Endoprosthetic replacement after extra-articular resection of bone and soft-tissue tumours around the knee.
We evaluated the clinical results and complications after extra-articular resection of the distal femur and/or proximal tibia and reconstruction with a tumour endoprosthesis (MUTARS) in 59 patients (mean age 33 years (11 to 74)) with malignant bone or soft-tissue tumours. According to a Kaplan-Meier analysis, limb survival was 76% (95% confidence interval (CI) 64.1 to 88.5) after a mean follow-up of 4.7 years (one month to 17 years). Peri-prosthetic infection was the most common indication for subsequent amputation (eight patients). Survival of the prosthesis without revision was 48% (95% CI 34.8 to 62.0) at two years and 25% (95% CI 11.1 to 39.9) at five years post-operatively. Failure of the prosthesis was due to deep infection in 22 patients (37%), aseptic loosening in ten patients (17%), and peri-prosthetic fracture in six patients (10%). Wear of the bearings made a minor revision necessary in 12 patients (20%). The mean Musculoskeletal Tumor Society score was 23 (10 to 29). An extensor lag > 10° was noted in ten patients (17%). These results suggest that limb salvage after extra-articular resection with a tumour prosthesis can achieve good functional results in most patients, although the rates of complications and subsequent amputation are higher than in patients treated with intra-articular resection.
University Clinic of Muenster, Department of Orthopaedics and Tumour Orthopaedics, Albert-Schweitzer-Str. 33, Muenster, Germany.
J
J
Hardes
M P
MP
Henrichs
G
G
Gosheger
C
C
Gebert
S
S
Höll
R
R
Dieckmann
G
G
Hauschild
A
A
Streitbürger
D000293:Adolescent; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods*; D001859:Bone Neoplasms / Q000601:surgery*; D002648:Child; D005260:Female; D005266:Femoral Neoplasms / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007720:Knee Prosthesis / Q000009:adverse effects; D023821:Limb Salvage / Q000379:methods; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000209:etiology; D012086:Reoperation / Q000379:methods; D012983:Soft Tissue Neoplasms / Q000601:surgery*; D013977:Tibia / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
Extra-articular; Peri-prosthetic infection; Sarcoma; Tumour endoprosthesis