COMPLICATION RATE IN LIMB SALVAGE SURGERY WITH ENDOPROSTHETIC RECONSTRUCTION

Abstract

The use of megaprosthesis presents a major advancement in orthopaedic oncology in the treatment of malignant bone and soft tissue tumours.

In the present study, we retrospectively analyse the complication rate of limb salvage surgery with megaprosthesis due to malignant tumours treated in our unit.

From 1997 until 2006, 64 patients (37 men, 27 women), aged between 16–78 years old (mean 43.3), have been treated with megaprosthesis insertion. The diagnosis was metastatic bone lesions in 26 patients, osteosarcoma in 14, chondrosarcoma in 14, soft tissue sarcoma with osseous involvement in 3 (2 synovial sarcoma and 1 MPNST), malignant giant cell tumour in 3, angiosarcoma in 2, Ewing sarcoma in 1, and revision of a failed reconstruction in 1 patient. Lower extremity reconstruction included proximal femur (30 patients), distal femur (19), proximal tibia (3) and total femur replacement (4). Upper extremity procedures were proximal humerus (7 patients) and distal humerus reconstruction (1).

Sixty patients were available for follow-up (minimum 1 year, mean 4.2 years). The following complications were encountered: periprosthetic fracture (1 patient), deep infection (4), superficial wound infection (6), local recurrences (2), hip dislocation (3), knee extensor apparatus failure (2), skin necrosis, (3) unsuccessful vascular reconstruction (1). The deep infection led to hip disarticulation in 1 patient and Tikhoff-Linberg resection in 1 patient with proximal humerus prosthesis. A rare case of bone leismaniasis was also encountered (treated conservatively).

Limb salvage surgery is the mainstay of treatment in malignant musculoskeletal tumours. Special megaprosthesis has been developed for this purpose. Survival rate is substantially less than common prosthesis; the complication rate is increased, especially regarding wound healing complications and infection. Adverse prognostic factors are:

1. a) advanced age,

2. b) the amount of soft tissues that need to be excised,

3. c) prolonged surgical time, and

4. d) reconstruction about the knee.