Abstract
Introduction
The development of new megaprosthesis for the treatment of large bone defects has offered important opportunities to orthopedic oncologic surgeons for the replacement of skeletal segments such as the long bones of the upper and lower limbs and the relative joints. Our experience, treating non union and severe bone loss, has brought us, sometimes, to be confronted with the reality of some failures after unsuccessful attempts to reconstruct. Faced with certain radiological and / or clinical drastic situations we wanted to apply the principles of Biological Chamber and oncologic surgery with megaprosthetic replacement solutions. We implanted megaprosthesis with either 1 step or 2 steps (previous antibiotated spacer) technique depending on the septic patient conditions. The aim of this study is to retrospectively evaluate both clinical and radiological outcomes in patients underwented to a lower limb megaprosthesis implant and complications were recorded.
Materials and Methods
In total, we treated 58 patients with megaprosthesis mono-and bi-articular subdivided as follows: proximal femur, distal femur, proximal tibia and total femur. The mean follow-up of patients is about 24 months (5 yrs max, min 6 months) with clinical and serial radiographic revaluations with standard methods (X-ray in 45 days, 3–6-12-18-24 months) as well as monitoring of blood parameters of inflammation for at least 2 months
Results
Despite the follow up average is not so long, the first patients have now reached five years of monitoring and in all cases we have had encouraging clinical results with good articulation of the segments, no somato-sensory or motorial defict and acceptable functional recovery. During surgery and, even more, in the pre-operative planning much attention should be given to the evaluation of the extensor apparatus preserving it and, when necessary, reinforcing it with tendon substitutes.
Discussion
Megaprosthesis in traumatic and prosthetic failures can therefore be considered, in extreme cases appropriately selected, as a solution available to the orthopedic surgeon? In oncological surgery the opportunity to regive a function, although not ad integrum, to the patient is certainly an element of great fascination for the surgeon and an opportunity for the patient. Unfortunately, the high mortality associated with this disease does not allow us to have long-term follow-up. This then creates a lack of certainty about the survival of this type of prosthesis and the medium and long-term complications that may occur. Nevertheless, the patients treated by us should be considered as a oncologic patient, not because of the disease but for the limited therapeutic options available.
Conclusions
We can consider megaprosthesis as a valuable opportunity to restore functionality to patients who are, despite themselves, to deal with highly disabling diseases
