Abstract
Purpose
Durable fixation may be difficult to achieve when significant bone loss is present, as it occurs in pelvic sarcoma resection and revision surgery of tumor implants. Purpose of this study was to review clinical results of primary and revision surgery of the pelvis and lower extremity in the setting of severe bone loss following limb salvage procedures for bone sarcoma using modular porous tantalum implants.
Method
Retrospective study of 15 patients (nine females, six males) undergoing primary or revision pelvic reconstruction (five patients) or revision surgery of a tumor implant of the hip (five patients), knee (four patients), and ankle (one patient) using porous tantalum implants was undertaken. Reason for the tumor implant was resection of bone sarcoma in 13 cases and tumor-like massive bone loss in the remaining two cases. Cause for revision was aseptic failure (nine patients) or deep infection (six patients); average age at the time of surgery was 31 years (16–61 yrs). Revision was managed in a staged fashion in all the six infected cases. All patients presented severe combined segmental and cavitary bone defects. Bone loss was managed in all patients using porous tantalum implants as augmentation of residual bone stock and associated with a megaprosthesis in eight cases (five proximal femur, two distal femur, one proximal tibia). Average follow-up was 4.5 years for hip/knee implants and 2.5 yrs for pelvic reconstructions (range 1–6.8 yrs). Minimum follow-up of two years was available in 11 cases.
Results
Infection recurred in one of the six cases managed for infection, requiring further treatment but allowing retention of the porous tantalum implant. All the patients showed well-fixed and functioning implants at latest follow-up.
Conclusion
Porous tantalum has been very successful at early follow-up in patients with severe bone loss following primary and revision tumor-related surgery of the pelvis and lower extremity. Longer follow-up is required to appreciate long-term shortcomings.
