We report on a patient with an unusual pulmonary infection after resection of a high-grade osteosarcoma. In March 2007 a 30-year old female with pain and swelling of the left proximal humerus was submitted to the orthopaedic department. Rx and CT revealed a tumour with destruction and invasion of the surrounding soft tissue.

Incision biopsy led to the diagnosis of osteoblastic osteosarcoma. She was enrolled into the EURAMOS protocol and received neoadjuvant chemotherapy. In July 2007 an extra-articular resection of the proximal humerus with modular endoprosthetic replacement was performed. The sarcoma had responded well to chemotherapy (regression grade 3 according to Salzer-Kunts-chik). Surprisingly, the resection specimen demonstrated a “skip lesion” of vital sarcoma in the resection line not been detected by preoperative PET or MRT. After consultation of the German study group she was stratified into the standard risk group.

12 months later a control CT revealed multiple foci in both lungs, which were highly suspicious for pulmonary metastases. All clinical parameters were normal. A lung biopsy was performed by thoracotomy and a granulomatous infection was diagnosed, which was suspicious for tuberculosis. Extended microbiological investigations by culture and PCR analysis revealed an infection by Myco-bacterium Xenopi, which is a rare form of an atypical mycobacteriosis. Since then she is treated accordingly, however the infection has progressed and involvement of the liver has been diagnosed by cutting needle biopsy.

Objective: Modular tumour prostheses are often chosen for the reconstruction of osseous or joint defects following wide tumour resection in limb salvage procedures. In this retrospective trial we were looking for the clinical use in accordance to long-term-follow up especially on aseptic loosening of stem, wear of polyethylene, implant related complications and clinical and functional results.

Methods: From 1996 to 2008 we performed in our clinic in 69 cases a modular distal femur replacement (MUTARS) after wide bone or soft tissue tumour resection.

In our outpatient clinic we have assessed the clinical follow-up as clinical examination (Enneking-score) and standardized radiological follow-up for 5 years, then once per year. In the focus of interest were aseptic loosening of the stems, wear of polyethylene, and mechanical problems as implant failure

Results: In long-term-follow-up 6 polyethylene locks had to be changed into PEEK locks (8,6%9). PEEK-lock complications were not seen in this series. In 5 cases late infection of the prosthesis occured. In another 5 cases aseptic loosening of the prosthesis was diagnosed, fractures of the stems were not seen.

We conclude that in tumour patients with major osseous reconstruction after wide resection a certain loss ob function cannot be avoided, but the rate of complications in the long-term-follow-up after implantation of modular tumour prosthesis is acceptable.

Objective: To evaluate outcome parameters after custommade diaphyseal replacement of femur and humerus in long term allograft failures.

Methods: A subset of osteo allograft reconstructions after tumour resection ultimately will fail in patients achieving long-term survival. The reasons for original allograft failure were fractures, osteonecrosis or delayed bony ingrowths and implant loosening (plates, nails).In this study patients had a failed massive allograft after tumor resection of humerus or femur. Alternative surgical approach to revising these reconstructions are endoprosthetic revisions to preserve limb function with minimal complications due to custom made modular diaphyseal replacement systems of femur or humerus, especially with short proximal or distal intramedullary anchoring.

Results: A series of custom made diaphyseal replacement systems of femur or humerus was done in our department demonstrating the feasibility of this technique. Most patients initially were treated because of malignant bone tumors like Ewing sarcoma or soft tissue tumours. Allograft fractures occured up to 49 month after initial tumour resection. The follow up included radiographic and clinical parameters. In all cases limb salvage, good function and pain relief was achieved.

Conclusion: Reconstruction of the diaphyseal aspect of the femur or humerus after failure of osteoarticular allograft with custom made diaphyseal replacement of femur and humerus is a good option to achieve limb salvage, good function and pain relief.