Article
The use of megaprostheses in tumor and revision surgery in 310 patients
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Published: | June 13, 2005 |
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Between 1992 and 2002, endoprosthetic replacement with a MutarsR endoprostheses was performed on 310 patients after resection of a large bone segment. The mean age was 38.2 years (range, 7-89). The average follow-up was 3.5 years. Diagnosis was a malignant bone tumor in 230 patients, metastasis in 35, soft tissue sarcoma with bone involvement in 8, lymphoma in 3 and benignant tumours or tumour like lesions in 5 patients. In 29 patients the operation was performed in the case of revision surgery after failed endoprosthetic replacement or in the case of a comminuted fracture. The most common type of replacement was the distal femur in 104, proximal femur in 69, proximal humerus in 50 and proximal tibia in 41 patients.
The most common complication was infection in 30 patients (9.7%), predominantly in proximal femur (17.4%) and proximal tibia replacement (12.2%). Aseptic loosening was noted in 28 patients (9.0%), most common in a distal femur replacement (16.3%). Dislocation of a proximal femur replacement occurred in 10.1% of patients. However, no patient with a bipolar cup had dislocation. Wear of the load-bearing surfaces in distal femur replacement was noted 3.8%. Stem breakage occurred in 5 patients. At last follow-up, 22 patients had failed limb salvage because of recurrence and infection. In 4 patients amputation was avoided by rotationplasty.
Limb salvage with endoprosthesis was in most cases successful. The most common reasons for amputation or rotationplasty were recurrence and infection. Mechanical failures did not lead to amputation.