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Megaprosthesis in large bone defects: opportunity or chimaera?

G M Calori1, M Colombo1, C Ripamonti1

  • 1Orthopaedic Institute, G. Pini, University of Milan, Italy.

Injury
|October 12, 2013
PubMed
Summary

Lower limb megaprosthesis implantation offers a viable solution for extensive bone defects, restoring function in complex orthopedic oncology cases. While long-term outcomes require further study, initial results show promising functional recovery and joint articulation.

Keywords:
Large bone defectsMegaprosthesisNon-unionProsthesis revision

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Area of Science:

  • Orthopaedic Surgery
  • Oncology
  • Biomedical Engineering

Background:

  • Megaprosthesis implantation is a critical option for orthopedic oncologic surgeons managing large bone defects in the limbs.
  • These prostheses replace skeletal segments, including long bones and joints, offering reconstructive solutions.

Purpose of the Study:

  • To retrospectively evaluate the clinical and radiological outcomes of lower limb megaprosthesis implantation.
  • To assess the effectiveness of one-step versus two-step implantation techniques based on patient condition.

Main Methods:

  • A cohort of 32 patients received mono- and bi-articular megaprosthesis for proximal femur, distal femur, proximal tibia, and total femur reconstructions.
  • Follow-up averaged 18 months (range 3 months to 5 years), with clinical and radiographic assessments at regular intervals.
  • Inflammatory blood markers were monitored for at least two months post-implantation.

Main Results:

  • Encouraging clinical results were observed, including good joint articulation and acceptable functional recovery without significant somato-sensory or motor deficits.
  • Pre-operative planning and surgical technique must prioritize the evaluation and preservation or reinforcement of the extensor apparatus.

Conclusions:

  • Megaprosthesis serves as a potential solution for severe bone loss and prosthetic failure in orthopedic surgery, particularly in oncological cases.
  • Restoring patient functionality, even if not fully, is a significant benefit in oncological surgery.
  • Despite uncertainties in long-term prosthesis survival due to high cancer mortality, megaprosthesis offers a valuable option for highly disabling conditions.