From amputation to limb salvage reconstruction: evolution and role of the endoprosthesis in musculoskeletal oncology

Abstract

In 1943, Austin Moore developed the first endoprosthesis fashioned from Vitallium, providing the first alternative to traditional amputation as primary treatment of bone tumors. The success of the Vitallium endoprosthesis has since then led to the development of new materials and designs further advancing limb salvage and reconstructive surgery. Combined with the advent of chemotherapy use and imaging advances, conservative treatment of musculoskeletal tumors has expanded greatly. As the implantable options increased with the development of the Lewis expandable adjustable prosthesis and the noninvasive Phenix Growing prosthesis, receiving the diagnosis of a bone tumor no longer equates to automatic limb loss. Our review details the history and development of endoprostheses throughout orthopedic oncology in the treatment of musculoskeletal tumors.

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

“…Custom-made prosthetic implants were used until the beginning of the 1980 s when the first modular prosthetic systems were introduced [5,23]. Modular systems can be used after oncologic resections and in posttraumatic or revision bone loss, allowing individual assembly based on intraoperative requirements [6].…”

Novel Applications of Osseointegration in Orthopedic Limb Salvage Surgery

“…Cemented and uncemented diaphyseal stems are the standard fixation options for most tumor endoprosthetic reconstructions of the extremities. [42][43][44] With the exception of metastatic bone disease, most bone pathology requiring limb salvage reconstructions occurs in children, adolescents, and young adults; in those who survive their disease, multiple revision operations are likely. [45][46][47] Assuming implant survivorship of 50% at 15 years after limb salvage, 45 an adolescent who survives a malignant bone sarcoma of the femur will likely undergo 2 substantial revisions of their endoprosthesis by 50 years of age.…”

Long‐term results of the Global Modular Replacement System tumor prosthesis for reconstruction after limb‐sparing bone resections in orthopedic oncologic conditions: Results from a national cohort

“…In recent decades, improvements in the diagnostic process and oncological treatment with the introduction of neoadjuvant chemotherapy and radiotherapy have resulted in increased numbers of patients with bone sarcomas (BS) who can be treated with limb‐sparing surgery without compromising survival outcome . Consequently, endoprosthetic replacement surgery using tumor prostheses are today offered to 90% to 95% of all patients suffering from primary malignant bone tumors without compromising the oncological outcome .…”

“…The GMRS prosthesis has shown acceptable performance in earlier studies, with a performance score (Musculoskeletal Tumor Society [MSTS] score) of 82% and a 5-year estimated revision-free survival of 65% in a mixed population consisting of both MBD and BS patients. 11 The aims of the current study were (1) to investigate implant revision, failure, and amputation risk following limb-sparing surgery using the GMRS prosthesis (Stryker) in patients suffering from BS, giant cell tumors (GCT), or MBD, (2) to assess complications to surgery, and finally (3) to determine functional outcome after surgery.…”