses justify the use of limb-salvage surgery and prosthetic reconstruction. Our results are fully comparable with other findings, with regard to limb and prosthesis survival, but also with regard to functional outcome.


Mega-endoprostheses Bone tumors Limb-salvage surgery Tumour endoprosthesis infection Amputation MSTS 



We thank consultant pathologist Søren Daugaard.

Compliance with ethical standards

Ethical approval

The study has been approved by the Danish Data Protection Agency (no. 2013-41-2591) and the Danish Health and Medicines Authority (no. 3-3013-894/1).

Informed consent

Informed consent was obtained from all individual participants alive included in the study.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Christina Enciso Holm
    • 1
  • Christian Bardram
    • 1
  • Anja Falk Riecke
    • 1
  • Peter Horstmann
    • 1
  • Michael Mørk Petersen
    • 1
  1. 1.The Musculoskeletal Tumor Section, The Department of Orthopedic Surgery, RigshospitaletUniversity of CopenhagenCopenhagenDenmark

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