The use of a noninvasive growing endoprosthesis in the management
of primary bone tumours in children is well established. However,
the efficacy of such a prosthesis in those requiring a revision
procedure has yet to be established. The aim of this series was
to present our results using extendable prostheses for the revision
of previous endoprostheses. All patients who had a noninvasive growing endoprosthesis inserted
at the time of a revision procedure were identified from our database.
A total of 21 patients (seven female patients, 14 male) with a mean
age of 20.4 years (10 to 41) at the time of revision were included.
The indications for revision were mechanical failure, trauma or infection
with a residual leg-length discrepancy. The mean follow-up was 70
months (17 to 128). The mean shortening prior to revision was 44 mm
(10 to 100). Lengthening was performed in all but one patient with
a mean lengthening of 51 mm (5 to 140).Aims
Patients and Methods
We evaluated the clinical results and complications
after extra-articular resection of the distal femur and/or proximal
tibia and reconstruction with a tumour endoprosthesis (MUTARS) in
59 patients (mean age 33 years (11 to 74)) with malignant bone or
soft-tissue tumours. According to a Kaplan–Meier analysis, limb
survival was 76% (95% confidence interval (CI) 64.1 to 88.5) after
a mean follow-up of 4.7 years (one month to 17 years). Peri-prosthetic infection
was the most common indication for subsequent amputation (eight
patients). Survival of the prosthesis without revision was 48% (95%
CI 34.8 to 62.0) at two years and 25% (95% CI 11.1 to 39.9) at five years
post-operatively. Failure of the prosthesis was due to deep infection
in 22 patients (37%), aseptic loosening in ten patients (17%), and
peri-prosthetic fracture in six patients (10%). Wear of the bearings
made a minor revision necessary in 12 patients (20%). The mean Musculoskeletal
Tumor Society score was 23 (10 to 29). An extensor lag >
10° was
noted in ten patients (17%). These results suggest that limb salvage after extra-articular
resection with a tumour prosthesis can achieve good functional results
in most patients, although the rates of complications and subsequent
amputation are higher than in patients treated with intra-articular
resection. Cite this article:
The purpose of this study was to assess the outcome
of 15 patients (mean age 13.6 years (7 to 25)) with a primary sarcoma
of the tibial diaphysis who had undergone excision of the affected
segment that was then irradiated (90 Gy) and reimplanted with an
ipsilateral vascularised fibular graft within it. The mean follow-up was 57 months (22 to 99). The mean time to
full weight-bearing was 23 weeks (9 to 57) and to complete radiological
union 42.1 weeks (33 to 55). Of the 15 patients, seven required
a further operation, four to obtain skin cover. The mean Musculoskeletal
Society Tumor Society functional score at final follow-up was 27
out of 30 once union was complete. The functional results were comparable
with those of allograft reconstruction and had a similar rate of
complication. We believe this to be a satisfactory method of biological reconstruction
of the tibial diaphysis in selected patients.
We reviewed 25 patients who had undergone resection of a primary bone sarcoma which extended to within 5 cm of the knee with reconstruction by a combination of a free vascularised fibular graft and a massive allograft bone shell. The distal femur was affected in four patients and the proximal tibia in 21. Their mean age at the time of operation was 19.7 years (5 to 52) and the mean follow-up period 140 months (28 to 213). Three vascularised transfers failed. The mean time to union of the fibula was 5.6 months (3 to 10) and of the allograft 19.6 months (10 to 34). Full weight-bearing was allowed at a mean of 21.4 months (14 to 36). The mean functional score at final follow-up was 27.4 (18 to 30) using a modfied 30-point Musculoskeletal Tumour Society rating system. The overall limb-salvage rate was 88%. The results of our study suggest that the combined use of a vascularised fibular graft and allograft is of value as a limb-salvage procedure for intercalary reconstruction after resection of bone tumours around the knee, especially in skeletally immature patients.
