Reoperation results after segmental prosthetic replacement of bone and joint for limb salvage

Thirty-eight patients who had undergone reoperations because of complications or implant failure subsequent to a prosthetic replacement for limb salvage procedure for the treatment of musculoskeletal neoplasm were followed until death or a minimum of 2 years, then reviewed. The mean follow-up time before reoperation was 35 months, and the mean follow-up time after reoperation was 51 months. The major indication for reoperation was aseptic loosening (34%). The reoperative procedures included 19 major revisions of the prosthesis and 19 other reconstructions. There were 7 complications, including 1 local tumor recurrence. Twelve patients died of metastatic disease at a mean of 16 months after reoperation. The probability for patient survival was 74% beyond 3 years and 67% after 5 years. The surgical staging, site of tumor involvement, and type of reoperation all correlated with long-term patient survival. Overall, 72% of the patients achieved excellent or good functional results: a rate that was slightly inferior to that of the initial arthroplasty. Despite this, 84% of the implants demonstrated either excellent or good performance at 5 years. Therefore, reoperation because of a failed initial prosthesis or for other reasons after a limb salvage procedure using custom-designed or modular-segmental bone and joint implants seems feasible with no significant effect on subsequent functional performance or on patient survival.