title: Reoperation results after segmental prosthetic replacement of bone and joint for limb salvage.
abstract: Thirty-eight patients who had undergone reoperations because of complications or implant failure subsequent to a prosthetic replacement for limb salvage procedure for the treatment of musculoskeletal neoplasm were followed until death or a minimum of 2 years, then reviewed. The mean follow-up time before reoperation was 35 months, and the mean follow-up time after reoperation was 51 months. The major indication for reoperation was aseptic loosening (34%). The reoperative procedures included 19 major revisions of the prosthesis and 19 other reconstructions. There were 7 complications, including 1 local tumor recurrence. Twelve patients died of metastatic disease at a mean of 16 months after reoperation. The probability for patient survival was 74% beyond 3 years and 67% after 5 years. The surgical staging, site of tumor involvement, and type of reoperation all correlated with long-term patient survival. Overall, 72% of the patients achieved excellent or good functional results: a rate that was slightly inferior to that of the initial arthroplasty. Despite this, 84% of the implants demonstrated either excellent or good performance at 5 years. Therefore, reoperation because of a failed initial prosthesis or for other reasons after a limb salvage procedure using custom-designed or modular-segmental bone and joint implants seems feasible with no significant effect on subsequent functional performance or on patient survival.
authors.affiliation: Department of Orthopedics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC.
authors.forename: R W
authors.initials: RW
authors.lastname: Hsu
authors.forename: F H
authors.initials: FH
authors.lastname: Sim
authors.forename: E Y
authors.initials: EY
authors.lastname: Chao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019643:Arthroplasty, Replacement; D019644:Arthroplasty, Replacement, Hip; D001859:Bone Neoplasms / Q000601:surgery*; D002813:Chondrosarcoma / Q000601:surgery; D005260:Female; D018212:Giant Cell Tumor of Bone / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012516:Osteosarcoma / Q000601:surgery; D019736:Prostheses and Implants; D012086:Reoperation; D012785:Shoulder Joint / Q000601:surgery