Endoprosthesis revision in cancer patients. MRRC experience

In more than 80% of cases of primary and metastatic bone tumors with a modern integrated approach to treatment, it is possible to perform organ-sparing intervention for resection with joint replacement. The frequency of revision interventions for various complications, according to various sources, is from 5 to 50%. The article provides an analysis of the results of arthroplasty and revision arthroplasty for primary and metastatic bone tumors in the A.F. Tsyba MRRC for the period from 2012 to 2018. Background. With advances in combined modality therapy for osseous malignancies, it has become possible to perform endoprosthetic joint replacement for limb salvage after bone resection in more than 80% of patients with primary and metastatic bone tumors. According to the literature data, the frequency of revision procedures for various complications is from 5% to 50%. This study presents an analysis of the results of endoprosthetic replacement and endoprosthetic revision for primary and metastatic bone tumors performed in MRRC between 2012 and 2018.

Purpose. To analyze the results of endoprosthetic replacement of large joints in cancer patients and to identify the causes of complications.

Materials and methods. In the years 2012—2018, we performed 248 endoprosthetic replacements for primary and metastatic tumors of the musculoskeletal system including 42 (17%) endoprosthesis revisions. A greater number of revision procedures were done for tumors of the distal femur and the proximal tibia (55% and 22%, respectively).

Results. Revisions were performed for aseptic instability of one of endoprosthesis stems in 19 (45.2%) cases, for infectious complications in 10 (23.8%), for breakage of the components of the endoprosthesis in 6 (14.3%), and for periprosthetic fractures in 2 (4.8%) cases. Endoprostheses were built up 5 times (11.9 %) due to recurrent disease.

Conclusion. Endoprosthesis revision is one of the most important challenges in orthopedic oncology indicating the need for an individualized approach. Revision procedures are extremely complex due to deficiency of intact bone tissue and surrounding soft tissue, as well as due to infected endoprosthesis bed most often requiring two-stage surgical interventions.

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