Malawer, J Bone Joint Surg Am 1995 - Prosthetic Survival and Clinical Results with Use of Large-Segment Replacements in the Treatment of High-Grade Bone Sarcomas
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Prosthetic Survival and Clinical Results with Use of Large-Segment Replacements in the Treatment of High-Grade Bone Sarcomas
Malawer, Chou·J Bone Joint Surg Am·1995·347 citations
Malawer and Chou reported prosthetic survival and clinical results after limb‑sparing resection of high‑grade bone sarcomas reconstructed with large‑segment prostheses.
Single‑surgeon retrospective series of 82 patients (median age 19) treated 1979 to 1991 and followed 2 to 12 years (median three and a half).
Key Findings
Prosthetic survival was 83% at 5 years and 67% at 10 years. Only 10 patients were followed to 10 years.
Tumor site was the strongest predictor of revision (p < 0.003). Proximal tibial prostheses were revised in 6 of 13, vs 3 of 31 distal femoral and 3 of 29 proximal humeral prostheses.
The authors attribute the proximal tibial failures mainly to the over‑constrained spherocentric prosthesis, which they abandoned. No proximal tibial tumor recurred locally.
Infection developed in 11 patients (13%), at a median of 25 months, and led to amputation in 6. The authors suggest chemotherapy‑related bacteremia may seed late infections.
Local recurrence occurred in 5 patients (6%), and 9 (11%) eventually needed amputation, 6 for infection. Two of the 5 recurrences followed a pathologic fracture that had healed.
Proximal humeral patients scored highest on the Musculoskeletal Tumor Society scale (mean 26 of 30) and proximal tibial patients lowest (mean 21). Revision did not significantly lower function.
Board pearl
Pathologic fracture is a relative contraindication to limb salvage. The authors go further and advise against it, especially around the pelvis, even if the fracture heals with chemotherapy. Two of their 5 local recurrences followed a healed fracture.
Authors' conclusion
Large-segment prostheses were a good reconstructive option for the treatment of high-grade bone sarcomas in our patients. The rates of long-term survival of the prostheses were acceptable and the functional results were good or excellent after this form of treatment at most of the anatomical sites at which they were used.
Malawer and Chou reported prosthetic survival and clinical results after limb‑sparing resection of high‑grade bone sarcomas reconstructed with large‑segment prostheses.
Single‑surgeon retrospective series of 82 patients (median age 19) treated 1979 to 1991 and followed 2 to 12 years (median three and a half).
Key Findings
Prosthetic survival was 83% at 5 years and 67% at 10 years. Only 10 patients were followed to 10 years.
Tumor site was the strongest predictor of revision (p < 0.003). Proximal tibial prostheses were revised in 6 of 13, vs 3 of 31 distal femoral and 3 of 29 proximal humeral prostheses.
The authors attribute the proximal tibial failures mainly to the over‑constrained spherocentric prosthesis, which they abandoned. No proximal tibial tumor recurred locally.
Infection developed in 11 patients (13%), at a median of 25 months, and led to amputation in 6. The authors suggest chemotherapy‑related bacteremia may seed late infections.
Local recurrence occurred in 5 patients (6%), and 9 (11%) eventually needed amputation, 6 for infection. Two of the 5 recurrences followed a pathologic fracture that had healed.
Proximal humeral patients scored highest on the Musculoskeletal Tumor Society scale (mean 26 of 30) and proximal tibial patients lowest (mean 21). Revision did not significantly lower function.
Board pearl
Pathologic fracture is a relative contraindication to limb salvage. The authors go further and advise against it, especially around the pelvis, even if the fracture heals with chemotherapy. Two of their 5 local recurrences followed a healed fracture.
Authors' conclusion
Large-segment prostheses were a good reconstructive option for the treatment of high-grade bone sarcomas in our patients. The rates of long-term survival of the prostheses were acceptable and the functional results were good or excellent after this form of treatment at most of the anatomical sites at which they were used.