Kadir Büyükdoğan1, Barlas Göker2, Mazhar Tokgözoğlu2, Ulukan İnan3, Korhan Özkan4, Tahsin Sami Çolak5, Lercan Aslan1, Mehmet Ali Deveci6, Mehmet Ayvaz2

1Department of Orthopedics and Traumatology, Koç University Hospital, Istanbul, Turkey
2Department of Orthopedics and Traumatology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
3Department of Orthopedics and Traumatology, Osmangazi University, Faculty of Medicine, Eskişehir, Turkey
4Department of Orthopedics and Traumatology, Medeniyet University, Faculty of Medicine, Istanbul, Turkey
5Department of Orthopedics and Traumatology, Necmettin Erbakan University, Faculty of Medicine, Konya, Turkey
6Department of Orthopedics and Traumatology, Koç University, Faculty of Medicine, Istanbul, Turkey

Keywords: Diaphyseal bone metastases, endoprosthesis, intercalary modular endoprosthesis, modular tumor prosthesis

Abstract

Objectives: This study aims to evaluate functional outcomes of patients and to analyze complication rates of modular intercalary endoprosthetic reconstruction after resection of metastatic diaphyseal bone lesions.

Patients and methods: Between December 2017 and February 2020, 22 patients (15 males, 7 females; median age: 64.2 years; range, 49 to 91) who underwent reconstruction with modular intercalary endoprostheses for metastatic bone tumors at five different centers were retrospectively analyzed. Age, sex, diagnosis, follow-up duration, previous treatments of patients, and resection lengths were recorded. The Musculoskeletal Tumor Society Scores (MSTS) were used to assess functional status of available patients at the final follow-up. Failures were categorized according to the Henderson classification.

Results: Locations of the resected tumors included 10 humeri (45.5%), five tibiae (22.7%), and seven femurs (31.8%). The length of the resected tissues ranged from 35 mm to 180 mm. Seven patients (31.8%) died of disease, and one patient died of pneumonia within follow-up period. The functional outcomes of surviving patients were satisfying with a median MSTS score of 86.9% (range, 70 to 100%) at a median follow-up of 17 months (range, 8 to 26). There were two cases of type II (9%), one cases of type IIIa (4.5%), two cases of type IIIb (9%), and one case of type IV (4.5%) failure. Complications were most commonly observed in tibial reconstructions.

Conclusion: The good short-term functional results were achieved in surviving patients. Uncomplicated patients were able to perform daily living activities without limitations. The overall rate of complications was relatively low and, among them, mechanical problems were the most commonly encountered problems.