Background: Endoprosthetic reconstruction is considered a reliable reconstructive option after periarticular tumor resection as it provides component modularity, improved fixation, near anatomic appearance and good functional outcomes. This study aimed at evaluation of the outcomes of the cemented modular distal femoral tumor prosthesis after wide intra-articular resection of aggressive or malignant bone tumors.
Methods: The mean age of the patients was 29.77 years. There were 12 males and 6 females. The final diagnosis was osteosarcoma in 13 patients, giant cell tumor in 3 patients, and chondrosarcoma in 2 patients. All patients with osteosarcoma received neo-adjuvant chemotherapy. Wide intra-articular tumor resection was done through the antero-medial approach of the femur with reconstruction by cemented modular endoprosthesis.
Results: One patient died with pulmonary metastasis. The five-year cumulative patient survival rate was 88.88 % and five-year cumulative implant survival rate was 93.65%. Local recurrence occurred in one patient (5.5%) while distant metastasis occurred in another. Both of those patients died and were consequently excluded from further statistical work. The mean functional score, the modified Musculoskeletal Tumor Society (MSTS) rating scale, was 73.7%. Complications occurred in five patients (27.7%). One patient (5.5%) had had a deep infection with failure of reconstruction requiring two-staged revision. There were four cases of superficial wound infection that were successfully treated conservatively. There was no aseptic loosening, periprosthetic fracture or dislocation, soft-tissue problem, or vascular impairment in the operated limb till the final follow up.
Conclusion: Modular prosthetic reconstruction after wide resection of aggressive and malignant bone tumors of distal femur offers satisfactory clinical and functional outcomes as it allows immediate postoperative stability, early mobilization and rehabilitation, with reasonable complication rate.
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