Endoprosthetic replacement after extra-articular resection of bone and soft-tissue tumours around the knee

Abstract

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.

Management of sarcomas possibly involving the knee joint when to perform extra-articular resection of the knee joint and is it safe?

“…Limb salvage after extra-articular resection with an EPR reconstruction 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. 8 Our results suggest that there is no difference between IAR and EAR functional results in terms of MSTS functional scores but EAR patients developed a higher rate of complications. 8,9,15 Survival curve distribution for limb salvage procedure survival showed that EAR reconstruction were associated with a higher risk of failure in the first 5 years but reconstruction survival results for long terms follow-up presented no significant differences between the two groups.…”

“…12,13 On the other hand, patients selected for EAR are those with obvious tumour invasion of the joint, iatrogenic contamination due to biopsy, or a pathological fracture with intraarticular extension. 8,9 Neurovascular involvement is an indication for amputation or rotationplasty. 14 There is uncertainty about those patients with suspicion of intraarticular extension of the tumour not clearly proven by preoperative imaging studies.…”

“…7 Management of sarcomas involving the knee joint represents a great challenge to oncology surgeons and extra-articular resections (EAR) have been reported to be associated with a higher complication rate and worse functional results. 8,9 The purpose of this study was to review a group of patients with a primary sarcoma involving the knee joint, analyse the oncological and functional outcomes and construct an algorithm to guide treatment.…”

What Was the Survival of Megaprostheses in Lower Limb Reconstructions After Tumor Resections?

“…The original technique was described by the authors in a previous report [5]. Hardes et al [20] described 59 cases of prosthetic reconstructions after extraarticular resection of the knee preserving the extensor apparatus (patellar-split technique), reporting an implant survival rate of 48% at 2 years and 25% at 5 years; the most frequent complication was deep infection, observed in 37% of cases. Ten patients (16.9%) lost their limb as a result of complications.…”

CORR Insights®: What Sports Activity Levels Are Achieved in Patients With Modular Tumor Endoprostheses of Osteosarcoma About the Knee?

“…The authors specifically mentioned a 51% revision rate, but did not attribute this to sports activities. Revisions were performed for soft tissue failure in eight patients, aseptic loosening of the press fit In a previously published study, Hardes et al [1] analyzed 59 patients with a mean followup time of 4.7 years. The authors found worn bearings in 20% of their patient group and periprosthetic fractures in 6% of the patient population.…”