J Korean Orthop Assoc.  2015 Dec;50(6):453-461. 10.4055/jkoa.2015.50.6.453.

Endoprosthetic Reconstruction in the Limb Salvage Surgery for Treatment of Malignant Bone Tumors

• Kim HS

• KMID: 2185086
• DOI: http://doi.org/10.4055/jkoa.2015.50.6.453

Abstract

Endoprosthetic replacement is the most frequently used surgical method for the skeletal reconstruction in the limb salvage surgery for malignant bone tumors. Modular prostheses are generally used for typical locations such as distal and proximal femur, proximal tibia and proximal humerus. Expandable prosthesis is used to overcome leg length discrepancy in growing children. Aseptic loosening, infection and mechanical failure are major complications resulting in revision surgery. Many efforts should be made to develop more durable and functional implants to improve the quality of life of sarcoma survivors.

Keyword

limb salvage surgery; endoprosthetic reconstruction

MeSH Terms

Child
Extremities*
Femur
Humans
Humerus
Leg
Limb Salvage*
Prostheses and Implants
Quality of Life
Sarcoma
Survivors
Tibia

Figure

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  Figure 1 Osteosarcoma of the distal femur. (A) Osteolytic lesion of the medullary canal and periosteal reaction are seen on the plain radiograph. (B) Intramedullary geographic lesion of low signal is seen on the T1 weighted magnetic resonance imaging. (C) The image shows endoprosthetic replacement with uncemented fixation of the distal femur.

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  Figure 2 (A) Plain radiographs show the total femur replacement with bipolar type. (B) Photograph of the total femoral prosthesis with expandable type.

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  Figure 3 Osteosarcoma of the pelvis. (A) The tumor is located in the superior ramus and acetabulum with huge extraosseous mass formation, which suggests osteosarcoma of the pelvis. (B) After type II, III pelvic resection, which means resection of pubic ramus (type III) and acetabulum (type II), hip was reconstructed with pelvic allograft (for acetabulum) augmented with reinforcement cage and cemented fixation. The allograft with cage was fixed with ilium using pins, plate and screws. The junction between the ilium and the acetabulum of the allograft was well united.

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  Figure 4 Expandable prosthesis of the distal femur. (A) After resection of the distal femur, custom type expandable prosthesis was placed with cement fixation. (B) Screwdriver pits for lengthening procedure are seen at the proximal portion of the implant. (C) After two times of lengthening procedure, the length of 4 cm was gained.

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  Figure 5 Modular-type endoprosthesis of the proximal femur. (A) During the operation, a surgeon can select the implant of the same size with the excised specimen. (B) Plain radiograph shows the well placed implant instead of the proximal femur. (C) The implant is wrapped tightly with the fabric-like polymer material, and the hip abductors and psoas muscle were sutured to the material.

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  Figure 6 Endoprosthesis of the proximal tibia. (A) Osteosarcoma of the proximal tibia. (B) Endoprosthesis was placed after excision of the proximal tibial lesion. (C) The implant is wrapped tightly with the fabric-like polymer material for attachment of the patellar tendon. (D) The implant was covered with the muscle flap in order not to be placed just beneath the skin.

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  Figure 7 Endoprosthetic replacement for the proximal humerus. (A) A typical image of the proximal humeral osteosarcoma. (B) The magnetic resonance imaging finding is compatible with the osteosarcoma. (C) A photograph of the endoprosthesis. (D) Surrounding muscles are attached the polymer material wrapped around the implant. (E) Postoperative radiograph.

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