PROSTHETIC AND EXTREMITY SURVIVORSHIP AFTER LIMB SALVAGE FOR SARCOMA - HOW LONG DO THE RECONSTRUCTIONS LAST

Ninety-three consecutive prosthetic reconstructions performed for limb salvage after the resection of sarcomas of the lower extremity were r eviewed to determine how long the reconstructions lasted, how successf ul they were in avoiding amputation in the long term, how significant a problem was aseptic loosening, and what was the associated patient s urvival. Reconstruction was of the proximal femur in 16, distal femur in 61 and proximal tibia in 16 patients. Minimum follow-up time was 24 months, with a median of 66 months and mean of 80 months. If any even t leading to the removal of the prosthesis is considered a reason for failure, the event-free prosthetic survival at five years for the prox imal femur was 88%, distal femur 59%, and proximal tibia 54%. Limb sur vival at five years was significantly better, with the proximal femur at 88%, distal femur at 88%, and proximal tibia at 78% intact. Aseptic loosening survival was better than the event free prosthetic survival , which demonstrates the influence of factors such as sepsis (hematoge nous) or wound necrosis that lead to prosthetic removal. Aseptic loose ning survivorship of the proximal femur at five years was 100%; distal femur, 78%; and the proximal tibia, 73%. At five years, patient survi val was low for the proximal femur (62%) and distal femur (75%) but no tably better for the proximal tibia (93%). Prosthetic, extremity, and patient survival differed depending on the site. Wound necrosis was a significant cause of prosthetic removal and loss of limb early in this series, but the more aggressive use of soft tissue procedures has imp roved this. Aseptic loosening at the distal femur and proximal tibia i s currently the most significant long-term problem.