Megaprostheses for the treatment of malignantbone tumours of the lower limbs

Abstract

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.

Influence of stem design on the primary stability of megaprostheses of the proximal femur

“…Apart from some modifications, the GMRS™ (group C) has been in clinical use for about three decades [8] and its fixation parts are cylindrical, porous-coated, straight stems of titanium with round fins on the proximal portion (Table 1). With this design a fixation over a longer distance in the narrowest bone area and with the fins close to the proximal osteotomy can be expected.…”

“…Apart from infection, aseptic loosening constitutes the major failure mode leading to operative revision in 8-27 % of patients [1,[5][6][7]. These high complication rates may be caused by the extent of the defects [8] resulting in impaired fixation. However, in consideration of the predominantly younger age of patients undergoing oncological resections, these complication rates seem to be unacceptable.…”

Custom-made endoprosthetic total humerus reconstruction for musculoskeletal tumours

“…With advances in effective adjuvant chemotherapy, diagnostic imaging and improved surgical methods, limbsalvage surgery is now an accepted treatment modality, with functional and oncological outcomes better than limb ablation [1][2][3][4]. In particular, salvage of the upper limb provides better emotional and social acceptance of patients due to forearm and hand preservation.…”

Endoprosthetic reconstruction using total femoral custom mega prosthesis in malignant bone tumours

“…Limb salvage surgery is now an accepted modality of treatment for selected bone sarcomas of the extremities. With the advent of limb salvage surgery, the functional and oncological outcomes have proven to be better than limb ablation [11,13,17]. With the improving survival rates, the long-term behaviour and associated ratings of various methods of limb reconstruction have become an important issue.…”