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Review of Endoprosthetic Reconstruction in Limb-sparing Surgery

  • Robert Henshaw
  • Martin Malawer

Overview

Endoprosthetic replacement of segmental skeletal defects is the preferred technique of reconstruction after resection of bone sarcomas. Today, all of the major anatomic joints with their adjacent segmental bone can be reconstructed safely and reliably with a modular endoprosthetic replacement. Prosthetic reconstruction is routinely performed for the proximal femur, distal femur, total femur, proximal tibia, proximal humerus, and scapula. Allografts are rarely used.

A major advantage of a modular endoprosthetic system is intraoperative flexibility; it enables the surgeon to reconstruct defects of any size with minimal preoperative planning. Instead of performing a resection to match a prosthesis customized on the basis of imaging studies that are 4–8 weeks old, the surgeon can concentrate on performing the best possible resection indicated for the patient at the time of surgery. Overall survival analysis of large segmental replacements is approximately 90% at 10 years (reported at 98% for the proximal humerus and 90% for the distal femur).

This chapter reviews the indications and techniques for performing endoprosthetic replacements for bone tumors. Many of the described surgical techniques were developed by the senior author, placing emphasis on techniques for reconstructing the soft tissues after implantation of a modular endoprosthesis to optimize the functional outcome.

Keywords

Distal Femur Limb Salvage Proximal Humerus Endoprosthetic Replacement Endoprosthetic Reconstruction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Enneking WF. Clinical Musculoskeletal Pathology. Gainesville: University Press of Florida; 1977.Google Scholar
  2. 2.
    Gebhardt MC, Flugstad DI, Springfield DS, Mankin HJ. The use of bone allografts for limb salvage in high-grade extremity sarcomas. Clin Orthop. 1991;270: 181–96.PubMedGoogle Scholar
  3. 3.
    Hejna MJ, Gitelis S. Allograft prosthetic composite reconstruction for bone tumors. Sem Surg Oncol. 1997;13: 18–24.Google Scholar
  4. 4.
    Marcove RC, Lewis MM, Rosen G et al. Total femur and total knee replacement. A preliminary report. Clin Orthop. 1977;126:147–52.PubMedGoogle Scholar
  5. 5.
    Capanna R, Morris HG, Campanacci D et al. Modular uncemented prosthetic reconstruction after resection of tumours of the distal femur. J Bone Joint Surg. 1994;76B: 178–86.Google Scholar
  6. 6.
    Aboulafia AJ, Buch R, Mathews J, Li W, Malawer MM. Reconstruction using the saddle prosthesis following excision of primary and metastatic periacetabular tumors. Clin Orthop. 1995;314:203–13.PubMedGoogle Scholar
  7. 7.
    Ward WG, Johnson KS, Dorey FJ, Eckardt JJ. Extra-medullary porous coating to prevent diaphyseal osteolysis and radiolucent lines around proximal tibial replacements. J Bone Joint Surg. 1993;75A:976–87.Google Scholar
  8. 8.
    An K, Chao EYS, Kaufman KR. Analysis of muscle and joint loads. In: Mow VC, Hayes WC, editors. Basic Orthopaedic Biomechanics, 2nd edn. New York: Lippincott Raven; 1997.Google Scholar
  9. 9.
    Andriacchi TP, Natarajan RN, Hurwitz DE. Musculoskeletal dynamics, locomotion and clinical applications. In: Mow VC, Hayes WC, editors. Basic Orthopaedic Biomechanics, 2nd edn. New York: Lippincott Raven; 1997.Google Scholar
  10. 10.
    Henshaw RM, Malawer MM. Survival of modular versus custom endoprostheses for limb salvage: are we actually doing better? Presented at American Academy of Orthopaedic Surgeons 1998 Annual Meeting — Scientific Program; Paper No. 157, 20 March 1998.Google Scholar
  11. 11.
    Malawer MM, Canfield D, Meller I. Porous-coated segmental prosthesis for large tumor defects. A prosthesis based upon immediate fixation (PMMA) and extracortical bone fixation. In: Yamamuro T, editor. New Developments for Limb Salvage in Musculoskeletal Tumors. New York: Springer; 1989:247–55.Google Scholar
  12. 12.
    Malawer MM. Tumors of the shoulder girdle. Technique of resection and description of a surgical classification. Orthop Clin N Am. 1991; 22:7–35.Google Scholar
  13. 13.
    Malawer MM, Price WM. Gastrocnemius transposition flap in conjunction with limb-sparing surgery for primary bone sarcomas around the knee. Plast Reconstr Surg. 1984;73:741.PubMedGoogle Scholar
  14. 14.
    Rougraff BT, Simon MA, Kneisl JS, Greenberg DB, Mankin HJ. 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. 1994;76:649.PubMedGoogle Scholar
  15. 15.
    Roberts P, Chan D, Gimer RJ, Sneath RS, Scales JT. Prosthetic replacement of the distal femur for primary bone tumours. J Bone Joint Surg. 1991;73B:762.Google Scholar
  16. 16.
    Horowitz S, Glasser D, Lane J, Healey J. Prosthetic and extremity survivorship in limb salvage: how long do the reconstructions last? Clin Orthop. 1993;293:280.PubMedGoogle Scholar
  17. 17.
    Malawer MM, Chou LB. Prosthetic survival and clinical results with use of large-segment replacements in the treatment of high-grade bone sarcomas. J Bone Joint Surg. 1995;77A:1154–65.Google Scholar
  18. 18.
    Capanna R, Morris HG, Campanacci D et al. Modular uncemented prosthetic reconstruction after resection of tumours of the distal femur. J Bone Joint Surg. 1994;76B: 178–86.Google Scholar
  19. Henshaw RM, Jones V, Malawer MM. Endoprosthetic reconstruction with the modular replacement system. Survival analysis of the first 100 implants with a minimum 2 year follow-up. Proceedings, Fourth Annual Combined Meeting of the American and European Musculoskeletal Tumor Societies, Washington, DC; 1998:90.Google Scholar

Copyright information

© Kluwer Academic Publishers 2004

Authors and Affiliations

  • Robert Henshaw
  • Martin Malawer

There are no affiliations available

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