MODULAR ENDOPROSTHETIC RECONSTRUCTION FOR SEGMENTAL BONE DEFECTS IN NON-NEOPLASTIC LIMB SALVAGE

Abstract

Segmental bone defects with complex fractures or chronic infections comprise a very special subset of patients. Modular endoprosthetic reconstruction is an operative solution. Without reconstruction amputation/disarticulation is the likely outcome.

Aim of the study was to analyse preliminary results of modular endoprosthetic reconstruction in nonneoplastic limb salvage.

11 patients(9 – distal femoral replacement, 2 – total femoral replacement) underwent salvage reconstruction between January 2005 and March 2008 for chronic periprosthetic infections(6 – single stage revision; 2 – two stage revision) and complex periprosthetic fractures(3) with segmental bone defects. Microbiological and haematological evidence of infection was confirmed in the infection group and treated with concomitant community based antibiotic therapy as per guidance from specialist team.

The mean age and follow up were 74.2 years and 27.5 months respectively. No intraoperative complications identified. Average post operative mobilisation was with frame at 5 days, 2 sticks at 2 weeks. 1 patient required plastic surgical intervention at index operation. 1 patient had recurrence of infection.

Radiographs at 6, 12 & 24 months showed no changes from immediate post-op. Microbiological and haematological evidence of infection eradication was considered as successful treatment. Knee range of movements averaged full extension to 95 degrees. Oxford knee scores showed maximal improvement in the single stage revision group.

We conclude that salvage endoprosthetic reconstruction has provided an oppourtunity to avoid amputation. A significant improvement in overall range of motion, knee scores, pain relief and stability was achieved in this highly complex subset of patients. Multidisciplinary support from plastic surgeons and specialist microbiologists is essential.