Page 225 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

General conclusions
During recent decades, there has been a tremendous improvement in treatment possibilities for bone tumors of the pelvis and extremities. Nevertheless, functional outcomes vary greatly between patients, in part owing to the frequent occurrence of complications. We therefore set out to assess complications of various reconstructive techniques and to identify risk factors for those complications, with the ultimate aim to improve outcomes for patients with musculoskeletal tumors.
Treatment of pelvic bone tumors is associated with a high risk of complications, regardless of the reconstructive technique used. The design principle of modern stemmed acetabular implants for reconstruction after periacetabular resections is comparable to those of decades ago. However, due to improvements in production processes and modi cations in implant design, including the introduction of modularity, coatings, and dual-mobility articulation, their reliability and durability has improved dramatically. At present, they can be used for the vast majority of pelvic tumor reconstructions and the reconstruction itself has become less technically demanding. The main issues that remain to be solved are the high risk of instability and infection, and it appears that the occurrence of these complications is closely tied to the extent of surgery. Future research should be directed at prevention and adequate treatment of these complications.
Fortunately, complications are less frequent in treatment of extremity bone tumors. During the early years of limb-salvage surgery, allografts were the preferred method of reconstruction in many large European sarcoma centers. As with any surgical procedure, the outcome is dependent on the right indication. It however appears that this especially holds true for allografts: they o er a reliable, durable and elegant option when they are being used for meticulous reconstruction of defects of limited size in younger patients. On the other hand, when they are being used for reconstruction of extensive osseous defects in older patients with poor healing potential and their tting is suboptimal, the risk of complications is extremely high and the reconstruction is likely to fail. During the last few decades, endoprostheses have largely replaced allografts as the technique of choice for reconstruction of extremity bone tumor defects. Again, improvements in production and design of these implants have caused an enormous increase in reliability and long-term stability. The challenge for the orthopaedic oncologist is to choose the right technique for the speci c patient and tumor type. Apart from introducing new techniques, it is extremely important to be aware of risk factors for complications of existing techniques. In the end, the outcome of any
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General discussion
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