Evaluation of endoprosthetic reconstruction after distal femoral bone-tumor resection

Abstract

Background Endoprosthetic reconstruction is considered a reliable reconstructive option after periarticular tumor resection as it provides component modularity, improved fixation, near-anatomic appearance, and good functional outcomes. This study aimed at evaluation of the outcomes of the cemented modular distal femoral tumor prosthesis after wide intra-articular resection of aggressive or malignant bone tumors. Patients and methods The mean age of the patients was 29.77 years. There were 12 males and six females. The final diagnosis was osteosarcoma in 13 patients, giant-cell tumor in three patients, and chondrosarcoma in two patients. All patients with osteosarcoma received neoadjuvant chemotherapy. Wide intra-articular tumor resection was done through the anteromedial approach of the femur with reconstruction by cemented modular endoprosthesis. Results One patient died with pulmonary metastasis. The 5-year cumulative patient-survival rate was 88.88% and 5-year cumulative implant-survival rate was 93.65%. Local recurrence occurred in one (5.5%) patient, while distant metastasis occurred in another. Both of those patients died and were consequently excluded from further statistical work. The mean functional score, the modified Musculoskeletal Tumor Society rating scale, was 73.7%. Complications occurred in five (27.7%) patients. One (5.5%) patient had had a deep infection with failure of reconstruction requiring two-staged revision. There were four cases of superficial wound infection that were successfully treated conservatively. There was no aseptic loosening, periprosthetic fracture or dislocation, soft-tissue problem, or vascular impairment in the operated limb till the final follow-up. Conclusion Modular prosthetic reconstruction after wide resection of aggressive and malignant bone tumors of distal femur offers satisfactory clinical and functional outcomes as it allows immediate postoperative stability, early mobilization, and rehabilitation, with reasonable complication rate. Level of evidence: IV case series.