Endoprosthetic reconstruction after resection of musculoskeletal tumors

In the literature, long-term survival of endoprosthetic reconstruction varies widely. Few long-term reports analyze both anatomical and disease-specific implant and patient survival. We retrospectively reviewed the results of 489 patients who underwent resection of musculoskeletal tumor and reconstruction using an endoprosthetic device between December 1980 and August 2009. Implants were considered to have failed if the cemented components were revised for any reason, or the major body segment was removed for any reason. Implant survival, limb survival, and patient survival were determined using the Kaplan-Meier method. Sixty-one (12.5%) of the 489 cases were revised at a mean follow-up of 6.6 years (range, 1 month to 27.3 years). Kaplan-Meier analysis revealed overall implant survival of 23.1% at 27 years (95% CI, 5.0% to 100.0%). At 15 years, modular implants outperformed older custom designs (90.8% and 59.6% survival, respectively; P < .05). Complications that led to failure of the limb-salvage effort included local recurrence (21 cases), infection (11), positive surgical margins (3), and intractable pain (1). Thirty-six amputations (7.4%) were performed. There were no cases of amputation performed as a direct outcome of mechanical failure. Endoprosthetic implants provide a reliable, durable method of reconstruction after resection of musculoskeletal tumors.