ABSTRACT
Introduction: Amputation is no longer the sole contribution of the orthopaedic surgeon to the management of primary bone tumours. Improvements in the design of endoprostheses and surgical reconstructive techniques have combined with advances in chemotherapeutic regimens to result in surgical procedures for salvaging limbs with aggressive sarcomas and in limb reconstruction. This has made limb salvage a viable alternative to amputation in many cases. The aim of this study was to evaluate functional outcome and complications of patients with primary bone tumours who were treated with re-section and mega-endoprosthetic replacement. Materials and Methods: Nineteen patients with bone tumours were retrospectively reviewed. These patients had wide local re-section and mega-endoprosthetic reconstruction performed between 1999 and 2006 in a tertiary hospital. Functional evaluation was performed based on the Musculoskeletal Tumour Society (MSTS) scoring system, with numerical values from 0 to 5 points assigned for each of the following 6 categories: pain, function, emotional acceptance, use of supports, walking ability and gait. These values were added, and the functional score was presented as a percentage of the maximum possible score. Complications were also analysed. Results: The final mean functional score was 78.3% ± 16.6%. Eight patients had complications related to surgery, including infection and subluxation of hip implant. Six patients had infection, while 2 had subluxation of hip implants. Infection was a common complication in our study. None had implant breakage, loosening or fracture. We found no statistical difference in the functional outcome between upper limb and lower limb procedures, and between hip and knee procedures. T-test also showed no evidence of gender differences in functional outcome. Kaplan-Meier survival analysis revealed the mean survival duration of megaprosthesis to be 75.6 months. Conclusion: Mega-endoprosthetic reconstruction in limb salvage provides good functional outcome in patients with bone tumours. The early results from patients treated with megaendoprosthesis have been encouraging.
Limb salvage surgery is a widely accepted alternative to amputation in patients with primary bone tumours. The success of limb salvage is the result of the combined understanding of the biology and staging of tumours, improvements in reconstructive techniques, and the development of effective adjuvant chemotherapy for the primary tumours and bone sarcomas. Metallic implants fixed with methylmethacrylate cement are now well established in the management of pathological fractures secondary to metastatic carcinoma.1,2 In such patients with metastatic disease, the treatment aims at improving the quality of short life expectancy that remains, and the demands placed on the prosthetic implant and the length of time it is expected to function satisfactorily are also limited. On the other hand, patients requiring resection of primary bone tumours are often young and are expected to live with the prosthesis for many years. A substantial amount of healthy bone may need to be resected to ensure a safe margin, leaving the remnant bone segment a little short for the secure fixation of a mega-endoprosthesis.
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