Long-Term Outcomes Following Reconstruction of Diaphyseal Defects of the Upper and Lower Extremities Using Diaphyseal Implants: A Retrospective Study with Focus on Fixation Technique.

Abstract

Background: The reconstruction of diaphyseal bone defects following tumor resection offers various biological and endoprosthetic treatment options. The present study analyzes the impact of the fixation method (cemented; uncemented; with locking screw; without locking screw) of the diaphyseal implant on clinical outcomes. Factors such as patient age and weight as well as tumor type and location are also considered. Methods: This study included 39 patients who underwent intercalary endoprosthetic reconstruction of the humerus (n = 4); femur (n = 29); and tibia (n = 6) between 1998 and 2020. Prosthetic complications, fixation methods and the MSTS score for functional outcome were statistically analyzed using SPSS and R. Results: The event-free probability in the competing risk model was 61% (95% CI 43-74%) after one year and 11% (95% CI 3-28%) after five years. The complication rate in the patient cohort was 54%. Cementless prosthesis fixation was associated with a statistically significant better functional outcome. Additionally, higher body weight and older patient age were associated with lower MSTS scores. Conclusions: Patients requiring rapid remobilization or adjuvant radiation therapy may benefit more from diaphyseal implants compared to biological reconstructions. However, the complication and revision rates of diaphyseal implants are elevated. The chosen fixation method shows a statistically significant influence on functional outcome.