Implant Survival, Clinical Outcome and Complications of Megaprosthetic Reconstructions Following Sarcoma Resection

Abstract

Megaprosthetic reconstruction of segmental bone defects following sarcoma resection is a frequently chosen surgical approach in orthopedic oncology. While the use of megaprostheses has gained popularity over the last decades and such implants are increasingly used for metastatic reconstructions and in non-tumor cases, there still is a high risk of long-term complications leading to revision surgery. This article investigates current implant survivorship, frequency and types of complications as well as functional outcomes of upper and lower limb megaprosthetic reconstructions.

Function and return to sports after proximal humeral replacement in patients with primary bone sarcoma

“…Over the past decades, advances in oncological and surgical treatment have resulted in improved limb and patient survival rates [6]. These achievements have subsequently led to an increased interest in patients' postoperative function and return to sports activities and the potential factors associated with a successful return to sports activities-especially considering that mostly young patients are affected by primary bone sarcomas [7][8][9][10]. However, while sports activities in sarcoma patients who have undergone megaprosthetic reconstruction have previously been studied for lower extremity tumours, there is a paucity of studies on upper extremity reconstructions, particularly studies applying homogeneous inclusion criteria and larger patient cohorts [11,12].…”

Evaluation of tumor-prostheses over time: Complications, functional outcome, and comparative statistical analysis after resection and reconstruction in orthopedic oncologic conditions in the lower extremities

“…Since rotating-hinge prosthesis has been taken into use, many studies now report deep infection as the most common cause for revisions 4 , 11 , 40 , 41 due to the higher risks in terms of wide resections, loss of tissue and prolonged surgery time, and often also adjuvant oncological treatment. 18 The most common cause for revision in present modern tumor-prostheses was deep infection, with distal femur (n = 3) and proximal tibia (n = 3) as the most common sites.…”

“… 8 Despite advances, the incidence of revisions and complications of tumor-prostheses is continuously described higher compared to primary arthroplasty. 4 , 7 , 9 – 11 In 2011, Henderson et al 12 introduced a classification system that classifies five different types of implant failures, aiming to facilitate clearer interstudy comparison and understanding of failure modes and their causes. The Henderson classification is now widely used in studies reporting outcome after insertion of tumor-prosthesis.…”

“…The Henderson classification is now widely used in studies reporting outcome after insertion of tumor-prosthesis. 11 , 13 – 15 …”

“…11,[13][14][15] Aseptic loosening and deep infection are the most common reported causes for revision and implant failure. 11,16,17 Sarcoma patients are prone to infection due to the wide resections, loss of tissue, prolonged surgery time and often also radiation or chemotherapy. 18 The two most commonly reported causes for amputation after LSS are deep infection and local recurrence.…”