Functional Outcomes and Complications of Megaprosthetic Reconstruction in Limb-Salvage Surgery for Musculoskeletal...

Limb salvage surgery (LSS) has replaced amputation in most cases of primary malignant bone tumors, achieving comparable oncologic control while preserving limb function and quality of life. Among reconstruction techniques, megaprosthetic replacement offers immediate stability, modular flexibility, and early rehabilitation potential. However, variability in tumor site, prosthesis design, and post-operative care continues to influence functional outcomes and complication rates across regions.

A comprehensive scoping review of studies published between 2014 and 2025 was conducted using PubMed, Scopus, Google Scholar, and EBSCO databases. Nineteen studies involving more than 600 patients who underwent LSS with megaprosthetic reconstruction for primary or recurrent bone tumors were analysed. Extracted data included patient demographics, tumor type, prosthesis characteristics, functional outcomes (musculoskeletal tumor society [MSTS], Toronto extremity salvage score [TESS], range of motion [ROM], gait parameters, Karnofsky Performance Status [KPS], return to work), and complications such as infection, mechanical failure, and aseptic loosening.

Functional recovery was favourable, with mean MSTS and TESS scores ranging from 66% to 89%. Distal femur reconstructions demonstrated the highest functional outcomes (>80%), while proximal femur and humerus reconstructions showed slightly reduced scores (66-73%) due to soft-tissue limitations and reduced mobility. Improvements in ROM, gait symmetry, and KPS indicated successful restoration of biomechanics and independence. Complications included deep infections (5-24%), aseptic loosening (6-15%), and mechanical failures (up to 12.5%), most commonly in expandable implants. Despite these, limb retention exceeded 88% at 5 years, and long-term implant survival remained encouraging across different centers. Socioeconomic disparities and limited access to rehabilitation were identified as key factors affecting recovery and patient satisfaction.

Megaprosthetic reconstruction remains a cornerstone of modern LSS, providing durable oncologic safety and functional restoration. Early physiotherapy, infection prevention, and careful prosthesis selection are vital for optimising outcomes. Future studies should include standardized reporting of functional and psychosocial parameters and integrate socioeconomic factors to ensure equitable, patient-centred recovery worldwide.