Outcomes of Megaprosthesis Reconstruction for the Salvage of Failed Osteoarticular Allograft Around the Knee implanted before Skeletal Maturity in Primary Bone Sarcoma: A Case-Series

Document Type : RESEARCH PAPER

Authors

Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

Abstract

Objectives: Functional expectations following the salvage of a failed osteoarticular allograft are poorly 
described. In this study, we aim to evaluate functional outcomes, implant survival, and complications 
of the megaprosthesis in salvaging a failed osteoarticular allograft around the knee.
Methods: We retrospectively reviewed the medical profiles of 21 skeletally mature patients who underwent 
megaprosthesis reconstruction to salvage a failed osteoarticular allograft around the knee implanted before skeletal 
maturity. The location of reconstruction was the proximal tibia in 13 patients and the distal femur in eight patients. 
Knee function was evaluated by the Musculoskeletal Tumor Society (MSTS) score and the Toronto Extremity 
Salvage Score (TESS).
Results: The mean age of patients was 16±1.7 years. The mean interval between the primary (allograft) and 
secondary (megaprosthesis) reconstructions was 59.4±23.6 months. At an average follow-up of 51.2 months, the 
mean knee range of motion was 101.2±15.6°. The mean MSTS score and TESS were 83.6±7 and 86.6±7.9, 
respectively. The mean limb length discrepancy was 2.5±1 cm before and 0.36±0.74 cm after the operation 
(P<0.001). Six postoperative complications (28.6%) occurred in this series, including one wound dehiscence, one 
periprosthetic fracture, two acute infections, one aseptic loosening, and one delayed periprosthetic infection. Only 
the last two complications required revision. Accordingly, the two- and five-year implant survivals were 95.7% and 
90%, respectively.
Conclusion: Megaprosthesis is a viable option for salvaging failed osteoarticular allografts around the knee. It also 
provides the opportunity to correct the limb length discrepancy.
 Level of evidence: IV

Keywords

Main Subjects

References

  1. Puri A. Limb salvage in musculoskeletal oncology: Recent advances. Indian J Plastic Surgery. 2014; 47(2):175-84. doi:10.4103/0970-0358.138937.
  2. Bus M, Van De Sande M, Taminiau A, Dijkstra P. Is there still a role for osteoarticular allograft reconstruction in musculoskeletal tumour surgery? A long-term follow-up study of 38 patients and systematic review of the literature. Bone Joint J. 2017; 99(4):522-530. doi: 10.1302/0301-620X.99B4.BJJ-2016-0443.R2.
  3. Zeegen EN, Aponte-Tinao LA, Hornicek FJ, Gebhardt MC, Mankin HJ. Survivorship analysis of 141 modular metallic endoprostheses at early follow-up. Clin Orthop Relat Res (1976-2007). 2004; 420:239-250.
  4. Verbeek BM, Kaiser CL, Paulino Pereira NR, et al. Primary arthroplasty in healed osteoarticular allograft in patients with history of primary femoral bone tumors. Surg Oncol. 2017; 26(4):498-505. doi:10.1016/j.suronc.2017.10.003.
  5. Foo LS, Hardes J, Henrichs M, Ahrens H, Gosheger G, Streitbürger A. Surgical difficulties encountered with use of modular endoprosthesis for limb preserving salvage of failed allograft reconstruction after malignant tumor resection. J Arthroplasty. 2011; 26(5):744-50. doi:10.1016/j.arth.2010.06.011.
  6. Wang J, Temple HT, Pitcher JD, Mounasamy V, Malinin TI, Scully SP. Salvage of failed massive allograft reconstruction with endoprosthesis. Clin Orthop Relat Res. 2006; 443:296-301. doi:10.1097/01.blo.0000194071.40892.ab.
  7. Jeys LM, Kulkarni A, Grimer RJ, Carter SR, Tillman RM, Abudu A. Endoprosthetic reconstruction for the treatment of musculoskeletal tumors of the appendicular skeleton and pelvis. J Bone Joint Surg Am. 2008; 90(6):1265-71. doi:10.2106/jbjs.f.01324.
  8. Ahlmann ER, Menendez LR, Kermani C, Gotha H. Survivorship and clinical outcome of modular endoprosthetic reconstruction for neoplastic disease of the lower limb. J Bone Joint Surg Br. 2006; 88(6):790-5. doi:10.1302/0301-620x.88b6.17519.
  9. Jamshidi K, Karimi A, Hoseinzadeh Moghadam M, Mirzaei A. Effect of an Endoprosthetic Reconstruction Tube and Medial Gastrocnemius Flap on Extensor Mechanism Function After Oncologic Prosthesis Reconstruction of the Proximal Tibia. J Arthroplasty. 2022; 37(11):2233-2238. doi:10.1016/j.arth.2022.05.042.
  10. Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 1993 ;( 286):241-246.
  11. Davis AM, Wright JG, Williams JI, Bombardier C, Griffin A, Bell RS. Development of a measure of physical function for patients with bone and soft tissue sarcoma. Qual Life Res.1996; 5(5):508-16. doi:10.1007/bf00540024.
  12. Sabharwal S, Kumar A. Methods for assessing leg length discrepancy. Clin Orthop Relat Res. 2008; 466(12):2910-22. doi:10.1007/s11999-008-0524-9.
  13. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957; 16(4):494-502. doi:10.1136/ard.16.4.494.
  14. Henderson ER, O'Connor MI, Ruggieri P, et al. Classification of failure of limb salvage after reconstructive surgery for bone tumours: a modified system including biological and expandable reconstructions. Bone Joint J. 2014; 96-

 

B (11):1436-40. doi:10.1302/0301-620x.96b11.34747.

  1. Jamshidi K, Najd-Mazhar F, Abolghasemzadeh Ahangar F, Mirzaei A. The effect of cement augmentation and anteromedial plating on proximal humerus allograft reconstruction. J Orthop Sci. 2017; 22(1):69-74. doi:10.1016/j.jos.2016.09.002.
  2. Jamshidi K, Mirkazemi M, Gharedaghi M, et al. Bipolar hemiarthroplasty versus total hip arthroplasty in allograft-prosthesis composite reconstruction of the proximal femur following primary bone tumour resection. Bone Joint J. 2020; 102-B(4):524-529. doi:10.1302/0301-620x.102b4.bjj-2019-0925.r2.
  3. Jamshidi K, Ramezan Shirazi M, Bagherifard A, Mirzaei A. Curettage, phenolization, and cementation in paediatric Ewing's sarcoma with a complete radiological response to neoadjuvant chemotherapy. Int Orthop. 2019; 43(2):467-473. doi:10.1007/s00264-018-4094-5.
  4. Zeegen EN, Aponte-Tinao LA, Hornicek FJ, Gebhardt MC, Mankin HJ. Survivorship analysis of 141 modular metallic endoprostheses at early follow-up. Clin Orthop Relat Res. 2004 ;( 420):239-50. doi:10.1097/00003086-200403000-00034.

 

 

 

 

 

The Archives of Bone and Joint Surgery
Volume 12, Issue 3
March 2024
Pages 211-218

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History

  • Receive Date: 07 August 2023
  • Revise Date: 08 January 2024
  • Accept Date: 13 December 2023

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