Late Complications and Survival of Endoprosthetic Reconstruction after Resection of Bone Tumors

Abstract

Mechanical complications were the most common cause of implant failure. Infection was the leading cause of both complication and amputation; risk of infection increased substantially with revision surgery. Modular implants had fewer mechanical complications, thus leading to fewer revisions and subsequent infections.

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

“…Survival of the implants in our series was similar to previously reported experience. An implant survival at 10 years ranging from 58% to 77% for cemented megaprostheses [1,25,33,34] and from 58% to 70% for cementless megaprostheses was reported [16,17,31]. Eighty percent survival at 10 years was reported by Healey et al [21] in a study including only distal femur replacements.…”

“…Aseptic loosening (Type 2 failure) in megaprostheses was reported in the literature with a rate ranging from 2.4% to 15.4% for cemented stems [1,4,19,25,34] and from 0% to 8% for cementless implants [10,16,21,26,31] with evolving designs of the prosthesis allowing improvements in the last decades, like the introduction of a rotating hinge system at the knee [12,18,29]. Our series confirmed a low incidence of this type of failure, which occurred in six stems (3%) involving the distal femur in three patients and the proximal femur in three.…”

“…Prosthetic replacement with modular implants has become the most common reconstructive technique of bone loss of the lower limb after tumor resection [1,16,17,25,26,31,33,34]. The same modular systems may be used to restore osteoarticular defects of the hip and knee in prosthetic revision surgery and posttraumatic situations [6,14,32].…”

“…When compared with conventional prostheses used in total joint arthroplasty for arthritis, a consistently higher rate of complications has been reported with modular megaprostheses, particularly resulting from infection, wear or breakage of prosthetic components, and stem loosening [1,3,11,12,17,19,27,28,[34][35][36][37][38]. The higher infection rate is believed to be the result of prolonged surgical times and large soft tissue exposure in oncologic resections and to a higher risk of contamination in revision and posttraumatic cases.…”

Management of infection following reconstruction in bone tumors

“…The risk of amputation due to infected tumor prostheses for oncological reconstructions has been reported to be between 23.5% and 87%. 70,[72][73][74][75][76] Management with two-stage revision remains the gold standard, 64,65,77,78 but a single-stage exchange of the prosthesis without removing the stems is possible in selected cases. 60 In two-stage procedures, the first stage includes debridement, insertion of culture-specific antibiotic-loaded bone cement in the form of beads and/or rods, temporary fixation with a custom-made IM nail or self-designed, mobile hinged-joint prosthesis covered with antibiotic-loaded PMMA.…”