The risk for complications and reoperations with the use of mega prostheses in bone reconstructions

Abstract

Background Despite a relatively high risk for complications and reoperations, mega prostheses are considered a useful method for reconstruction of bone defects after tumour resections. The total number of reoperations has not previously been described, and little is known about the complication rate of mega prostheses used for other indications than primary bone tumours. Questions/purposes The current retrospective observational study aimed to describe the patient population treated with mega prostheses at Sahlgrenska University Hospital, Sweden, during 14 consecutive years, reports the complications leading to reoperation and the number and type of reoperations for different kinds of complications, and reports on implant survival. Methods All patients treated with a mega prosthesis, regardless of surgical indication and anatomical location, at Sahlgrenska University Hospital during the period 2006–2019 were identified. The medical records for all patients were reviewed. Data regarding age, sex, diagnosis, site of disease, bone resection length, chemotherapeutical treatment and postoperative complications including infections and oncological outcome, were collected and evaluated. Results One hundred and fourteen patients treated with 116 mega prostheses were included in the study. The predominant indication for primary surgery with a mega prosthesis was sarcoma of either bone or soft tissue (53.5% of the patients). In total 51 prostheses (44%) did not require any reoperation after the primary surgery. The most common reason for reoperation was infection (22%) followed by soft tissue failure (13%). The risk for prosthetic infection was significantly higher in the group of patients operated due to sarcoma compared with all other indications for surgery regardless of surgical site (p = 0.004). Conclusion The study reveals a total reoperation rate of 56% after reconstructive surgery using mega prostheses. Despite the high reoperation rates, at the end of the study period, 83% of the patients had still a functioning prosthesis. Therefore, the use of mega prostheses can be considered a reliable method for reconstruction of large bone defects in selected patients. Level of Evidence Level IV, therapeutic study.

Risk factors for peri-megaprosthetic joint infections in tumor surgery: A systematic review

“…Eleven of the included studies in this review were retrospective in nature, presenting outcomes related to PJI after tumor resection and megaprosthetic reconstruction [11,12,14,15,[17][18][19][20][21][22][23]. Two studies specifically compared results between patients with silver-coated and titanium prostheses.…”

“…The implementation of any adjuvant therapy for the treatment of malignancy was shown to increase the possibility of infection [14,18]; specifically, four studies reported that radiotherapy was a significant risk factor for PJI [2,12,13,19]. Chemotherapy has been associated with a higher risk for PJI in one study [19], while in others it did not seem to be associated with increased rates of infection [2,11,12,15,20,22]. Tumor location and reconstruction in the tibia [2,14,17] and the pelvis [2,17] notably increased the risk of PJI.…”

“…After exclusions, a total of 15 studies were left for review [2,[10][11][12][13][14][15][16][17][18][19][20][21][22][23]. All the studies included in the analysis underwent thorough evaluation, and relevant data pertaining to areas of interest were extracted and summarized (Table 1…”

Functional and Rehabilitative Outcomes of Patients Affected by Bone Cancer of the Upper Limb Treated with MUTARS Prosthesis: A Narrative Review

“…Megaprostheses are modular endoprostheses, consisting of several different components in promptly available sets, which can be assembled in different combinations to fit the specific skeletal defect allowing limb sparing. The rational use of this system aims to restore the function of limbs as quickly as possible in order to improve quality of life, minimize the morbidity associated with the surgical procedure and hospitalization, and continue oncologic therapies [ 10 ].…”

Novel reconstruction method by mega-prosthesis wrapped with vancomycin-containing cement after resection of malignancies

“…[1] MP is a widely accepted technique for joint reconstruction after the resection of bone and soft tissue tumors, but it has a relatively high complication rate. [2] Among the various complications, postoperative infection is the most frequent and difficult problem. [3] In fact, the incidence of periprosthetic joint infections (PJIs) has been reported as 0.25% to 2.0% for hip and knee joint revisions [4] and as 4% to 20% after tumor resection.…”