Ten year results of 100 primary lower limb reconstruction prostheses implanted between 1982 and 1989 were analysed. In a Kaplan-Meier estimate there was a 85% three years, a 79% five years and 71% ten years survival rate. Most common reason for implant failure was aseptic loosening in 27% of patients (11 patients; range 10–121 months) after initial operation. Other reasons for revision surgery were implant failure (4) and infection (4). Early repair of prostheses-related minor complications, was polyethylene bushings destruction. After a median followup of 127.5 months after the initial surgery, 51 patients had died and eight patients were lost to followup. Forty-one patients were evaluated clinically and radiologically using the MTS score and the radiologic implant evaluation system of the International Symposium on Limb Salvage. 41 patients had a mean of 80% (range, 40%–100%) of the normal functional capability.

In 251 patients over a period of 15 years an uncemented Kotz modular femoral and tibial reconstruction mega prosthesis was implanted after resection of a malignant tumour of the lower limb. Twenty-one patients (8.4%) underwent revision for aseptic loosening, again using an uncemented prosthesis, and five of these required a further revision procedure. The median follow-up time from the first revision was 60 months (11 to 168) and after a second revision, 33 months (2 to 50). The probability of a patient avoiding aseptic loosening for ten years was 96% for a proximal femoral, 76% for a distal femoral and 85% for a proximal tibial implant.

At the time of follow-up all radiographs were assessed according to the International Symposium of Limb Salvage criteria. The first radiological signs of aseptic loosening were always seen at the most proximal or distal part of the anchorage stem at a mean of 12 months (4 to 23) after the first implantation. Using the Musculoskeletal Tumor Society score for evaluation, the clinical results showed a mean of 88% of normal function.