The concept of limb-sparing surgery has gradually evolved over past 25 years. Prior to this the basic principles of surgical oncology for the extremities consisted of determining the correct level at which to perform an amputation.[1].
Extremity amputation with wide or radical surgical margins was the primary treatment for bone and soft tissue malignancies involving the extremities until the 1970s. While today 90-95% of patients with extremity bone malignancy who are treated at major centers specializing in musculoskeletal oncology can undergo successful limb sparing procedures.[2].
Limb salvage surgery is a widely accepted alternative to amputation in patients with primary bone tumors. The success of limb salvage is the result of the combined understanding of the biology and staging of tumors, improvements in reconstructive techniques, and the development of effective adjuvant chemotherapy for the primary tumors and bone sarcomas. Metallic implants fixed with methylmethacrylate cement are now well established in the management of pathological fractures secondary to metastatic carcinoma.[3,4].
The appropriate treatment to achieve local control after the resection of bone tumors is still a subject of debate, and the long-term durability of various reconstructive methods is not known. Currently, the three most popular options are using an endoprosthesis, allograft-prosthetic composite and biological reconstructions. Each of these methods has its short- and long-term advantages and disadvantages, and a surgeon should consider each patient individually.[5,6,7,8].
Endoprosthetic implants (sometimes referred to as megaprosthesis) are commonly used to reconstruct the skeleton after resection of primary bone tumors, soft tissue tumors secondarily invading bone and other selected cases of segmental defects. Limb-sparing reconstructions should fulfill several requirements; most importantly, the patient should not be at increased risk of local recurrence as compared with amputation. The reconstruction should be durable with few complications, especially those that could interfere with postoperative adjuvant therapy. Finally, the reconstruction should routinely produce a good functional result .With advances in adjuvant therapy for osseous malignancies, the 5-year long-term survival rate has improved from 20% to 70 %. [9].
Endoprosthetic replacement offers several advantages, such as early stability, mobilization and weight bearing, a shorter operating time and hospital stay in comparison to biological reconstructions, and it allows the early introduction of postoperative adjuvant therapy. Reconstruction with a modular endoprosthesis after resection of a bone tumor gives good functional results in most of the cases.[10,11].
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