COMPLICATIONS AND SURVIVAL OF MEGAPROSTHESES AFTER RESECTION OF BONE METASTASES

Abstract

Treatment of bone metastases is often palliative, aiming at pain control and stabilization or prevention ofpathological fractures. However, a complete resection with healing purposes can be performed in selectedcases. The aim of our work was to evaluate the survival of megaprostheses used for reconstruction afterbone metastases. Between January 2001 and March 2015, we implanted 169 Megasystem-C® (WaldemarLINK® GmbH & Co. KG, Hamburg, Germany) after bone metastasis resection. Patients, 95 females and74 males, were operated at an average age of 61 (12-87) years for proximal femoral resection in 135 (79.9%)cases, distal femur in 24 (14.2%), proximal tibia in 6 (3.6%), total femur in 3 (1.8%) and intercalary femurin 1 (0.6%). Mostly, breast cancer metastases (30.8%), kidney (17.8%) and lung (14.2%) were treated. Atan average follow-up of 21 (1-150) months, we found a 99.4% overall limb salvage and a 96.1% overallsurvival rate at 1 year, 92.8% at 2 years, and 86.8% at 5 and 10 years. We found 9 (5.3%) mobilizationcases of the proximal femoral implant, 3 needed surgical reduction; 2 (1.2%) cases of aseptic loosening ofthe prosthetic stem; 2 (1.2%) periprotetic infection cases, one requiring a 2-stage revision. Few literaturestudies have evaluated the survival of megaprosthetic implant in the treatment of bone metastases. Ourdata show how in this specific context the rate of complications is significantly lower than expected ingeneral orthopedic orthopedic surgery. The use of modular prostheses is a valid reconstructive strategyafter bone metastasis resection in selected patients. The rate of short-term complications is exceptionallylow; further studies will have to confirm this in the longer term.