Commentary on an article by Eric R. Henderson, MD, et al.: “Failure Mode Classification for Tumor Endoprostheses: Retrospective Review of Five Institutions and a Literature Review”

Abstract

Surgeons have always preferred limb salvage surgery for patients with extremity tumors, and even before adjuvant chemotherapy and the use of irradiation in association with surgery, approximately a quarter of patients with an extremity tumor requiring surgical resection had a limb salvage operation. Before the 1970s, almost all osseous reconstructions involved the use of autogenous bone grafts and the associated joint was either managed with arthrodesis or left flail. During the 1970s, as total joint replacements became functional, custom endoprostheses were used to replace resected bone and restore joint function. The initial endoprostheses were not well designed and performed poorly. It was not until the mid-1980s that endoprostheses with improved mechanics and modularity were available. These authors have collected follow-up data from patients treated with the early custom endoprostheses and from those treated with the modern modular endoprostheses. To borrow a principle of internal fixation of fractures, the success of an endoprosthesis is a race between its failure and the patient’s death. Most endoprostheses eventually fail because the patients are, for the most part, young and active, but we expect the endoprostheses to function for at least fifteen years and, we hope, longer. That only a quarter of the endoprostheses in this review failed is due to a …