Endoprosthetic reconstruction of the diaphysis for segmental bone defects after bone tumour resection : a mid- and long-term retrospective study of 112 cases.

AIMS: This study evaluated the clinical outcome, complications, and overall efficacy of diaphyseal endoprosthetic reconstruction after tumour resection, with the aim of providing a comprehensive insight into the role of diaphyseal prostheses in managing segmental bone defects after resection of a bone tumour.

METHODS

A retrospective analysis was carried out of 112 patients treated at two centres. Resection length, intramedullary stem length, and fixation type were recorded. Clinical outcomes were assessed with Musculoskeletal Tumor Society (MSTS) scores, while survival rates were calculated using Kaplan-Meier analysis. Complications were classified according to the Henderson system.

RESULTS

The mean duration of follow-up was 27.2 months (3 to 159), the mean operating time 142.4 minutes (SD 44.1), and the mean blood loss 658.8 ml (SD 437.3). The mean resection length was 106.8 mm (SD 33.3), and the mean intramedullary stem length 96.1 mm (SD 34.1). Cemented fixation was used in 90.2% of cases (101 of 112), and auxiliary plates in 63.4% (71 of 112). The mean MSTS score was 24.3 (SD 3.3). Kaplan-Meier analysis revealed three-, five-, and ten-year survival rates of 42.9% (95% CI 33.4 to 55.1), 34.6% (95% CI 24.8 to 48.3), and 25.2% (95% CI 14.5 to 43.9) for patients, and 91.6% (95% CI 86.1 to 97.5), 82% (95% CI 69.4 to 96.8), and 82% (95% CI 69.4 to 96.8) for prostheses, respectively, with a significant difference between the two (p < 0.001). Medium- to long-term analysis showed that prosthesis survival, both for primary and metastatic tumours, exceeded patient survival. Additionally, cemented prostheses had significantly higher survival rates than uncemented prostheses (p = 0.006). Postoperative complications occurred in 16% of patients (18 of 112), with 6.3% (7 of 112) requiring reoperation.

CONCLUSION

Diaphyseal prostheses are a reliable solution for reconstructing segmental defects after resection of a bone tumour, with benefits such as early weightbearing, improved functional outcome, acceptable mid- to long-term failure rates, and effective local disease control for a variety of tumour types and anatomical locations.