Advertisement

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

Abstract

Purpose

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.

Methods

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.

Results

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%.

Conclusions

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.

Keywords

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

Notes

Acknowledgements

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.

References

  1. 1.
    Rougraff BT, Simon MA, Kneisl JS, Greenberg DB, Mankin HJ (1994) Limb salvage compared with amputation for osteosarcoma of the distal end of the femur. A long-term oncological, functional, and quality-of-life study. J Bone Joint Surg Am 76(5):649–656CrossRefPubMedGoogle Scholar
  2. 2.
    Saeter G, Alvegard TA, Elomaa I et al (1991) Treatment of osteosarcoma of the extremities with the T-10 protocol, with emphasis on the effects of preoperative chemotherapy with single-agent high-dose methotrexate: a Scandinavian Sarcoma Group study. J Clin Oncol 9:1766–1775CrossRefPubMedGoogle Scholar
  3. 3.
    Rydholm A, Gustafson P, Rooser B et al (1991) Limb-sparing surgery without radiotherapy based on anatomic location of soft tissue sarcoma. J Clin Oncol 9:1757–1765CrossRefPubMedGoogle Scholar
  4. 4.
    Smeland S, Müller C, Alvegard TA et al Scandinavian Sarcoma Group Osteosarcoma Study SSG VIII: prognostic factors for outcome and the role of replacement salvage chemotherapy for poor histological responders. Eur J Cancer 39:488–494Google Scholar
  5. 5.
    Ferrari S, Smeland S, Mercuri M et al (2005) Neoadjuvant chemotherapy with high-dose ifosfamide, high-dose methotrexate, cisplatin, and doxorubicin for patients with localized osteosarcoma of the extremity: a joint study by the Italian and Scandinavian Sarcoma Groups. J Clin Oncol 23:8845–8852.  https://doi.org/10.1200/JCO.2004.00.5785 CrossRefPubMedGoogle Scholar
  6. 6.
    Grimer RJ, Taminiau AM, Cannon SR (2002) Surgical subcommitte of the European osteosarcoma intergroup; Surgical outcomes in osteosarcoma. J Bone Joint Surg Br 84(3):395–400CrossRefPubMedGoogle Scholar
  7. 7.
    Houdek MT, Wagner ER, Wilke BK et al (2016) Long term outcomes of cemented endoprosthetic reconstruction for periarticular tumors of the distal femur. Knee 23:167–172.  https://doi.org/10.1016/j.knee.2015.08.010 CrossRefPubMedGoogle Scholar
  8. 8.
    Hardes J, Gebert C, Schwappach A et al (2006) Characteristics and outcome of infections associated with tumor endoprostheses. Arch Orthop Trauma Surg 126:289–296.  https://doi.org/10.1007/s00402-005-0009-1 CrossRefPubMedGoogle Scholar
  9. 9.
    Qadir I, Umer M, Baloch N (2012) Functional outcome of limb salvage surgery with mega-endoprosthetic reconstruction for bone tumors. Arch Orthop Trauma Surg 132:1227–1232.  https://doi.org/10.1007/s00402-012-1542-3 CrossRefPubMedGoogle Scholar
  10. 10.
    Schmidt M, Pedersen L, Sørensen HT (2014) The Danish Civil Registration System as a tool in epidemiology. Eur J Epidemiol 29:541–549.  https://doi.org/10.1007/s10654-014-9930-3 CrossRefPubMedGoogle Scholar
  11. 11.
    Wada T, Kawai a IK et al (2007) Construct validity of the Enneking score for measuring function in patients with malignant or aggressive benign tumours of the upper limb. J Bone Joint Surg Br 89:659–663.  https://doi.org/10.1302/0301-620X.89B5.18498 CrossRefPubMedGoogle Scholar
  12. 12.
    Pala E, Henderson ER, Calabrò T et al (2013) Survival of current production tumor endoprostheses: complications, functional results, and a comparative statistical analysis. J Surg Oncol 108:403–408.  https://doi.org/10.1002/jso.23414 CrossRefPubMedGoogle Scholar
  13. 13.
    Henderson ER, Groundland JS, Pala E et al (2011) Failure mode classification for tumor endoprostheses: retrospective review of five institutions and a literature review. J Bone Joint Surg Am 93:418–429.  https://doi.org/10.2106/JBJS.J.00834 CrossRefPubMedGoogle Scholar
  14. 14.
    Torbert JT, Fox EJ, Hosalkar HS et al (2005) Endoprosthetic reconstructions. Clin Orthop Relat Res NA:51–59.  https://doi.org/10.1097/01.blo.0000179735.37089.c2 CrossRefGoogle Scholar
  15. 15.
    Simon MA, Aschliman MA, Thomas N, Mankin HJ (1986) Limb-salvage treatment versus amputation for osteosarcoma of the distal end of the femur. J Bone Joint Surg Am 68:1331–1337CrossRefPubMedGoogle Scholar
  16. 16.
    Carty CP, Dickinson IC, Watts MC et al (2009) Impairment and disability following limb salvage procedures for bone sarcoma. Knee 16:405–408.  https://doi.org/10.1016/j.knee.2009.02.006 CrossRefPubMedGoogle Scholar
  17. 17.
    Mittermayer F, Krepler P, Dominkus M et al (2001) Long-term followup of uncemented tumor endoprostheses for the lower extremity. Clin Orthop Relat Res:167–177Google Scholar
  18. 18.
    Kemp HBS, Sneath RS, Walker PS (1996) Custom-made prosthetic replacements for bone tumours of the lower limb. Bone Joint J 78–B:5–13Google Scholar
  19. 19.
    Morgan HD, Cizik AM, Leopold SS et al (2006) Survival of tumor megaprostheses replacements about the knee. Clin Orthop Relat Res 450:39–45.  https://doi.org/10.1097/01.blo.0000229330.14029.0d CrossRefPubMedGoogle Scholar
  20. 20.
    Gosheger G, Gebert C, Ahrens H et al (2006) Endoprosthetic reconstruction in 250 patients with sarcoma. Clin Orthop Relat Res 450:164–171.  https://doi.org/10.1016/S0276-1092(08)70278-5 CrossRefPubMedGoogle Scholar
  21. 21.
    Rubio D, Serrano M, Wang E (2013) Tumour endoprosthetic reconstruction for primary aggressive and malignant bone tumours of the distal femur. Malays Orthop J 7(3):1–5.  https://doi.org/10.5704/MOJ.1311.007 CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Zeegen EN, Aponte-Tinao LA, Hornicek FJ et al (2004) Survivorship analysis of 141 modular metallic endoprostheses at early followup. Clin Orthop Relat Res 90025:239–250.  https://doi.org/10.1097/01.blo.0000126224.97525.5b CrossRefGoogle Scholar
  23. 23.
    Jeys LM, Grimer RJ, Carter SR, Tillman RM (2005) Periprosthetic infection in patients treated for an orthopaedic oncological condition. J Bone Joint Surg Am 87:842–849.  https://doi.org/10.2106/JBJS.C.01222 CrossRefPubMedGoogle Scholar
  24. 24.
    Pala E, Trovarelli G, Calabrò T et al (2015) Survival of modern knee tumor megaprostheses: failures, functional results, and a comparative statistical analysis. Clin Orthop Relat Res 473:891–899.  https://doi.org/10.1007/s11999-014-3699-2 CrossRefPubMedGoogle Scholar
  25. 25.
    Mavrogenis AF, Pala E, Angelini A et al (2015) Infected prostheses after lower-extremity bone tumor resection: clinical outcomes of 100 patients. Surg Infect 16:267–275.  https://doi.org/10.1089/sur.2014.085 CrossRefGoogle Scholar
  26. 26.
    Unwin PS, Cannon SR, Grimer RJ, Kemp HB, Sneath RS, Walker PS (1996) Aseptic loosening in cemented custom-made prosthetic replacements for bone tumours of the lower limb. J Bone Joint Surg Br 78(1):5–13CrossRefPubMedGoogle Scholar
  27. 27.
    Flint MN, Griffin AM, Bell RS et al (2006) Aseptic loosening is uncommon with uncemented proximal tibia tumor prostheses. Clin Orthop Relat Res 450:52–59.  https://doi.org/10.1016/S0276-1092(08)70276-1 CrossRefPubMedGoogle Scholar
  28. 28.
    Capanna R, Scoccianti G, Frenos F et al (2014) What was the survival of megaprostheses in lower limb reconstructions after tumor resections? Clin Orthop Relat Res 473:820–830.  https://doi.org/10.1007/s11999-014-3736-1 CrossRefPubMedCentralGoogle Scholar
  29. 29.
    Schwartz AJ, Kabo JM, Eilber FC et al (2010) Cemented distal femoral endoprostheses for musculoskeletal tumor: improved survival of modular versus custom implants. Clin Orthop Relat Res 468:2198–2210.  https://doi.org/10.1007/s11999-009-1197-8 CrossRefPubMedGoogle Scholar
  30. 30.
    Mittermayer F, Windhager R, Dominkus M et al (2002) Revision of the Kotz type of tumour endoprosthesis for the lower limb. J Bone Joint Surg Br 84:401–406CrossRefPubMedGoogle Scholar
  31. 31.
    Jeys LM, Grimer RJ, Carter SR, Tillman RM (2003) Risk of amputation following limb salvage surgery with endoprosthetic replacement, in a consecutive series of 1261 patients. Int Orthop 27:160–163.  https://doi.org/10.1007/s00264-003-0429-x PubMedPubMedCentralGoogle Scholar
  32. 32.
    Malawer MM, Chou LB (1995) Prosthetic survival and clinical results with use of large-segment replacements in the treatment of high-grade bone sarcomas. J Bone Joint Surg Am 77:1154–1165CrossRefPubMedGoogle Scholar
  33. 33.
    Jeys LM, Kulkarni a GRJ et al (2008) Endoprosthetic reconstruction for the treatment of musculoskeletal tumors of the appendicular skeleton and pelvis. J Bone Joint Surg Am 90:1265–1271.  https://doi.org/10.2106/JBJS.F.01324 CrossRefPubMedGoogle Scholar
  34. 34.
    Tunn PU, Pomraenke D, Goerling U, Hohenberger P (2008) Functional outcome after endoprosthetic limb-salvage therapy of primary bone tumours—a comparative analysis using the MSTS score, the TESS and the RNL index. Int Orthop 32:619–625.  https://doi.org/10.1007/s00264-007-0388-8 CrossRefPubMedGoogle Scholar
  35. 35.
    Aksnes LH, Bauer HCF, Jebsen NL et al (2008) Limb-sparing surgery preserves more function than amputation: a Scandinavian sarcoma group study of 118 patients. J Bone Joint Surg Br 90:786–794.  https://doi.org/10.1302/0301-620X.90B6.19805 CrossRefPubMedGoogle Scholar
  36. 36.
    Sharil AR, Usm MO, Nawaz AH et al (2013) Early functional outcome of resection and endoprosthesis replacement for primary tumor around. Knee 7:30–35Google Scholar
  37. 37.
    McGoveran BM, Davis AM, Gross AE, Bell RS (1999) Evaluation of the allograft-prosthesis composite technique for proximal femoral reconstruction after resection of a primary bone tumour. Can J Surg 42:37–45PubMedPubMedCentralGoogle Scholar
  38. 38.
    Davis AM, Devlin M, Griffin AM et al (1999) Functional outcome in amputation versus limb sparing of patients with lower extremity sarcoma: a matched case-control study. Arch Phys Med Rehabil 80:615–618.  https://doi.org/10.1016/S0003-9993(99)90161-2 CrossRefPubMedGoogle Scholar

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

Personalised recommendations