Megaprosthetic reconstruction for malignant bone tumors: complications and outcomes

Limb salvage surgery and reconstruction of bone defects is challenging in orthopaedic oncology. Allogenic and autologous bone grafting are well-recognized methods for bone reconstruction. Custom-made and modular, cemented and cementless, mega-prostheses provide the modular options needed intraoperatively to bridge variable bone defects. However, these mega-prostheses have worse long-term results compared to conventional total joint replacements. Mechanical failure, aseptic loosening, infection, dislocation, skin necrosis, extensor mechanism ruptures and periprosthetic fractures are acknowledged complications of orthopaedic oncology procedures. These complications are due to the large defects that need to be bridged with a more difficult fixation in the diaphysis of the native bone, the more complex restoration of joint biomechanics, the extensive soft-tissue resection, the lengthy surgical operations, and the need for chemotherapy and radiation therapy. Because of the difficulties and the high rate of complications associated with the implantation of such highly modular systems, the treatment of patients with malignant bone tumors should only be carried out in specialized centers.