Over a period of time limb salvage surgery has evolved as a gold standard for salvageable malignant bone tumors. In tumors around the joint, megaprosthesis is the most preferred reconstruction option. Although custom megaprosthesis was widely used, it is now been replaced by modular prosthesis. We have analysed our series of modular and custom megaprosthesis cases done for bone tumors and the results are being presented.
Material & Methods:
Series of surgeries performed by the same surgeon in various hospital of Bangalore have been compiled from June 2009 to December 2014. All primary and secondary bone tumors involving both upper and lower limbs have been included.All patients where staged both locally and systemically. All patients have undergone wide excision and reconstruction with cemented custom or modular megaprosthesis. Patients where followed up every 3 months with local radiographs, every 6 months lung CT Scan and yearly bone scan.
58 patients from the age of 8 to 72 years have been studied with a minimum follow up period from 3 months to a maximum 66 months. Malignant tumor cases were 53 and remaining were benign tumors. Osteosarcoma cases were 33, Ewings sarcoma were4, Chondrosarcoma was 3, Giant cell tumors were 5, bone metastasis cases were 5 and miscellaneouscases were 8. 2 patients were implanted with non-invasive expandable megaprosthesis.5 patients were implanted with Stryker GMRS. 1 patient had custom made prosthesis from Medani. Remaining patients were implanted with Sushrut Restor implant. 7 patients had implant with a rotating hinge and remaining were total constrained joints. 4 patients had total Femur replacement, 2 had total Humerus replacement, 2 had total elbow replacement, 8 had proximal Humerus hemiarthroplasty megaprosthesis, 5 had proximal Femur megaprosthesis, and the remaining 37 had knee megaprosthesis. 9 cases had pathological fracture at presentation. 14 cases had undergone one or more surgeries prior to presentation. 6 cases had distant metastasis at presentation.
Post surgery, 2patients have chronic infection.3 had transient nerve injury which recovered, 2 had vascular injury which was repaired. 3 had minor flap necrosis which healed on its own. 1 had major flap necrosis which needed surgery. 3 patients had local recurrence which was excised. 7 patients needed resurgery. 3 had wound wash, 3 had excision of local recurrence and one for vascular repair. 8 patients had distant metastasis. 12 patients have died, out of which 6 died of metastasis, 4 died during chemotherapy, 2 died after completion of chemotherapy due to other causes.12 patients were lost for follow up. No one had implant removal or implant breakage or clinical evidence of loosening. The average MSTS score was 25 in lower limb cases and 23 in upper limb cases.
Megaprosthesis is an excellent option for reconstructing defects around the joints following tumor excision. No implant related complication where seen in our series so far. Though the followup period is short, early results are promising with low complications rate. Long term results are awaited.
How to Cite this Abstract
Srinivas C H. Role of Megaprosthesis in treatment of Bone Tumors – our results.International Journal of Conference Proceedings. March 2015;(2015):13.