Femoral diaphyseal endoprosthetic reconstruction after segmental resection of primary bone tumours.
Segmental resection of malignant bone disease in the femoral diaphysis with subsequent limb reconstruction is a major undertaking. This is a retrospective review of 23 patients who had undergone limb salvage by endoprosthetic replacement of the femoral diaphysis for a primary bone tumour between 1989 and 2005. There were 16 males and seven females, with a mean age of 41.3 years (10 to 68). The mean overall follow-up was for 97 months (3 to 240), and 120 months (42 to 240) for the living patients. The cumulative patient survival was 77% (95% confidence interval 63% to 95%) at ten years. Survival of the implant, with failure of the endoprosthesis as an endpoint, was 85% at five years and 68% (95% confidence interval 42% to 92%) at ten years. The revision rate was 22% and the overall rate of re-operation was 26%. Complications included deep infection (4%), breakage of the prosthesis (8%), periprosthetic fracture (4%), aseptic loosening (4%), local recurrence (4%) and metastases (17%). The 16 patients who retained their diaphyseal endoprosthesis had a mean Musculoskeletal Tumour Society score of 87% (67% to 93%). They were all able to comfortably perform most activities of daily living. Femoral diaphyseal endoprosthetic replacement is a viable option for reconstruction following segmental resection of malignant bone disease. It allows immediate weight-bearing, is associated with a good long-term functional outcome, has an acceptable complication and revision rate and, most importantly, does not appear to compromise patient survival.
The Sarcoma Unit Royal National Orthopaedic Hospital, Stanmore, Middlesex HA7 4 LP, UK. sammyhanna@hotmail.com
S A
SA
Hanna
M D
MD
Sewell
W J S
WJ
Aston
R C
RC
Pollock
J A
JA
Skinner
S R
SR
Cannon
T W R
TW
Briggs
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D018483:Diaphyses / Q000601:surgery; D004812:Epidemiologic Methods; D005260:Female; D005266:Femoral Neoplasms / Q000175:diagnosis / Q000601:surgery*; D005269:Femur / Q000601:surgery*; D006801:Humans; D023821:Limb Salvage / Q000379:methods; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D019736:Prostheses and Implants; D011475:Prosthesis Failure; D019919:Prosthesis Implantation / Q000379:methods*; D016459:Prosthesis-Related Infections / Q000209:etiology; D012086:Reoperation / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult