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Late Complications and Survival of Endoprosthetic Reconstruction after Resection of Bone Tumors

  • Symposium: Highlights of the ISOLS/MSTS 2009 Meeting
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

While complications following massive endoprosthetic reconstruction have been previously described, the incidence and effects of these complications over extended periods of time have not been well characterized in large series.

Questions/purposes

We therefore determined: (1) incidence and types of complications; (2) relative risk of complications; (3) likelihood of secondary complications; (4) whether modularity altered such complications; (5) implant failure and limb salvage rates and (6) implant survival over extended followup.

Methods

We retrospectively reviewed 232 patients (241 implants: 50 custom,191 modular) who underwent endoprosthetic reconstruction for malignant and aggressive bone tumors between 1980 and 2002. Complications were classified as infection, mechanical, superficial soft tissue, deep soft tissue, or dislocation. Survival was determined by Kaplan-Meier analysis. Minimum followup was 5 years (mean: 10 years; range: 5–27 years).

Results

One hundred thirty-seven of 232 patients (59%) underwent a single reconstruction. Ninety-five patients had 242 additional procedures. Forty-four revised patients retained their original prosthesis. Limb salvage rate was 90%; implant failure (removal of the cemented part) was seen in 29% (70/241) with a median survival of 190 months. Twenty-five of 50 custom implants failed (8 then failed again) while 30/180 modular implants failed (7 then failed again). Of 70 instances of implant failure, 38/70 were mechanical, 27/70 infectious. Risk of infection increased 30% after a second procedure; 16 of 24 amputations were performed because of infection.

Conclusions

Mechanical complications were the most common cause of implant failure. Infection was the leading cause of both complication and amputation; risk of infection increased substantially with revision surgery. Modular implants had fewer mechanical complications, thus leading to fewer revisions and subsequent infections.

Level of Evidence

Level III, therapeutic study. See the guidelines for authors for a complete description of levels of evidence.

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Acknowledgments

We thank Hart Squires and Eloise Salmon, Research Assistants, Orthopedic Oncology, Washington Cancer Institute; and Morris Wu, MD, and Felasfa Wodajo, MD, Fellows, Orthopedic Oncology, Washington Cancer Institute for their contributions to this project.

Author information

Authors and Affiliations

  1. Washington Cancer Institute at Washington Hospital Center, Washington, DC, USA

    Ahmad Shehadeh MD, Jenna Noveau BS, Martin Malawer MD, FACS & Robert Henshaw MD

  2. Orthopedic Oncology, King Hussein Cancer Center, Amman, Jordan

    Ahmad Shehadeh MD

  3. University of Maryland School of Medicine, Baltimore, MD, USA

    Jenna Noveau BS

  4. Orthopedic Oncology, Georgetown University Medical Center, Washington, DC, USA

    Martin Malawer MD, FACS

  5. Orthopedic Oncology, Washington Cancer Institute, Washington, DC, USA

    Martin Malawer MD, FACS

  6. Orthopedic Oncology, Georgetown University Medical Center, Washington, DC, USA

    Robert Henshaw MD

  7. Orthopedic Oncology, Washington Cancer Institute, 110 Irving Street NW, Room C-2173, Washington, DC, 20010, USA

    Robert Henshaw MD

Authors
  1. Ahmad Shehadeh MD
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  2. Jenna Noveau BS
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  3. Martin Malawer MD, FACS
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  4. Robert Henshaw MD
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Corresponding author

Correspondence to Robert Henshaw MD.

Additional information

One author (MM) received royalties and consulting fees from Stryker Howmedica. No direct or indirect funding from any institution was received for this study. All of the remaining authors certify that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution either has waived or does not require approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at Washington Hospital Center, Washington, DC, USA.

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Shehadeh, A., Noveau, J., Malawer, M. et al. Late Complications and Survival of Endoprosthetic Reconstruction after Resection of Bone Tumors. Clin Orthop Relat Res 468, 2885–2895 (2010). https://doi.org/10.1007/s11999-010-1454-x

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  • DOI: https://doi.org/10.1007/s11999-010-1454-x

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