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Background: Megaprostheses contain many more modular components than conventional total hip and knee arthroplasty, which may lead to higher serum levels of metal ions. The aim of this study was to determine serum concentrations of titanium, chromium, and cobalt ions in cancer patients after limb salvage surgery with a megaprosthesis., Methods: A retrospective, descriptive cohort analysis consisting of patients who underwent cancer-related limb salvage surgery with a megaprosthesis at our hospital between 2010 and 2020 was conducted. Baseline and follow-up data were extracted from clinical and surgical records. Blood samples were prospectively obtained. Descriptive statistics were used for the analysis., Results: A total of 71 patients underwent limb salvage surgery during the study period. Of these, 22 (10 women, 12 men) were included in the study. The mean age was 52 years (range, 21 to 80). Most cases (n = 16; 72.7%) involved the femur. Most patients (n = 14, 63.6%) underwent total knee megaprosthesis surgery. Implant revision surgery was required in 45% of cases (n = 10), with a mean interval of 4.32 years between the initial and revision surgeries. The mean follow-up time after revision surgery was 4.05 years. High levels of chromium were observed in 22.7% of patients (n = 5). High cobalt levels were found in 68.2% (n = 15) of patients, with toxic levels in 9.1% (n = 2). Titanium levels were high in 77.3% (n = 17) of cases and toxic in 22.7% (n = 5). Postoperative chemotherapy was significantly associated with titanium levels (P = .017). No correlation was observed between metal ion levels and time from primary or revision surgery or time from the first to revision surgery., Conclusions: This study shows that cancer-related limb salvage surgery with megaprosthesis is associated with metal ion levels that exceed established safe thresholds. Compared to conventional hip arthroplasty, a higher proportion of the patients in this cohort presented elevated levels of metal ions., Level of Evidence: III., (Copyright © 2024 Elsevier Inc. All rights reserved.)

In recent decades, limb-salvage surgery has replaced amputation as the first choice for the treatment of bone tumors around knee. After tumor resection, there are a variety of reconstruction methods for us to choose, including autograft or allograft, inactivation and reimplantation, artificial prosthesis replacement, and allograft-prosthesis compound reconstruction. Compared with other reconstruction methods, artificial prosthesis reconstruction has some advantages: relatively simple, early weight bearing, fewer early complications, and good function in the early and mid-term follow-up. After decades of continuous improvements, the design of tumor prosthesis has reached a relatively mature stage, and the failure rate of prosthesis has also been declining year by year. However, artificial prostheses also have multiple complications such as infection, aseptic loosening, prosthetic breakage, and patients sometimes face the risk of revision or amputation. Therefore, clinicians need to deeply understand the characteristics of related complications and the principles of treatment.

Background: The distal humerus is a rare location of bone tumors. Because of the complexity of the elbow joint, poor soft-tissue coverage, and proximity of nerves and vessels, resection and endoprosthetic reconstruction are demanding., Methods: This retrospective study evaluated the clinical results after distal humeral resection and megaprosthetic reconstruction in 12 patients with an average age of 46 years. All patient files were reviewed for clinical information, and postoperative function and patients' contentment were assessed using the Musculoskeletal Tumor Society score., Results: The predominant diagnoses were bone and soft-tissue sarcoma (n = 6), giant cell tumor (n = 2), and renal cell carcinoma metastasis (n = 2). Local recurrence was the reason for secondary amputation in all cases (n = 3). The prosthetic survival rate after surgery was 82% at 2 years and 64% at 5 years. Reconstruction failure was mainly caused by aseptic loosening of the humeral stem, occurring in 27% (n = 3), followed by aseptic loosening of the ulnar stem in 9% (n = 1) and periprosthetic infection in 9% (n = 1). The mean Musculoskeletal Tumor Society score was 24 points (range, 20-30 points). An extension lag of more than 10° was noted in 6 patients (55%)., Conclusion: Our results suggest that limb salvage with a distal humeral replacement can achieve good functional results in most patients, although the complication rate with special emphasis on the loosening rate of the humeral stem is high. However, limb salvage was not achieved in 27% of patients because of local recurrence., (Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Purpose: Limb salvage surgery is increasingly used for the treatment of distal femur bone sarcomas. Total knee replacement using megaprosthesis and epiphysis-sparing biologic reconstruction using an allograft are widely used in order to preserve joint motion. We aimed to compare the results of these procedures using gait analysis in patients undergoing limb salvage surgery., Methods: Fifteen patients were included, nine undergoing allograft with epiphysis sparing (Allograft group) and six undergoing megaprosthesis (Megaprosthesis group). Every patient underwent a gait analysis using the Plug-in-Gait protocol. Spatiotemporal parameters, knee kinematics, and kinetics were compared between the two groups and a cohort of ten asymptomatic subjects. Knee function was assessed by the Gait Deviation Index (GDI) and the Gilette Gait Index (GGI)., Results: Both treatment groups showed decreased knee flexion during the loading response phase. Megaprosthesis patients showed a decreased knee flexion all along stance phase. There was no difference in gait pattern between the treatment groups. GDI was significantly lower in Megaprosthesis and Allograft patients when compared to controls (86.4 and 84.3 vs 94, all p < 0.05). This difference was not clinically relevant., Conclusion: Our study reveals that Megaprosthesis and Allograft patients did not show differences in gait patterns and global function. Even though Allograft and Megaprosthesis patients have significant changes in gait pattern, knee function is acceptable with effective gait mechanisms. Changes occur during stance phase and are due to the quadriceps weakness. The particular pattern of gait in Megaprosthesis patients could be a concern for prosthesis wear and should be investigated on this specific aspect., Level of Evidence: 4.

Purpose: The non-invasive expandable prosthesis for skeletally immature patients is used after limb salvage surgery following tumor resection. The aim of the study was to assess the effectiveness of this treatment., Methods: Seven paediatric patients with femoral tumors had resection and limb salvage with an uncemented non-invasive growing prosthesis. Mean age at the time of surgery was 9.8 (range 8-12) years. There were six distal femur osteosarcomas and one proximal femur Ewing sarcoma. Six total knee prosthesis were implanted at the time of primary tumor resection and one bipolar hip prosthesis was a revision from a failed osteoarticular hip allograft. Functional outcomes and emotional acceptance were assessed using the MSTS score., Results: The mean follow-up was 65.3 months (range 29-91) months. Two patients died of pulmonary metastasis and there was no local recurrence. The mean femoral resection was 18 cm (range 17-19) on the knee, and 24 cm on the hip. Mean total expansion was 36.4 mm (range 12.3-63.5). The mean MSTS score after rehabilitation was 26.3 (range 21-29). There was one lengthening device failure, one late infection and one patient who required iliofemoral bypass grafting surgery for a pelvic metastasis. No local recurrence occurred., Conclusions: The non-invasive expandable prosthesis reduces the final limb-length discrepancy in growing patients with an acceptable function and appears to have an advantage as compared to invasive expandable prostheses which require multiple surgical procedures, but the complications rate is still high.

Introduction: The recent evolution of prosthesis technology has enabled the surgeon to replace entire limbs. These special prostheses, or megaprostheses, were developed for the treatment of severe oncological bone loss; however, the indications and applications of these devices have expanded to other orthopaedic and trauma situations. For some years, surgeons have been implanting megaprostheses in non-oncological conditions, such as acute trauma in severe bone loss and poor bone quality; post-traumatic failures, both aseptic and septic (represented by complex non-unions and critical size bone defects); major bone loss in prosthetic revision, both aseptic and septic; periprosthetic fractures with component mobilisation and poor bone stock condition. The purpose of this study was to evaluate retrospectively the complications during and after the implantation of megaprosthesis of the lower limb in post-traumatic and prosthetic bone loss, and to propose tips about how to avoid and manage such complications., Materials and Methods: All the complications and difficulties we have encountered during or after the implantation of megaprosthesis in non-oncology patients were evaluated retrospectively. A total of 72 patients were treated with large resection mono-and bi-articular prostheses between January 2008 and January 2014., Results: The main critical problems found in the study were: restoration of the correct length and rotation of the limb; reconstruction of the knee extensor mechanism; trochanteric reconstruction; stability/dislocation of the implant; mobility/range of motion (ROM) of the implant; skin cover; sepsis, and bone quality., Conclusion: Megaprosthesis in severe bone loss can be considered as an available solution for the orthopaedic surgeon in extreme, appropriately selected cases. This type of complex surgery must be performed in specialised centres where knowledge and technologies are present. Patients with severe bone loss should not be treated in the same way as oncology patients because life expectancy is definitely longer; therefore, the surgical technique and the system implantation must be extremely rigorous to ensure longevity of the prosthesis. The characteristics of the bone and soft tissue conditions in these patients are very different from those presented by oncology patients, which creates critical problems that the surgeon should be able to manage to avoid serious complications., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Introduction: The development of new megaprosthesis for the treatment of large bone defects provides important options to orthopaedic oncologic surgeons for the replacement of skeletal segments, such as the long bones of the upper and lower limbs and the relative joints. We implanted megaprosthesis using either a one-step or two-step technique depending on the patient's condition. The aim of this study was to evaluate retrospectively both clinical and radiological outcomes in patients who underwent lower limb megaprosthesis implant., Materials and Methods: A total of 32 patients were treated with mono- and bi-articular megaprosthesis subdivided as follows: proximal femur, distal femur, proximal tibia and total femur. The mean follow-up of patients was about 18 months (range 3 months to 5 years). Clinical and serial radiographic evaluations were conducted using standard methods (X-ray at 45 days, 3, 6, 12, 18 and 24 months) and blood parameters of inflammation were monitored for at least 2 months., Results: Although the mean length of follow-up was only 18 months, the first patients to enter the study were monitored for 5 years and showed encouraging clinical results, with good articulation of the segments, no somato-sensory or motor deficit and acceptable functional recovery. During surgery and, more importantly, in pre-operative planning, much attention should be given to the evaluation of the extensor apparatus, preserving it and, when necessary, reinforcing it with tendon substitutes., Discussion: Megaprosthesis in extreme cases of severe bone loss and prosthetic failure is a potential solution for the orthopaedic surgeon. In oncological surgery, the opportunity to restore functionality to the patient (although not ad integrum) is important for both the patient and the surgeon. The high mortality associated with cancer precludes long-term patient follow-up; therefore, there is a lack of certainty about the survival of this type of prosthesis and any medium- to long-term complications that may occur. Nevertheless, patients should be considered as an oncologic patient, not because of the disease, but because of the limited therapeutic options available., Conclusions: Megaprosthesis provides a valuable opportunity to restore functionality to patients with highly disabling diseases., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

AbstractPurposeMaterials and methodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONTo explain the needs for rehabilitation of patients with bone sarcoma before and after surgical resection and reconstruction with megaprosthesis.We performed a qualitative study following constructivist grounded theory principles. We purposefully recruited rich cases. Data were collected using semi-structured interviews and analyzed with grounded theory data-analysis. Initial, focused, and theoretical coding were first performed independently by two authors and followed by discussion in consensus meetings with all authors. Ultimately, a conceptual model was created.Thirteen participants were interviewed between March and May 2023. Seven theoretical codes were found. The first is the need to achieve a new normal, being able to function with their medical history and megaprosthesis in a new normal life. Two key values patients needed were being understood and being prepared. Four important conditions that patients needed were: optimal conditions for rehabilitation, a trustworthy physical therapist, a clear closure from rehabilitation, and access to expertise in the hospital. The core category was achieving a new normal.Patients with bone sarcoma need rehabilitation to achieve a new normal life. With the understanding of needs regarding rehabilitation now gained, the care for patients with bone sarcoma should be better tailored.Bone sarcoma is a life threatening, disabling disease requiring intensive medical treatment.The goal of rehabilitation should be to help patients achieve a new normal.Rehabilitation professionals will need to acquire the additional knowledge and relevant skills to treat patients.Rehabilitation professionals should prepare the patients by providing clear and uniform information about their rehabilitation.Bone sarcoma is a life threatening, disabling disease requiring intensive medical treatment.The goal of rehabilitation should be to help patients achieve a new normal.Rehabilitation professionals will need to acquire the additional knowledge and relevant skills to treat patients.Rehabilitation professionals should prepare the patients by providing clear and uniform information about their rehabilitation. [ABSTRACT FROM AUTHOR]

Objective: Bone and soft tissue tumors have high mortality and morbidity rates. With new improvements in adjuvant–neoadjuvant therapies and new endoprosthesis designs, limb salvage surgery methods became more popular than amputations. The aim of our study was to evaluate the clinical and radiological results of patients who underwent surgery due to tumors around the knee with megaprosthesis. We also compared hinged and rotational hinged megaprosthesis to determine if they have advantages over each other. Methods: This study has a cohort design. Thirty-one patients who had been operated between 2000 and 2018 by a single surgeon with knee megaprosthesis were evaluated using International Limb Salvage Symposium criteria (ISOLS score). Results: The 5-year survival rate for the prostheses was 46.2%. The overall Musculoskeletal Tumor Society (MSTS) score was 84.65% ± 9.94% (range: 54%-97%) (fair-excellent), and the ISOLS score was 86.60% ± 10.47% (range: 45%-100%) (poor-excellent). There were no significant differences between the scores according to prosthesis types. As the strength of straight leg lift increased, so did the emotional acceptance for both types of prostheses. Conclusion: Megaprosthesis is a good choice of treatment for tumors around the knee without decreasing life expectancy. Both hinged and rotational hinged prostheses can be used according to clinical needs. [ABSTRACT FROM AUTHOR]

Delayed fracture healing can have devastating functional consequences, including pseudoarthrosis. Many factors can contribute to delayed healing, including decreased vascularity, micro-motion at the fracture site, large fracture gaps, multiple traumas at the same site, compromised metabolic status, surgical complications, and other conditions. A 61-year-old female patient was referred to our hospital with left distal humeral pseudarthrosis, accompanied by chronic pain and disability. Two years prior, the patient suffered a traumatic incident. At another medical facility, the patient underwent open reduction and internal fixation surgery with simultaneous ulnar nerve transposition. She showed favorable postoperative recovery. Unfortunately, approximately one year later, the patient sustained a second trauma to the same arm. This led to peri-implant fracture and post-traumatic aseptic degradation of the osteosynthesis system which was subsequently removed. Twelve months after the last surgery, the patient was referred to our hospital and, after thorough consideration of the therapeutic options, we decided to perform left elbow arthroplasty with left distal humeral reconstruction by using Zimmer's Comprehensive Segmental Revision System. This approach is generally reserved for tumors, and only a handful of cases of megaprostheses for non-tumoral indications have been previously reported. The surgery and perioperative care of our patient were optimal, there were no complications, and the patient recovered arm functionality following rehabilitation. [ABSTRACT FROM AUTHOR]

Medical advancements in musculoskeletal oncology has significantly reduced the mortality rate associated with limb-sparing surgery, making it comparable to amputation. The use of modular megaprosthesis for sarcoma treatment has now become a standard practice. However, these non-biological implants are not without their complications. A retrospective cohort study was conducted on all patients who underwent wide resection of locally aggressive and malignant bone tumors, followed by reconstruction with megaprosthesis between January 2018 and January 2023 at tertiary care hospital. Patients were evaluated based on oncological outcomes, functional outcomes, and complications with a minimum follow-up period of 6 months. The study included a total of 30 patients, comprising 16 males and 14 females, with a mean age of 33.6 ± 15.6 years. They all underwent wide resection and reconstruction with megaprosthesis. Diagnosis among the patients included 19 cases of giant cell tumors, 5 cases of osteosarcomas, 2 cases of metastatic bone tumors, and 1 case each of chondrosarcoma, malignant fibrous histiocytoma, multiple myeloma, and chondromyxoid fibroma. These tumors were predominantly located in the distal femur (15 patients) and proximal tibia (12 patients). The average follow-up period was 33 ± 21 months, resulting in an average final Musculoskeletal Tumor Society (MSTS) score of 81 % ± 9 %. Complications were observed in 21 patients, with infection being the most common, specifically Type 4 (10 patients, 37 %), followed by Type 1 (4 patients, 13 %) and Type 3 (4 patients, 13 %). Two patients (7 %) experienced Type 5 complications, while three succumbed to their illnesses. Additionally, two patients required amputation, one due to local recurrence and the other due to a deep-seated infection. Megaprosthesis is a viable reconstruction option following wide resection of bone tumors. Infection remains the most common issue, and cost poses a significant challenge. [ABSTRACT FROM AUTHOR]

Crush injury is one of the most challenging decisions for a surgeon to decide whether to proceed with an amputation or salvage a limb.We presented a 24-year-old man who complained of having suffered a crushed thigh 12 h before admission to the hospital. The patient was driving a truck and hit the iron bridge barrier, which penetrated his left thigh. The patient's left foot was cold, pallid, and pulseless, with a MESS score of 11. The femur x-ray showed a displaced fracture of the left femur associated with a 15 cm bone defect. The patient was diagnosed with a crush injury on the left femur with vascular compromise.We performed a proximal femoral megaprosthesis for a crush injury on the lower extremity, After the sixth year's follow-up, it shows a good outcome and increased quality of life for this patient. In addition, there was an improvement in the Harris Hip Score and EQ5D score.Megaprosthesis used to treat a crush injury revealed good functional outcomes despite the MESS score of 11. A multi-professional approach to the patient is essential for decision-making regarding limb salvage rather than the use of a score.

Purpose: Limb salvage procedures for musculoskeletal tumors have inherent complications. Though most complications can be managed with retention of the reconstructions, occasionally salvaging these reconstructions is not possible. We evaluated the outcomes of patients undergoing rotationplasty after multiple failed revisions of limb salvage surgery and document the success rate of this "salvage" technique and the subsequent functional outcome of these patients. Method: Between January 1, 1999, and December 31, 2018, 14 patients (12 male and 2 female) with a median age of 24 years (11–51 years) underwent rotationplasty after multiple failed revisions of limb salvage surgery. Indication for rotationplasty was infection (10 patients), failed megaprosthesis (2 patients), unstable biological reconstruction (1 patient) and local recurrence (1 patient). The mean number of surgeries done before the patient underwent rotationplasty was 5 (range 2–7). Results: One patient developed a vascular complication (venous congestion) immediately after rotationplasty and underwent an early amputation. The remaining 13 patients had no surgical complications. Mean Musculo Skeletal Tumor Society score in 13 evaluable patients was 26 (23–30). Conclusion: Our study demonstrates the utility of rotationplasty as a "salvage" procedure after multiple failed lower limb salvage surgeries. It offers good success rates, low rates of complications and good functional outcomes in carefully selected cases. [ABSTRACT FROM AUTHOR]

Modular megaprostheses (MPs) are commonly used after bone-tumor resection, but they can offer a limb salvage solution in massive bone defects. The aim of this systematic review of the Literature is to provide a comprehensive data collection concerning the use of MPs in non-oncologic cases, and to provide an overview of this topic, especially from an epidemiologic point of view. Three different databases (PubMed, Scopus, and Web of Science) were searched for relevant articles, and further references were obtained by cross-referencing. Sixty-nine studies met the inclusion criteria, reporting on cases of MP in non-oncologic cases. A total of 2598 MPs were retrieved. Among these, 1353 (52.1%) were distal femur MPs, 941 (36.2%) were proximal femur MPs, 29 (1.4%) were proximal tibia MPs and 259 (10.0%) were total femur MPs. Megaprostheses were most commonly used to treat periprosthetic fractures (1158 cases, 44.6%), in particular in the distal femur (859, 74.2%). Overall, complications were observed in 513 cases (19.7%). Type I (soft tissue failures) and type IV (infection) according to the Henderson classification were the most frequent (158 and 213, respectively). In conclusion, patients with severe post-traumatic deformities and/or significant bone loss who have had previous septic complications should be considered as oncologic patients, not because of the disease, but because of the limited therapeutic options available. The benefits of this treatment include relatively short operative times and immediate weight-bearing, thus making MP particularly attractive in the lower limb. [ABSTRACT FROM AUTHOR]

The knee is the most frequent site of primary bone tumour. A majority of the tumours arising in the knee can be treated with limb salvage surgery and result in good functional outcomes. We evaluated functional outcomes for patients who underwent surgery for resection and megaprosthesis replacement for primary tumours around the knee. We used the Musculoskeletal Tumour Society Scoring System (MSTS) for functional evaluations to compare differences between distal femur and proximal tibia placements. This study was an observational analysis study with cross sectional approach in primary bone tumor knee region which has been done limb salvage surgery. The study sample included 11 cases of distal femur and 6 cases of proximal tibia megaprosthesis replacement. Primary tumours were classified as follows: 5 osteosarcoma, 12 giant cell tumour (GCT). The Patients was subjected to a physical examination to complete MSTS score and then commpared data were obtained. Functional outcomes, as measured by MSTS functional assessment were good to excellent in a majority of study patients. This study shows an unsignificant differences functional outcome using MSTS Score between resection tumour in distal femur and proximal tibia (p >0.05). There were no differences in functional outcomes when comparing distal femur megaprostheses with proximal tibia megaprostheses. [ABSTRACT FROM AUTHOR]

Objective: We present data from our recently completed study that suggests that joint salvage is the key parameter in keeping the limb salvage ethos relevant. Methods: We reviewed all patients operated on nationally over 30 years (1978 to 2008). We identified 265 survivors of which 162 were available for evaluation at the time of survey. Results: There were 92 males and 70 females followed an average 9.1±SD3.1 years. Average age at survey was 38±SD17 years. ANOVA for mental health and TESS degree of importance for ADL identified that all categories of joint preservation were similar to an average group of people from the population. Physical health scores were significantly better amongst joint‐preserved versus joint replacement patients (p = 0.003). Nevertheless, there was no significant difference between amputees with respect to physical health scores compared to arthrodesed and joint‐replaced individuals. Biological reconstructions scored significantly better than metallic segmentary reconstructions (p < 0.001). Dissatisfaction appeared to correlate best with the presence of pain following reconstruction (p < 0.001). Conclusions: While our study supports the finding of amputations being as satisfactory as arthrodeses and joint replacement salvage surgery, joint salvage was superior to all other categories. Assessments of equivalence should incorporate joint salvage and materials used as evaluable parameters. [ABSTRACT FROM AUTHOR]

Introduction: Infected post-traumatic distal femur defects remain a therapeutic challenge. Non-biological reconstruction offers an option for avoiding complex biological knee arthrodesis procedures. The CompressⓇ implant is an alternative to the traditional distal femur stemmed megaprosthesis. The aim of this study is to analyse the first patients treated with a distal femur CompressⓇ prosthesis to manage massive infected post-traumatic defects of the distal femur with joint involvement.Methods: We retrospectively reviewed all patients with massive infected defects of the distal femur where this implant was used in a two-stage strategy, together with an antibacterial coating hydrogel (DACⓇ). The specific protocol, microbiological data, clinical and radiological results, complications, functional results and prosthesis survivorship were determined. Follow-up was for a minimum of 12 months, or until implant removal.Results: Ten patients (11 CompressⓇ implants) with a mean age of 52 years (range 35-73) were included. On average, patients had undergone 4.4 previous surgical procedures before index surgery. The mean bone defect was 14 cm (range 8-21). After a median follow-up of 27 months (range 12-50 months) no patient had presented with recurrence of the infection, and limb salvage was achieved in all cases. Two patients suffered aseptic loosening which required revision of the femoral component. The short-term survivorship of the implant in our series was 81.8% at 4 years, with all failures occurring in the first 7 months. After this 7-month time threshold, we encountered no further loosening. Regarding functional outcomes, patients had a mean knee ROM of -4/86, expressed high overall satisfaction with the procedure according to the SAPS scale, and had an average LEFS of 52.5% (40-72.5%).Conclusion: Non-biological reconstruction of the distal femur with the CompressⓇ implant is a valid option in selected patients with massive infected defects with joint involvement. Survivorship was high, with all loosening occurring in the first months after surgery-representing a failure in the osseointegration of the implant. [ABSTRACT FROM AUTHOR]

Purpose: Proximal femoral replacements (PFRs) have been recently utilized in complex revision arthroplasties where proximal femoral bone is compromised. The purpose of this study is to evaluate the clinical outcomes, complications, and survivorship of PFRs as a salvage treatment for severe bone loss after non-oncologic revision total hip arthroplasty.Methods: This is a retrospective review of all patients who underwent femoral revision surgery using a single design PFR between 2004 and 2013 at our institution. Forty patients (41 hips) were included with a mean age of 64 years (29-90). According to Paprosky classification, 15 femurs had type IIIB defect, and 26 had type IV defect. Patients were followed for a mean of five years (2-10). The average length of reconstruction was 150 mm (81-261). A Kaplan-Meier analysis was used to determine the survival of the PFR.Results: A total of nine patients (9 PFRs, 22%) were re-operated upon. Three re-operations were for infection, two for dislocation, two for aseptic loosening, and two for periprosthetic fracture. The survivorship at five years was 95.1% for revision of the femoral stem for aseptic loosening. We did not find length of the segmental reconstruction or the indication for revision, to be a risk factor for implant failure or re-revision.Conclusions: Proximal femoral replacements have shown an acceptable survivorship in non-oncologic revision hip arthroplasties for severe proximal femoral bone loss. The frequent use of constrained liners may decrease the risk of dislocation due to the loss of the abductor mechanism encountered in these complex reconstructions. [ABSTRACT FROM AUTHOR]

Purpose: Proximal tibia replacements are commonly associated with post-operative complications and poor functional results due to an insufficiency of the extensor mechanism.Methods: This study evaluated the clinical results with a special emphasis of the extensor mechanism reconstruction with a reattachment tube and complications after intra-articular resection of the proximal tibia and reconstruction with a tumour endoprosthesis (MUTARS®) in 98 patients (median age 18 years) with malignant bone tumours or giant cell tumours.Results: Kaplan-Meier analysis showed that the limb survival rates were 94.9, 90.5 and 74.5% at one, two and ten years, respectively. Periprosthetic infection was the most common reason for secondary amputation (eight patients). The cumulative incidence rates of prosthetic failure (Henderson II-IV) were 18% at two years and 29% at five years post-operatively. An active extension deficit of more than 10° was noted in six patients only.Conclusions: These results suggest that limb salvage with tumour prostheses after intra-articular resection can achieve good functional results with an active extension of the knee in the majority of patients. While mechanical complications can be treated successfully with revision surgery, periprosthetic infection continues to be the main reason for secondary amputation. [ABSTRACT FROM AUTHOR]

Background and Objectives: The aim of our study was to evaluate if there is an increased risk of periprosthetic infection (PJI) in patients following replacement of the proximal humerus by using a modular tumour prosthesis in combination with a trevira tube.Methods: Thirty patients were treated by using a modular tumour endoprosthesis (MUTARS®) following intra-articular resection of the proximal humerus. Fifteen patients received treatment by using a trevira tube. In 15 further cases the use of a trevira tube was not necessary. The mean follow-up time was 26 months (range: 24 months to 84 months). Both, Enneking score and range of motion (ROM), was evaluated. Further radiographs were obtained in two planes.Results: The survival rate one year after surgery was 83 % and 63 % after two years. We recorded a 96 % survival of the limb two years after surgery. We also observed only one case of periprosthetic joint infection (PJI) in the entire follow-up period in one patient who received treatment with a trevira tube. The mean Enneking score was 20 points (range 8 to 26 points). ROM was equal in both study groups. In total 20 % of the treated patients (n = 6) suffered complications.Conclusions: Replacement of the proximal humerus by using a trevira tube in combination with a modular tumour endoprosthesis is a safe and viable treatment option for both, bone tumours and metastases. There is no statistically significant increased risk of infection by using trevira tube even among immunosuppressed patients.Level Of Evidence: Level 3, retrospective comparative study. [ABSTRACT FROM AUTHOR]

From an era where amputation was the only option to the current day function preserving resections and complex reconstructions has been a major advance in the treatment of musculoskeletal sarcomas. The objectives of extremity reconstruction after oncologic resection include providing skeletal stability where necessary, adequate wound coverage to allow early subsequent adjuvant therapy, optimising the aesthetic outcome and preservation of functional capability with early return to function. This article highlights the concepts of surgical margins in oncology, discusses the principles governing safe surgical resection in these tumors and summarises the current modalities and recent developments relevant to reconstruction after limb salvage. The rationale of choice of a particular resection modality and the unique challenges of reconstruction in skeletally immature individuals are also discussed. Striking the right balance between adequate resection, while yet retaining or reconstructing tissue for acceptable function and cosmesis is a difficult task. Complications are not uncommon and patients and their families need to be counseled regarding the potential setbacks that may occur in the course of their eventual road to recovery, Limb salvage entails a well orchestrated effort involving various specialties and better outcomes are likely to be achieved with centralization of expertise at regional centers. [ABSTRACT FROM AUTHOR]

Due to its anatomical location, the upper end of the tibia poses unique problems while attempting limb salvage and appropriate reconstruction. This article attempts to highlight a few of the key steps, pearls and pitfalls while attempting this challenging procedure. [ABSTRACT FROM AUTHOR]

Abstract: Now a days, Total Knee Replacement (TKR) is a common for elderly patients but is an uncommon procedure in young individuals. Recently, limb conservation surgery for malignant bone tumours like osteosarcoma around the knee has become a common indication for TKR in young. We report, here a histologically confirmed osteosarcoma in right proximal tibia of a 14-year-old boy who was managed successfully by limb salvage surgery using Global Modular Replacement System (GMRS, Stryker). [Copyright &y& Elsevier]

Purpose: The aim of the present study was to assess whether using megaprostheses in revision knee arthroplasty procedures allows limb salvage with an acceptable outcome and complication rate, in comparison with other limb-saving procedures. Methods: Between 2000 and 2010, megaprosthesis implantation was required for non-oncologic indications in 20 patients (21 knees) (average age 73 years). Reconstructions involved the distal femur ( n = 15), proximal tibia ( n = 4), and both femur and tibia ( n = 2). The indications, type, and numbers of previous operations and implants, as well as complications associated with megaprosthesis implantation, were reviewed, and the clinical and radiographic outcomes after an average follow-up period of 34 months (range 10-84 months) were evaluated. Results: The indications for megaprosthesis implantation were periprosthetic infection ( n = 5), fracture ( n = 9), nonunion ( n = 5), and aseptic loosening ( n = 2). The types of implant placed before the megaprosthetic reconstruction were a cemented rotating-hinge arthroplasty ( n = 16) and a primary total knee arthroplasty ( n = 5). Six patients had an additional osteosynthesis of the distal femur. An average of 3.8 operations (range 1-7) had been carried out before megaprosthesis implantation. Complications developed in 11 patients. The Knee Society Score improved significantly, from 43 (±15) to 68 (±16.8); P < 0.05. Conclusions: Megaprosthesis implantation in revision knee arthroplasty is an exceptional indication. Despite the high complication rate, the patients can be spared amputation in most cases, and rapid mobilization with full weight-bearing is possible. [ABSTRACT FROM AUTHOR]

Background: The extent of tumor may necessitate resection of the complete femur rarely to achieve adequate oncologic clearance in bone sarcomas. We present our experience with reconstruction in such cases using an indigenously manufactured, low-cost, total femoral prosthesis (TFP). We assessed the complications of the procedure, the oncologic and functional outcomes, and implant survival. Materials and Methods: Eight patients (four males and four females) with a mean age of 32 years, operated between December 2003 and June 2009, had a TFP implanted. The diagnosis included osteogenic sarcoma (5), Ewing's sarcoma (1), and chondrosarcoma (2). Mean followup was 33 months (9-72 months) for all and 40 months (24-72 months) in survivors. They were evaluated by Musculoskeletal Tumor Society score, implant survival as well as patient survival. Results: There was one local recurrence and five of seven patients are currently alive at the time of last followup. The Musculoskeletal Tumor Society score for patients ranged from 21 to 25 with a mean of 24 (80%). The implant survival was 88% at 5 years with only one TFP needing removal because of infection. Conclusions: A TFP in appropriately indicated patients with malignant bone tumors is oncologically safe. A locally manufactured, cost-effective implant provided consistent and predictable results after excision of the total femur with good functional outcomes. [ABSTRACT FROM AUTHOR]

Abstract: The management of bone tumours has made vast strides in the last few decades. The advent of better imaging modalities, more effective chemotherapy, improved radiotherapy techniques, a better understanding of anatomy with continuous refinement in surgical techniques and advances in prosthesis design and materials have all played a part in increasing the incidence of limb salvage surgery. From an era where amputation was the only option, the current day function preserving resections and complex reconstructions have been a major advance. This article highlights the concepts of surgical margins in oncology, discusses the principles governing safe surgical resection in malignant bone tumours and describes the various reconstruction options available in order to restore structural and skeletal stability after resection of large bone segments. The rationale of choice of a particular resection modality, the unique challenges of reconstruction in skeletally immature individuals and the impact of adjuvant modalities like chemotherapy and radiotherapy on surgical outcomes are also discussed. [ABSTRACT FROM AUTHOR]

Abstract: Background and objectives: The aim of this study was to analyze our results using a modular endoprosthetic replacement system (MUTARS) for bone tumors of the proximal humerus. Methods: Thirty-nine patients were treated with a MUTARS endoprosthesis of the proximal humerus. Mean follow-up duration was 38 months (3–138 months). Most operations were necessitated by metastasis (n =30); surgery for a primary tumor (n =9) was less frequent. The Enneking score was recorded and the active ranges of motion for shoulder flexion, abduction, and external rotation. Complete refixation of the rotator cuff was possible in 23 cases. Radiographs of the affected shoulders were obtained in two planes. Results: Patient survival was 77% at 2 years and 45% at 11.5 years after surgery. The survival rate of the limb was 90% at 11.5 years. The mean Enneking score was 19 points (range 7–27 points). The mean shoulder flexion was 34° (range 0–90°), abduction 33° (range 0–90°), and external rotation 12° (range 10–50°). Patients with a complete rotator cuff repair showed a significant better range of motion compared to patients with a partial or no repair (p <0.015). No signs of implant loosening were observed on postoperative radiographs. Seven complications occurred, five of them leading to implant revision. At 11.5 years after surgery, the survival rate for the whole cohort without complications was 72%, without revision of the implant 70%. Conclusions: Replacement of the proximal humerus with MUTARS endoprosthesis is a viable treatment option for bone tumors with satisfying results. [Copyright &y& Elsevier]

Abstract: Currently, porous tantalum (trabecular metal) implants are widely accepted and frequently used for primary and revision hip and knee replacement surgery. This study examines the results of porous tantalum endoprostheses used to reconstruct large skeletal defects following resection of bone tumors. Seven custom tantalum implants were used to reconstruct 7 patients following resection for skeletal sarcomas in the femur and proximal tibia. Patient ages ranged from 13 to 71, with a mean of 34 years. Minimum patient follow-up was 6 years. The average Musculoskeletal Tumor Society functional evaluation score was 95 % of normal. There were no infections, hardware failures, or adverse events. One implant was revised 98 months post insertion because of fibrosis, loss of motion and loosening. In this small clinical series, the use of porous tantalum for limb salvage reconstruction is shown to be safe, to successfully provide osteointegration and soft tissue ingrowth, and to facilitate return of limb girdle muscle function. [Copyright &y& Elsevier]

Summary: Pathological fractures in patients with primary bone sarcomas should not be considered an absolute indication for amputation. Initial fracture management should include cast immobilisation or external fixation avoiding tumour-cell dissemination. The extent of fracture displacement and the type of fracture stabilisation may affect the outcome of patients with primary bone sarcomas presenting with pathological fractures. Patients with high-grade primary bone sarcomas should be treated by neo-adjuvant chemotherapy, and limb-salvage surgery. Pathological fractures in chemo-resistant primary bone sarcomas are a relative contraindication for limb salvage surgery. [Copyright &y& Elsevier]

This article briefly describes the evolution of orthopaedic oncology as practised in India over the last two decades. Striking the right balance between adequate resection and functional reconstruction with locally available expertise and resources is a challenging task. Techniques practised by Indian surgeons' have garnered global acceptability, both as durable biological options and cost effective practices in a world which faces ever increasing healthcare budgetary constraints and limitations. [ABSTRACT FROM AUTHOR]