The risk for complications and reoperations with the use of mega prostheses in bone reconstructions

Christina Berger,David Wennergren,Peter Bergh,Sofia Larsson,Helena Brisby

doi:10.1186/s13018-021-02749-z

Abstract

BackgroundDespite a relatively high risk for complications and reoperations, mega prostheses are considered a useful method for reconstruction of bone defects after tumour resections. The total number of reoperations has not previously been described, and little is known about the complication rate of mega prostheses used for other indications than primary bone tumours.Questions/purposesThe current retrospective observational study aimed to describe the patient population treated with mega prostheses at Sahlgrenska University Hospital, Sweden, during 14 consecutive years, reports the complications leading to reoperation and the number and type of reoperations for different kinds of complications, and reports on implant survival.MethodsAll patients treated with a mega prosthesis, regardless of surgical indication and anatomical location, at Sahlgrenska University Hospital during the period 2006–2019 were identified. The medical records for all patients were reviewed. Data regarding age, sex, diagnosis, site of disease, bone resection length, chemotherapeutical treatment and postoperative complications including infections and oncological outcome, were collected and evaluated.ResultsOne hundred and fourteen patients treated with 116 mega prostheses were included in the study. The predominant indication for primary surgery with a mega prosthesis was sarcoma of either bone or soft tissue (53.5% of the patients). In total 51 prostheses (44%) did not require any reoperation after the primary surgery. The most common reason for reoperation was infection (22%) followed by soft tissue failure (13%). The risk for prosthetic infection was significantly higher in the group of patients operated due to sarcoma compared with all other indications for surgery regardless of surgical site (p = 0.004).ConclusionThe study reveals a total reoperation rate of 56% after reconstructive surgery using mega prostheses. Despite the high reoperation rates, at the end of the study period, 83% of the patients had still a functioning prosthesis. Therefore, the use of mega prostheses can be considered a reliable method for reconstruction of large bone defects in selected patients.Level of EvidenceLevel IV, therapeutic study.

Highlights

Despite a relatively high risk for complications and reoperations, mega prostheses are considered a useful method for reconstruction of bone defects after tumour resections
The use of mega prostheses can be considered a reliable method for reconstruction of large bone defects in selected patients
Data All patients treated with a mega prosthesis, regardless of indication for surgery and anatomical location, at Sahlgrenska University Hospital during the period from January 2006 to May 2019 were identified using the hospital’s operation planning systems and included in the study

Summary

Introduction

Despite a relatively high risk for complications and reoperations, mega prostheses are considered a useful method for reconstruction of bone defects after tumour resections. The total number of reoperations has not previously been described, and little is known about the complication rate of mega prostheses used for other indications than primary bone tumours. During the last 4 decades the use of mega prostheses, known as tumour endoprostheses, has radically changed the treatment options for patients with malignant primary bone tumours. Despite the need for wide surgical margins in order for malignant primary bone tumours to ensure complete removal, the use of mega prostheses, together with refined imaging technology and improved oncological treatment, has changed the preferred surgical treatment from amputation to limb-sparing surgery at many centres [4]. The surgery is often performed in young patients, some still growing, with a long remaining life expectancy and high demands on function which require excellent implant quality

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