Ultra-short stem intercalary prosthetic reconstruction for joint preservation in metaphyseal tumor management: a retrospective review of twenty-five cases.

Purpose: This study evaluates the outcomes, survival, and ASL incidence of ultra-short stem intercalary prosthetic reconstruction for tumors involving the metaphysis of bone.

Methods: A retrospective analysis of 25 patients treated at two centers with wide resection for primary or metastatic bone tumors (femur, tibia, humerus) followed by reconstruction using ultra-short stem intercalary prostheses combined extracortical plates. Clinical outcomes were assessed using the Visual Analogue Scale (VAS) and Musculoskeletal Tumor Society (MSTS) score. Survival rates were calculated using the Kaplan-Meier method, and complications were classified according to the Henderson system.

Results: The mean follow-up was 20.2 months (range, 3-101 months). The average length of the ultra-short stems was 41.3 ± 9.6 mm. Mean operative time was 164 ± 61.3 min, blood loss averaged 646.4 ± 375.5 ml and the mean defect size was 122 ± 52.1 mm. Postoperative VAS scores were significantly lower than preoperative levels (P < 0.05). The mean MSTS score was 24.2 ± 3.5 (range, 15-29). Kaplan-Meier analysis revealed prosthesis survival rates at 1, 2, 3, and 5 years of 91.7%, compared to patient survival rates of 74.5%, 52.7%, 52.7%, and 52.7%. Postoperative complications occurred in 12% of patients (3/25), including one case of aseptic loosening (ASL), and two patients required reoperation.

Conclusions: Ultra-short stem intercalary prostheses with extracortical plates provide a viable, effective option for reconstruction of short bone stumps after tumor resection, offering improved functional outcomes and acceptable prosthesis failure rates.