Limb salvage for long-bone sarcomas: a comparative of clinical outcomes and cost-effectiveness analysis of biological versus endoprosthetic reconstruction.

PURPOSE: Endoprosthetic reconstruction (EPR) and biological reconstruction (BR) are the two primary methods for limb-salvage surgery in long-bone sarcomas. Comparative data on clinical outcomes and cost-effectiveness are lacking. This study aimed to compare EPR versus BR for long‑bone sarcomas in terms of these outcomes.

METHODS

We performed a retrospective cohort study of 1657 patients who underwent limb-salvage surgery for long‑bone sarcomas (2008-2023) at a single center. After propensity score matching, 70 BR patients were matched to 157 EPR patients. We compared perioperative outcomes, complications, MSTS-93 functional scores, and survival endpoints. A lifetime cost-effectiveness analysis from a Chinese healthcare perspective was performed using a Markov model.

RESULTS

BR was associated with greater blood loss (797 vs. 443 mL) and longer operative time (7.0 vs. 4.2 h; both P < 0.001). The cumulative complication rate within the first three postoperative years was higher in the BR group (28.6% vs. 15.3%; P = 0.019); however, the total complication rates were similar between the two groups (31.4% vs. 27.4%; P = 0.498) at final follow-up. The MSTS scores were higher in the EPR group at six months (22.2 vs. 17.7; P < 0.001), but higher in the BR group at final follow-up (24.9 vs. 22.6; P < 0.001). No significant differences were observed in overall survival (OS), disease-free survival (DFS), revision-free survival (RFS), and implant survival (IS). BR had lower implant costs (¥53,269 vs. ¥89,960; P < 0.001) and total hospitalization costs (¥94,224 vs. ¥122,586; P < 0.001), and was associated with lifetime cost savings of ¥82,690, an additional 2.44 QALYs, and an ICER of -¥33,964 per QALY.

CONCLUSION

Both EPR and BR effectively address long-bone defects post-tumour resection. Compared with EPR, BR had longer operative time and more early complications, but fewer intermediate-term complications and better functional outcomes. BR also had lower costs and favourable cost‑effectiveness.