Department of Orthopaedic Surgery and Traumatology, Marmara University, School of Medicine, İstanbul, Turkey.
Acta Orthop Traumatol Turc. 2021 Mar;55(2):147-153. doi: 10.5152/j.aott.2021.20101.
The study was aimed to determine the survivorship and functional outcomes of modular endoprosthetic reconstruction in the management of primary and metastatic bone tumors of the lower limbs and to investigate the rate and causes of implant failure.
A total of 84 limbs of 82 patients (49 male, 33 female; mean age=48 years, age range=13-78 years) with a minimum follow-up of 12 months in whom resection and modular endoprosthetic reconstructions were performed for primary or metastatic bone tumors of the lower extremity were retrospectively reviewed and included in the study. The mean follow-up was 43 (range=13-119) months. Functional status was assessed using the Musculoskeletal Tumor Society (MSTS) scoring system at the final follow-up. Implant survival was defined as the time from implantation until partial or complete exchange of the prosthesis secondary to mechanical or nonmechanical causes or amputation. The effects of the anatomical site on functional scores and implant survival were statistically analyzed. Additionally, the effects of diagnosis and adjuvant treatments on functional scores, implant survival, and failure rates were investigated.
At the time of the study, 55 patients were still alive with a mean follow-up of 48 (range=15-119) months. The mean MSTS scores resulting from the final follow-up of all patients and of those surviving were 87.9% (range=16%-100%) and 86.8% (range=16%-100%), respectively. Overall implant survival was 95.2%, 89.2%, 87%, and 87% at 1, 2, 3, and 4 years, respectively. Statistically, both functional scores and implant survival analysis in different anatomical sites were found similar. In 15 of the patients (17.8%), endoprosthetic reconstructions had failed. The causes of failure were soft tissue failure (dislocation) in 5 patients, infection in 5, structural/mechanical failure in 2, local recurrence in two, and aseptic loosening in one. The diagnosis and receiving preoperative and/or postoperative adjuvant treatment did not affect functional scores, implant survival or failure rates.
The results of this study have shown that modular endoprosthetic replacement can provide satisfactory functional results and a durable mid-term limb salvage option in the management of patients with primary and metastatic bone tumors of the lower limbs.
Level IV, Therapeutic Study.
本研究旨在确定下肢原发性和转移性骨肿瘤采用模块化假体重建的生存率和功能结果，并探讨假体失败的发生率和原因。
回顾性分析了 82 例患者（49 例男性，33 例女性；平均年龄 48 岁，年龄范围 13-78 岁）的 84 侧肢体，这些患者因下肢原发性或转移性骨肿瘤接受了切除和模块化假体重建。所有患者的平均随访时间为 43（范围 13-119）个月。末次随访时采用肌肉骨骼肿瘤学会（MSTS）评分系统评估功能状态。假体生存率定义为从植入到因机械或非机械原因或截肢而部分或完全更换假体的时间。统计学分析了解剖部位对功能评分和假体生存率的影响。此外，还研究了诊断和辅助治疗对功能评分、假体生存率和失败率的影响。
研究时，55 例患者仍存活，平均随访时间为 48（范围 15-119）个月。所有患者和存活患者的最终随访 MSTS 评分分别为 87.9%（范围 16%-100%）和 86.8%（范围 16%-100%）。总体假体生存率分别为 1、2、3 和 4 年时的 95.2%、89.2%、87%和 87%。统计学分析发现，不同解剖部位的功能评分和假体生存率分析结果相似。15 例患者（17.8%）发生假体重建失败。失败的原因包括 5 例软组织失败（脱位）、5 例感染、2 例结构/机械失败、2 例局部复发和 1 例无菌性松动。诊断和接受术前和/或术后辅助治疗并不影响功能评分、假体生存率或失败率。
本研究结果表明，模块化假体置换可在治疗下肢原发性和转移性骨肿瘤患者中提供令人满意的功能结果和持久的中期肢体保肢选择。
IV 级，治疗性研究。
