Regardless of achieving a low recurrence rate and satisfactory functional results, we found a high complication rate after implantation of a megaprosthesis. This was particularly evident for extraarticular resections and cemented fixation, which should be avoided when possible.
Lower limb salvage surgery remains a challenge in orthopaedic oncology. Both cemented and cementless, modular, endoprosthetic systems are widely used to treat defects of different sizes. The systems have changed over the years, and each major orthopaedic company offers a modular tumour and revision system for the lower extremities. All systems have worse long-term results compared to conventional total hip or total knee systems. This is due to the large defects that need to be bridged with a more difficult fixation in the diapyhsis of the femur and tibia and a more complex restoration of joint biomechanics. This article summarises the results of several clinical studies with different systems. Newer systems without clinical follow-up are described. We previously reported a prospective study of 50 consecutive patients treated with the MUTARS endoprostheses. The follow-up was 2-7 years. Clinical evaluation showed good results compared to other systems. The review of the literature and our own results do not validate the support or favouring of one specific system. The surgeon should choose a system with which he/she is familiar and that provides the modularity needed intraoperatively to bridge any defect in the lower limbs.Résumé Le sauvetage des membres demeure un challenge en oncologie orthopédique. Les prothèses modulaires, cimentées ou non, sont largement utilisées et chaque grand fabriquant offre des systèmes pour reconstruction des membres inférieurs. Tous les systèmes ont de moins bons résultats à long terme que les prothèses conventionnelles de hanche ou de genou. Ceci est due aux larges défauts osseux nécessitant la fixation dans les diaphyses fémorales et tibiales et la difficile restauration de la biomécanique articulaire. Cet article résume les résultats de plusieurs études cliniques avec différents systèmes. Nous avons rapporté une étude prospective de 50 patients traités avec une prothèse MUTARS, avec 2 à 7 ans de recul et un bon résultat comparable aux autres systèmes. La revue de la littérature et notre expérience ne permet pas de conseiller un système particulier. Le chirurgien doit choisir un système avec lequel il est familier et qui lui donne la possibilité opératoire de compenser les pertes de substances du membre inférieur.
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