engleski

Complications following endoprosthetic reconstruction after bone tumor resection in the hip and knee region

BACKGROUND: Many studies were performed to investigate endoprosthetic survival rates after tumor resection, but the results cannot be summarized and systematic review cannot be performed, mostly because of a relatively small number of patients, as well as different models and principles of endoprosthesis. Generally, endoprosthetic replacement offers several advantages over other available reconstructive methods in bone tumor treatment, such as early stability, mobilization and weight bearing, a shorter operating time and hospital stay in comparison to biologic reconstructions. It also allows early introduction of post-operative adjuvant therapy. The purpose of our study was to assess the outcome and to investigate complications of the endoprosthetic reconstruction after bone tumor resection in the hip and knee joint region, performed at our Department of Orthopaedic Surgery. PATIENTS AND METHODS: This retrospective study was based on 103 patients (104 operations) who in the period 1987-2005 underwent “ en bloc” resection and endoprosthesis reconstruction in the hip and knee joint region. The location of tumor was proximal femur (44 patients, 45 operations), distal femur (36 patients), or proximal tibia (23 patients). After proximal femur resection, reconstruction was performed with endoprosthesis “ Howmedica, KFTR” , designed by Kotz ; or with endoprosthesis “ W.Link, Lima-Lto” , designed by Wagner. Knee joint was reconstructed with endoprosthesis “ Howmedica, KFTR” , designed by Kotz, after distal femur or proximal tibia resection. The malignant bone tumors were present in 70 patients (67%), benign tumors in 18 (17%), metastasis in 8 patients (9 operations) (9%), and tumors like lesions in 7 patients (7 %). RESULTS: In total, 24 patients (23% of all patients = 34% of patients with malignant bone tumor) died due to tumor. Treatment complications, which occurred in 28 patients are as follows: local recurrence of tumor (11 patients), deep infection (4 patients), acetabular destruction following hemiarthroplasty (4 patients), recurrent dislocations of endoprosthesis (4 patients), periprosthetic fracture (2 patients), stress fracture (1 patient), aseptic loosening (1 patient), and technical problems with endoprosthesis (1 patient). DISCUSSION AND CONCLUSIONS: Complications following endoprosthetic reconstruction in bone tumor treatment are not rare, occurred in 35% of our patients. We believe the number of complications can be decreased if surgeons with expertise in musculoskeletal oncology undergo limb-sparing procedures. Tumor endoprostheses can give a satisfactory functional outcome, and should be considered as a treatment of choice for reconstruction after bone tumor in the hip and knee joint region.

bone tumor; limb salvage surgery; endoprosthesis

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