Page 186 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

Chapter 9
Table 1. continued
Variable
Reconstruction site
Distal femur
Proximal tibia
Neoadjuvant and adjuvant therapies (around implantation of MUTARS)
Neoadjuvant chemotherapy Adjuvant chemotherapy Neoadjuvant radiotherapy Adjuvant radiotherapy
Reconstruction details
Conventional polyethylene locking mechanism PEEK-OPTIMA locking mechanism
Extensor reconstruction
MUTARS attachment tube used
Complications
Type I (soft tissue, instability) Type II (aseptic loosening) Type III (structural)
Type IV (infection)
Type V (tumor progression)
Failure
Any type of revision, including re- xation
Major revision / removal entire prosthesis
Status at nal follow-up
No evidence of disease Alive with disease Died of disease
Died of other cause
Number Percent of relevant group
89 81 21 19
61 60 64 63 2 2 4 4
39 35 71 65 19 17 16 15
7 6 17 16 15 14 14 13 10 10
40 36 27 25
64 63 - - 34 34 3 3
All diagnoses were proven histologically before operation. The feasibility of limb-salvaging resection was evaluated on MRI. In the case of suspected joint involvement, an extra-articular resection was performed removing the joint en bloc with the patella cut in the coronal plane. Of 84 implants (84 of 110 [76%]) that were implanted for primary reconstruction after tumor resection, 39 (46%) had an extra-articular resection. Twenty-six implants (26 of 110 [24%]) were implanted as a revision of a failed reconstruction, including nine MUTARS and 17 other reconstructions (table 2).
A lateral or medial parapatellar approach was used; this depended on the location of the tumor and biopsy tract, which was excised in continuity with the
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