Introduction: Primary bone lymphoma is a rare neoplastic disease of bone. Treatment consists predominantly of chemotherapy and radiotherapy. Surgery can be considered for large lytic lesions with impending pathological fractures. This study was performed to find the functional and oncological outcome of patients who underwent limb salvage surgery and custom mega prosthesis for lymphoma of bone.

Materials and Methods: Eight patients with lymphoma of bone underwent limb salvage surgery and reconstruction with custom made prosthesis. Males predominated in the study with the average age of 30 years. Lower limb was commonly involved: 6 patients had tumour involving the femur. Five patients had pathological fracture. Resection and reconstruction was done using custom mega prosthesis. Proximal humeral prosthesis was used for proximal humeral tumour and proximal femoral or total hip prosthesis for proximal femoral lesion. One patient each had total femoral prosthesis and total knee prosthesis.

Results: With an average follow-up of 78.6 months, two patients died of disease and one patient was alive with disease. The patient with femoral shaft lesion had intra-operative vascular injury requiring vascular repair. The patient with total knee prosthesis had superficial skin necrosis which required skin cover. The functional outcome was satisfactory in 5 patients.

Discussion: Primary bone lymphoma accounts for 7% of all bone tumours. There is a male predominance and femur is the most common site of involvement. Five patients in our series had pathological fractures warranting surgical stabilisation. Limb salvage surgery with custom mega prosthesis appears to be a feasible option as more than 65% of our patients had satisfactory functional outcome. They were able to mobilise early with good pain relief and a useful functional limb.

Purpose Of The Study: To find the functional and oncological outcome of patients who underwent limb salvage surgery and custom mega prosthesis for Malignant Fibrous Histiocytoma of bone.

Methods And Results: Twenty patients with histologically diagnosed Malignant Fibrous Histiocytoma of bone were treated by resection and reconstruction with custom mega prosthesis between May 1991 and December 2002. The average age was 42 and two-thirds of the patients were males. Majority of the tumours were located around the knee and were in Stage II disease of the Enneking system. Wide margins of resection were achieved in 18 patients and reconstruction was done with total knee prosthesis in patients with distal femoral and proximal tibial tumours. The proximal humeral and proximal femoral sites were reconstructed with their respective prosthesis. Fourteen patients treated after 1996 received chemotherapy. With an average follow-up of 57.7 months, 4 patients had amputation for local recurrence and five patients died of disease. Two patients had fracture of prosthesis necessitating revision of prosthesis in one. Functional result was excellent in 5 patients and good in 9 patients. The Kaplan-Meier 5-year survival rates of the patients treated without chemotherapy and with chemotherapy were 50% and 75.8% respectively.

Conclusion: MFH is an aggressive malignant tumour with a poor prognosis. A combined approach using neoadjuvant chemotherapy together with adequate surgical margins improves survival.