The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

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
Khodamorad Jamshidi
Wael Ammar
Khalil Kargar Shooroki
Alireza Mirzaei
Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
10.22038/abjs.2023.74212.3434
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
Bone tumor
Knee
Oncologic prosthesis
Osteoarticular allograft
Salvage
Subjects
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The Archives of Bone and Joint Surgery
Volume 12, Issue 3
March 2024
Pages 211-218

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