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The Journal of Bone and Joint Surgery, Vol 77, Issue 8 1154-1165, Copyright © 1995 by Journal of Bone and Joint Surgery, Inc
Prosthetic survival and clinical results with use of large-segment replacements in the treatment of high-grade bone sarcomas
MM Malawer and LB Chou
Washington Cancer Institute, Washington Hospital Center, Washington, D.C. 20010, USA.
We evaluated the long-term clinical results and the survival of the
prostheses in eighty-two patients who had had a limb-sparing procedure by
means of the implantation of a large-segment prosthesis. All patients had
had a high-grade bone sarcoma of the distal, middle, or proximal part of
the femur; the proximal part of the humerus; the proximal part of the
tibia; or the pelvis. The duration of follow-up ranged from two to twelve
years (median, three and one-half years). Function was evaluated with the
revised 30-point classification system of the Musculoskeletal Tumor
Society. The survival of the prostheses was analyzed with regard to several
variables with use of Kaplan-Meier survival estimates. Sixty-eight patients
were alive at the latest follow-up evaluation. The survival rate of the
prostheses was 83 per cent at five years and 67 per cent at ten years.
Twelve prostheses were revised, and eleven revisions were successful. The
rate of revision was highest (six of thirteen) in the patients who had had
a tumor of the proximal part of the tibia. In contrast, only three (10 per
cent) of the thirty-one patients who had had a tumor of the distal part of
the femur and three (10 per cent) of the twenty-nine who had had a tumor of
the proximal part of the humerus had a revision. Eleven patients (13 per
cent) had an infection, which necessitated an amputation in six. Five
patients (6 per cent) had a local recurrence, and nine patients (11 per
cent), including the six already mentioned, ultimately needed an
amputation. Patients who had had a tumor of the proximal part of the
humerus had the highest functional scores, while those who had had a tumor
of the proximal part of the tibia had the lowest scores. Large-segment
prostheses were a good reconstructive option for the treatment of
high-grade bone sarcomas in our patients. The rates of long-term survival
of the prostheses were acceptable and the functional results were good or
excellent after this form of treatment at most of the anatomical sites at
which they were used.
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