engleski

Endoprosthesis in lower limb bone tumor treatment

INTRODUCTION: The success of limb salvage is the result of advances in the understanding of the biology and staging of tumors, improvement in the reconstructive techniques and the development of effective adjuvant chemotherapy for primary tumors, and progress is still continuing. Endoprosthetic replacement offers several advantages, such as early stability, mobilisation and weight bearing, a shorter operating time and hospital stay in comparison to biological reconstructions. It also allows the early introduction of postoperative adjuvant therapy. Reconstruction with a modular endoprosthesis after resection of a bone tumor gives good functional results in most of the cases. For medical, surgical and rehabilitative advances, limb-salvage surgery has surpassed amputation as the primary treatment for malignant bone tumors. PATIENTS AND METHODES: Presented data are the results from Department of Orthopaedic Surgery Zagreb University School of Medicine. We retrospectively analyzed 90 patients who underwent “ en bloc” resection and modular endoprosthesis reconstruction in the lower limbs between 1987– 2003. After resection of tumor, reconstruction was performed with a modular endoprostheses (by Howmedica: KFTR, designed by Kotz ; or by W. Link or Lima-Lto: Revision system, designed by Wagner). Only proximal femur, distal femur, and proximal tibia resections were included in this study. RESULTS: Malignant bone tumors were present in 58 patients (64.5%), benign tumors in 16 (17.8%), metastases in 8 (8.9%), tumor-like lesions in 4 (4.4 %) and non-tumor related destruction of the femur in 4 patients (4.4%). High grade tumors were found in the majority of malignant bone tumors (70.7%). Treatment complications, which occurred in 26 patients, were: local recurrence of the tumor, deep infection, acetabular destruction following hemiarthroplasty, recurrent dislocations of endoprosthesis, periprosthetic fracture and hardware problems. In total, 23 patients (25.6%) died due to tumors. CONCLUSION: Treatment must be strictly prioritised in terms of the patient’ s life, the limb, its function, length equalisation and cosmetic appearance. Orthopaedic intervention in the care of children and young adults with oncological conditions must be individualized. In our opinion, endoprostheses should be considered as the treatment of choice for bone tumors in the hip and knee joint region.

endoprosthesis; bone tumor; limb salvage surgery; orthopaedic treatment

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