Abstract
Simple SummaryMalignant bone and soft tissue tumors are usually surgically removed with an envelope of healthy tissue as a barrier. If located in the long bones of the upper and lower extremity, this approach leads to a large bone defect commonly affecting a joint. One way to rebuild the bone defect and the neighboring joint is the use of a megaprosthesis that is anchored in the remaining bone comparable to a conventional joint replacement. In general this approach is popular as it provides early stability and allows the affected patient to begin rehabilitation early on. However, complications leading to long-term unplanned reoperation are common. This article provides an overview of current implant survival, types of complication and long-term outcomes of megaprostheses used following tumor resection.Megaprosthetic reconstruction of segmental bone defects following sarcoma resection is a frequently chosen surgical approach in orthopedic oncology. While the use of megaprostheses has gained popularity over the last decades and such implants are increasingly used for metastatic reconstructions and in non-tumor cases, there still is a high risk of long-term complications leading to revision surgery. This article investigates current implant survivorship, frequency and types of complications as well as functional outcomes of upper and lower limb megaprosthetic reconstructions.
Highlights
The treatment of extremity bone sarcoma is an interdisciplinary challenge
This review investigates current survivorship and complications of megaprosthetic reconstruction after upper and lower extremity sarcoma resection as well as present challenges and debates in this evolving field
Soft tissue failures involving the surrounding tissues leading to dislocation, implant migration or complications regarding implant coverage and wound healing are common in megaprosthetic reconstructions of the shoulder joint, which is best investigated for proximal humerus replacements (PHRs) [7,8,16,17]
Summary
The treatment of extremity bone sarcoma is an interdisciplinary challenge. While (neo-). Megaprostheses have the advantage of a wide availability of different off-the-shelf modular implant systems that allow for individual, exact defect reconstruction, immediate, primary stability and the possibility to start early weight-bearing and functional rehabilitation. Despite these advantages and all efforts to improve implant design, the massive implants are expected to experience long-term complications associated with revision surgery in almost 50% of reconstructions [4,8]. This review investigates current survivorship and complications of megaprosthetic reconstruction after upper and lower extremity sarcoma resection as well as present challenges and debates in this evolving field. Articles from large, dedicated centers in Europe and North America including a minimum number of patients or long-term studies were preferably included whenever possible
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