Purpose- To review the long term survival of patients, complications and functional outcome of diaphyseal replacements in 40 consecutive femoral endoprosthetic reconstructions for treatment of primary bone sarcoma.

Methods- A retrospective case study analysis was performed on all patients treated in our hospital between 1991 and 2002 with diaphyseal replacements for the management of sarcomas of femur.

Results- 40 cases (28 males and 12 females) with a mean age of 38.4 years (10–56) were identified.The indications were ostesarcoma (18), chondrosarcoma (12), MFH (4) and ewings sarcoma (6). The presenting complaints were pain (24), swelling (16) or both (6). Fibular strut graft was used in 12 cases as an adjuvant to the diaphyseal replacement. Adequate surgical clearence was obtained in 37 cases (92.5%). The average follow up period was 98 months (11–158). The patients were assessed by the Musculoskeletal Tumour Society (MSTS) scoring system. The average MSTS score was 19 (range 16–22). The average range of motion at the knee was 94° (range 74°–126°). Twenty nine remained disease free at review. 16 patients died at a median of 28 months (11 to 124) – 6 from metastatic disease and 10 from other causes. The cumulative complication rate was 18%- wound debridement (5%), infection (3%), revision surgeries (10%–4 cases- periprosthetic fracture n=1, implant breakage n=1 and implant loosening n=2.) One patient needed amputation for recurrence.

Conclusion-.Surgical management of bone tumours using diaphyseal endoprosthesis is an effective method of treatment which allows the patient to retain a high level of function and range of motion.