Limb-salvage treatment of en-block resected distal femoral tumors with endoprosthesis of all-polyethylene tibial component: a 9-year follow-up study

Fan Tang, Yong Zhou, Li Min, Wenli Zhang, Rui Shi, Yi Luo, Hong Duan, Chongqi TuDepartment of Orthopedics, West China Hospital, Sichuan University, Chengdu, People’s Republic of ChinaObjective: To evaluate the medium-term outcome of limb-salvage surgery using all-polyethylene tibial endoprosthetic replacement following en-block resection for distal femoral tumors.Methods: Forty-nine patients with distal femoral tumor were treated between June 2006 and June 2012. The follow-up period was 6–110 months (average 53.4 months). The prosthetic survival was analyzed using the Kaplan–Meier method. The classification of failure of limb salvage after reconstructive surgery for bone tumors was adapted. Limb function was evaluated with the scoring system of the Musculoskeletal Tumor Society (MSTS).Results: Complications were observed in six cases (12.2%). Four suffered infection around the prosthesis, of which two cases were treated with debridement, drainage, and antibiotics without removal of the prosthesis, and the other two cases underwent amputation. Two cases were identified as radiographically loose at 7 year follow-up and did not require revision surgery. One patient underwent amputation due to local recurrence. Failure of limb salvage occurred in nine cases (18.4%), of which two cases were of type 1A, two cases of type 2B, three cases of type 4A, one case of type 4B, and one case of type 5A. The mean MSTS score was 84.3%. Twelve cases died due to distant metastases (24.5%), and the average survival time for these patients was 13.5 months. Thirty-seven patients survived (75.5%), for whom the average follow-up time was 66.3 months and the 5-year prosthetic survival rate was 88.2%.Conclusion: The outcome of medium-term and long-term clinical follow-up was satisfactory. All-polyethylene tibial endoprosthetic replacement following en-block resection can be an alternative method of limb salvage for distal femoral tumors.Keywords: limb salvage, endoprosthetic replacement, all-polyethylene tibia, distal femur, tumor