Page 212 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

Chapter 11
General Discussion
During recent decades, limb-salvage surgery has replaced amputation as the treatment of choice for musculoskeletal tumors of the appendicular skeleton and pelvis1, 2. This transition is largely attributable to the advent of e ective adjuvant treatment and concomitant sophistication of imaging and surgical techniques1, 3, 4. Simultaneously, ve-year survival rates increased from less than 20% before the 1970s, to approximately 55 to 70% nowadays1, 4-8. The preponderance of limb salvage surgery and increased patient survival resulted in an increased demand for durable reconstructions with favorable and predictable clinical results and functional outcome.
In this thesis, we evaluated the clinical outcomes of various reconstructive techniques in musculoskeletal tumor surgery. This thesis aimed to assess clinical outcome in terms of complications and reconstruction survival rates, and to identify risk factors for complications and impaired survival. Therewith, we ultimately aim to improve outcomes for patients with bone tumors. Part I of the thesis focused on management of pelvic bone tumors, part II focused on reconstructions of the appendicular skeleton.
In 2011, Henderson et al proposed a failure mode classi cation for tumor endoprostheses, with the aim to facilitate understanding of endoprosthetic failures and to stimulate uniform reporting9. They classi ed ve di erent modes of failure: soft-tissue failure (type 1), aseptic loosening (type 2), structural failure (type 3), infection (type 4) and tumor progression (type 5). Throughout the majority of the studies in this thesis, we have used this system to classify failures. In addition, we have attempted to classify complications that did not result in reconstruction failure. Therewith, we aimed to stimulate more uniform reporting on clinical results, in order to gain further insight in the outcomes of these complex reconstructions. Below, we will systematically discuss current concepts, complications and surgical strategies in management of pelvic (part I) and extremity (part II) bone tumors. Additionally, we will propose a number of modi cations to the Henderson classi cation system, with the aim to further improve registration and comparability of complication and failure rates.
Part I - Management of Pelvic Bone Tumors
Tumors of innominate bone are some of the most challenging conditions to treat for orthopaedic oncologists10-12. Pelvic tumors may present with vague
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