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Connective Tissue Oncology Society |
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| 2001 CTOS Annual Meeting Posters— Surgery LIMB-SPARING ENDOPROSTHETIC
RECONSTRUCTION FOLLOWING MAJOR ONCOLOGIC MUSCULOSKELETAL RESECTIONS:
IMPROVED LONG TERM RESULTS AND QUALITY OF LIFE WITH A MODULAR SYSTEM OBJECTIVE: Reconstruction of segmental skeletal defects following major resections for sarcoma remains a technically demanding procedure. A modular replacement system (MRS, Pfizer/Howmedica Inc.) was designed as a flexible off-the-shelf solution for resections of the proximal humerus (PH), proximal femur (PF), distal femur (DF), total femur (TF) and proximal tibia (PT). Implant assembly at surgery provides an optimal fit for the bone defect. This study reviews the long-term clinical outcome and prosthetic survival of this system. METHODS: 100 consecutive cases since 1986 were retrospectively analyzed. Standard Kaplan-Meier analysis was used to determine prosthetic survival. Failure was defined as any event leading to removal of the implant. RESULTS: Median f/u was 77.8 months (min 2 yrs). Dx at surgery: 72 primary bone sarcomas, 11 metastatic carcinomas, 11 revisions of failed allografts or prior reconstructions, 4 benign aggressive bone tumors, 1 myeloma and 1 lymphoma. Procedures performed: 48 distal femoral replacements, 22 proximal humeral replacements, 15 proximal femoral replacements, 13 proximal tibial replacements and 2 total femoral replacements. Age at surgery: 8 to 78 years. No mechanical failures of the stems, bodies, or interlocking tapers occurred. The ultimate limb-salvage rate was 93% while the infection rate was 8%. Both rates compare very favorably with outcomes associated with other methods of skeletal reconstruction for this patient population. Kaplan-Meier survival analysis of all implants at median f/u of 6.5 yrs was 90.5% [95%CI:0.83-0.98]. Survival rates of implants by anatomic sites were: DF 90.3% at median f/u of 76.5 months, PH 95.4% at 91.2 months, PF 100% at 72.2 months, PT 75.1% at 72.2 months, and TF 100% at 38.8 months. CONCLUSION: Long-term survival and limb salvage rates using the MRS exceeds that reported for allografts, custom endoprostheses, and other modular systems. This system sets a new standard for limb sparing reconstruction following major sarcoma resections as well as allowing limb salvage of failed massive allografts or custom endoprostheses.
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