Short Term Complications and Functional Results of Sarcoma Limb Salvage Surgeries

Limb salvaging surgeries are current surgical treatment of extremity bone sarcomas. Resected bone replacement consists of two main methods; tumor prosthesis versus structural allograft. Biological reconstruction with an allograft is an economic cheap method in young sarcoma patients, however, the surgeons are more convinced with tumor prosthesis replacement.

We evaluated the short-term complications and functional results of 40 patients with aggressive extremity tumors in a retrospective cohort study. The mean age of cases was 25 and we followed them for 24 months. 17 patients underwent tumor prosthesis replacement after wide resection of limb sarcomas. 16 cases had structural allograft reconstruction and 7 patients treated with amputation. We matched confounders including age, sex, blood cell count and chemotherapy treatment in the study groups.

We found 15 major complications (45.5%) in limb salvage surgeries composing infection, allograft nonunion, allograft fracture, prosthesis fracture, prosthesis loosening and device failure that needed another surgery to be resolved. We had 10 major complications in allograft group (62%) and 5 in tumor prosthesis group (29.4%). Although the rate of complications was higher in allograft group, it didn't statistically indicate strong correlation (Fisher's exact: 0.084). Mean Musculo-Skeletal tumor rating Scale (MSTS) score was 25.8(73.7%) and 22.3(63.7%) in allograft group and prosthesis cases respectively. MSTS score had a normal distribution in the different groups with no significant difference between them.

Although complications were higher in the allograft group, allograft could be offered to bone sarcoma patients, whom are predicted to have short life expectancy.