Outcome of segmental prosthesis reconstruction for diaphyseal bone tumors: a multi-center retrospective study

Abstract

Background The optimal reconstructive method after diaphyseal malignant bone tumor resection remains controversial. This multicenter clinical study was designed to investigate the clinical value and complications of segmental prosthesis in the repair of diaphyseal defects. Methods We present 49 patients from three clinical centers treated with wide resection for primary or metastatic bone tumors involving the diaphysis of the femur, tibia, humerus, or ulna, followed by reconstruction using a modular intramedullary segmental prosthesis. Results Enrolled patients included 23 men and 26 women with a mean age of 63.3 years. Of these, seven patients had primary bone tumors and 42 patients had metastatic lesions. At the mean follow-up of 13.7 months, 17 patients were alive, 31 patients were deceased due to tumor progression, and one patient was dead of another reason. There were eight nononcologic complications (two with radial nerve injury, three with delayed incision healing, two with aseptic loosening in the proximal humerus prosthetic stem and one with structural failure) and three oncologic complications (three with primary tumor recurrence) among all patients. The incidence of complications in primary tumor patients (4/7, 57.1%) was higher than that in patients with metastatic tumors (7/42, 16.7%) ( p = 0.036). Aseptic loosening and mechanical complications were not common for patients with primary tumors, although the reconstruction length difference was statistically significant ( p = 0.023). No statistically significant differences were observed in limb function, while the mean musculoskeletal tumor society score was 21.2 in femora, 19.6 in humeri, and 17.8 in tibiae ( p = 0.134). Conclusions Segmental prostheses represent an optional method for the reconstruction of diaphyseal defects in patients with limited life expectancy. Segmental prostheses in the humerus experienced more complications than those used to treat lesions in the femur.

Intercalary prosthetic replacement is a reliable solution for metastatic humeral shaft fractures: retrospective, observational study of a single center series

“…However, Dijkstra et al found that IMN and plate fixation yielded similar results [ 15 ]. In the present study, the incidence of postoperative complications in the IMN group was 18.8% (3/16) and 21.2% (7/33) in the PF group, which were in the range of reported incidence rates in previous studies [ 8 , 9 , 13 – 15 , 19 , 20 , 28 , 34 – 36 ] (Table 4 ).…”

“…Therefore, when possible, more radical treatment is needed for some patients with solitary bone lesions and a longer predicted life expectancy. Encouraging results regarding the application of intercalary prostheses have been obtained from studies on intercalary prostheses, leading to the expansion of surgical indications and controversy regarding the treatment of choice [ 13 , 19 , 20 ]. Additionally, mechanical studies conducted in vitro have indicated that prostheses provide a stronger construct than IMN does in a model of humeral segmental defects [ 21 , 22 ].…”

Strategies for large bone defect reconstruction after trauma, infections or tumour excision: a comprehensive review of the literature

“…6 ) are an alternative for intercalary reconstructions [ 4 ]. They allow immediate stability, rapid rehabilitation, and early weight bearing [ 24 , 104 ]. Common complications are infections, mechanical loosening, and mechanical wear [ 24 ].…”

“…The main advantages of these grafts are their relative abundance, which allows reconstruction even after massive bone defect, and the absence of morbidity of the donor site [ 21 ]. The disadvantages, on the other hand, are immunological rejection and the risk of transmissive diseases, such as HIV and Hepatitis C [ 22 – 24 ]. However, these latter are reduced by modern screening methods [ 21 , 23 ].…”

“…The main non-biological materials are segmental endoprosthesis [ 4 , 21 ]. Segmental prostheses have several advantages, such as immediate stability, rapid rehabilitation, and early weight bearing [ 24 ]. The disadvantages, on the other hand, are infections, mechanical loosening, mechanical wear, and prosthetic and periprosthetic fracture [ 21 , 29 ].…”