Lower Extremity Megaprostheses in Orthopaedic Oncology

Abstract

The megaprosthesis is designed to reproduce the form and function of a removed or lost large segment of bone and accompanying soft tissues. Slow but substantial improvements in the design and surgical implementation of these devices have advanced the capacity to restore patients' functional abilities. The essential challenges include identifying the ideal materials, bonding these materials to bone and soft tissues, reproducing functional anatomy, and adapting to the growing skeleton. Failure of these devices can result from soft-tissue insufficiency, aseptic loosening, structural failures, infection, and tumor recurrence. The history of the use of megaprostheses in the pelvis, proximal femur, distal femur, total femur, and proximal tibia has shown that each anatomic area presents unique challenges. Improvements that have been made over the years will guide the development of the next generation of devices. Despite early high complication rates, these devices are a reasonable choice in the right patient.

Is osseous reattachment of the greater trochanter necessary compared to soft‐tissue‐only abductor repair in proximal femoral megaprosthesis reconstruction?

“…Oncologic resection of the proximal femur presents several challenges to the orthopedic oncology surgeon 3‐9 . Resection of the femoral head, neck, intertrochanteric region, and variable portions of the proximal diaphysis of the femur carries consequences that the surgeon must address.…”

“…Oncologic resection of the proximal femur presents several challenges to the orthopedic oncology surgeon. [3][4][5][6][7][8][9] Resection of the femoral head, neck, intertrochanteric region, and variable portions of the proximal diaphysis of the femur carries consequences that the surgeon must address. In a proximal femur resection, the entirety of the joint capsule is detached from the intertrochanteric line; the attachments of the hip abductors and hip flexors are removed from the greater and lesser trochanters, respectively; and, depending on the length of resection, the gluteal sling may be detached from its insertion as well.…”

Tourniquet use in patients undergoing tumour resection and endoprosthetic reconstruction of the knee

“…Limb salvage surgery and endoprosthetic reconstruction is the standard way of treating patients with a tumour around the knee joint. 1 It has the advantage of enabling early ambulation and restoration of function. Advances in design, particularly modularity and the rotating hinge, have made endoprostheses more accessible for widespread use.…”

Prediction of soft tissue coverage following distal femur bone sarcoma resection: A preliminary report

“…Primary bone sarcomas are most commonly located in the distal femur. [1][2][3] The most common primary tumors of the bone are osteosarcoma, chondrosarcoma, and Ewing's sarcoma. 2 Limb-sparing surgery is the first choice of treatment for sarcomas located in the distal femoral region.…”

“…6 Soft tissue reconstruction is often needed for prosthetic coverage and recreating extensor mechanism after the resection of tumors located in the proximal tibia, whereas it is less often required following distal femoral resections. 3,7,8 A preoperative assessment of the need for soft tissue reconstruction may allow orthopedic oncology surgeons to be better prepared for bone sarcoma resection surgery. A more comprehensive preoperative planning can be done and, potential complications associated with a more extensive surgery can be taken into account.…”