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Bone Tumor reconstruction

Reconstructing the skeletal defects had been impossible in the past though its need has been frequent. The only possible solution was amputating the extremities. The custom-made prosthesis has been introduced to offer a solution to such problems. It has been found that in certain cases, like the oncologic orthopaedic surgery, the advanced medical treatments had helped prognosis and the preservation of limbs through surgery had better survival rates as compared to amputation.

How are megaprostheses bring about a change?
The introduction of the modular endoprostheses in the 1980s was the beginning of a new era in the orthopaedic oncologic surgery. These modular megaprostheses comprise a few different components which are readily available. These components can be assembled according to the defect in the bone. The mechanical failures have decreased a lot. The final outcome is quite satisfactory and the patients enjoy a better life. The major challenge faced today is to remove the non-mechanical complications associated with the surgery. These include deep infection, the risk of necrosis or wound dehiscence or the local recurrence of the tumour.
The megaprostheses have evolved and changed the outcome of the surgery vastly. Recent developments in this field offer even better results with fewer complications.

What indicates the use of megaprostheses?
The prostheses designs are now available in modular endoprostheses with rotating platforms from the earlier monoblock designs or the fixed hinge models. There is an improved geometry that enhances the stability and fixation. These megaprostheses are dominating surgical practice. Since the endoprostheses are readily available with the different components, surgery can proceed without all the delay for fabrication. The custom models can take as much as 6 weeks to build. This actually lets more freedom rest in the hands of the surgeon. Reconstructuring the defects gets a new outlook since they might be different from the preoperative planning. Complication rates, functional outcome and limb survival are improved.

What is the functional outcome after surgery?
The primary goal is to control the disease as effectively as possible. The limb or the part of the body with a tumour needs to be salvaged in a way that if functional as well as durable. Mostly when the malignant tumours are treated, the focus initially lays on the length of survival. When it has been established that there has been a substantial gain in survival time, proper attention is given to the quality of life. Different bones have different responses towards the megaprosthoses. However, it can be said the use megaprostheses always benefit the victim. While in some, it offers exceptional functional results, the results are satisfactory in others.
For instance, the reconstructions that include the distal humerus gives satisfactory results with respect to functional performance, while in patients who underwent reconstructions involving the lower extremity, there has been no difference in walking speed or difference in oxygen consumption.

Thus the modern modular megaprostheses have actually allowed to achieve the gold standard for limb preservation surgery in oncologic orthopaedic surgery. Reconstruction of large skeletal defects or a high salvage rate has been facilitated.

Authored By: Dr. S. V. Santpure

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