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
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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.
KeywordsMega-endoprostheses Bone tumors Limb-salvage surgery Tumour endoprosthesis infection Amputation MSTS
We thank consultant pathologist Søren Daugaard.
Compliance with ethical standards
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 was obtained from all individual participants alive included in the study.
Conflict of interest
The authors declare that they have no conflict of interest.
- 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
- 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.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
- 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
- 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.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.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
- 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
- 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
- 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