title: Classification of failure of limb salvage after reconstructive surgery for bone tumours : a modified system Including biological and expandable reconstructions.
abstract: Previous classification systems of failure of limb salvage focused primarily on endoprosthetic failures and lacked sufficient depth for the effective study of the causes of failure. In order to address these inadequacies, the International Society of Limb Salvage (ISOLS) formed a committee to recommend revisions of the previous systems. The purpose of this study was to report on their recommendations. The modifications were prepared using an earlier, evidence-based model with subclassification based on the existing medical literature. Subclassification for all five primary types of failure of limb salvage following endoprosthetic reconstruction were formulated and a complementary system was derived for the failure of biological reconstruction. An additional classification of failure in paediatric patients was also described. Limb salvage surgery presents a complex array of potential mechanisms of failure, and a complete and precise classification of types of failure is required. Earlier classification systems lacked specificity, and the evidence-based system outlined here is designed to correct these weaknesses and to provide a means of reporting failures of limb salvage in order to allow the interpretation of outcome following reconstructive surgery.
authors.affiliation: Norris Cotton Cancer Center, Musculoskeletal Oncology Program, One Medical Center Drive, Lebanon, PA, 03756, USA.
authors.forename: E R
authors.initials: ER
authors.lastname: Henderson
authors.affiliation: Mayo Clinic, Department of Orthopaedic Surgery, Jacksonville, Florida, USA.
authors.forename: M I
authors.initials: MI
authors.lastname: O'Connor
authors.affiliation: Instituto Ortopedico Rizzoli, Orthopaedic Oncology Division, Bologna, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Ruggieri
authors.affiliation: University of Vienna, Department of Orthopaedic Surgery, Vienna, Austria.
authors.forename: R
authors.initials: R
authors.lastname: Windhager
authors.affiliation: University of Vienna, Department of Orthopaedic Surgery, Vienna, Austria.
authors.forename: P T
authors.initials: PT
authors.lastname: Funovics
authors.affiliation: Oxford University, Orthopaedic Oncology, Oxford University Hospitals, Oxford, UK.
authors.forename: C L
authors.initials: CL
authors.lastname: Gibbons
authors.affiliation: People's Hospital, Musculoskeletal Tumor Center, Peking University, Beijing, China.
authors.forename: W
authors.initials: W
authors.lastname: Guo
authors.affiliation: Massachusetts General Hospital, Center for Connective Tissue Oncology, Boston, Massachusetts, USA.
authors.forename: F J
authors.initials: FJ
authors.lastname: Hornicek
authors.affiliation: University of Miami, Department of Orthopaedic Surgery, Miami, Florida, USA.
authors.forename: H T
authors.initials: HT
authors.lastname: Temple
authors.affiliation: Moffitt Cancer Center, Sarcoma Program, Tampa, Florida, USA.
authors.forename: G D
authors.initials: GD
authors.lastname: Letson
mesh_terms: D001859:Bone Neoplasms / Q000601:surgery*; D006801:Humans; D023821:Limb Salvage; D011183:Postoperative Complications / Q000601:surgery*; D019736:Prostheses and Implants; D019651:Plastic Surgery Procedures / Q000379:methods*; D017211:Treatment Failure
keywords: Limb salvage; Endoprosthesis; Allograft; Classification; Failure