[Reconstruction of massive femoral bone defects with modular endoprostheses in bone tumors and non-oncologic conditions]
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Published on: October 12, 2016
Ezequiel Ortiz1, Marcos Deimundo1, Eduardo Abalo1
1Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina.
Introduction:
Massive bone defects remain a significant challenge in limb reconstruction and salvage procedures. The aim of this study was to analyze the clinical outcomes and implant survival in a series of patients undergoing extensive femoral resections reconstructed with modular megaprosthesis.
Materials And Methods:
A retrospective case analysis was conducted including patients who underwent massive femoral bone resections, with a median age of 59 years (IQR 57-70) and a mean follow-up of 6.7 years (SD 4.9). Twenty-nine endoprostheses were used for oncologic resections and eleven for non-oncologic massive bone defects. Reconstructions included 21 proximal femurs, 17 distal femurs, one intercalary prosthesis, and one total femur replacement. Implant survival, complication rates and their management were analyzed. Functional outcomes were assessed using the Musculoskeletal Tumor Society (MSTS) scoring system.
Results:
Nineteen patients (47.5%) experienced complications: 9 in proximal femoral reconstructions and 7 in distal femoral cases. The most frequent complication was periprosthetic joint infection 20% (8), followed by prosthetic dislocation 15% (6), and aseptic loosening 10% (4). The MSTS improved from (11.8 ± 6.2) preoperatively to (17.3 ± 7.9) (p< 0.001). The incidence of death was higher in patients with an oncologic diagnosis compared to non-oncologic diagnosis. without reaching statistical significance.
Conclusion:
Modular resection endoprostheses offer a versatile option for segmental bone reconstruction, providing acceptable mid-term functional outcomes. However, prosthetic instability, particularly in proximal femoral replacements and periprosthetic joint infection remains a frequent relevant complication.
