Abstract
Background: Segmental metallic endoprostheses are widely used and important in reconstructive procedures of the lower limb. Most of the currently available endoprostheses are made in Europe or the United States of America and are too large for Asian knees. The Japanese Musculoskeletal Oncology Group developed a tumor prosthesis better suited for Asian skeletal anatomy, the Kyocera Modular Limb Salvage System (KLS).Methods: We performed a retrospective review of the records of patients who underwent reconstruction using KLS implants. Thirty-five patients fulfilled the inclusion criteria, 20 having undergone limb salvage surgery for tumor and 15, joint arthroplasty. Functional outcomes were evaluated using the revised Musculoskeletal rating scale for the tumor group and the Japanese Orthopedic Association Knee Score for the arthroplasty group. Complications and survivorship of the implants were also assessed.Results: At the latest follow-up, in the tumor group, 13 were alive with no evidence of recurrence, 6 died of disease, and 1 was alive with evidence of disease. The average MSTS scores on latest follow-up were 63 for the proximal femur, 67 for the distal femur, and 92 for the proximal tibia. The mean prosthesis survival was 28 months. Complications include 4 cases of aseptic loosening, 2 deep infections, 1 superficial infection, 1 valgus deformity, 2 periprosthetic fractures, 2 incidences of excessive polyethylene wear, and 2 local tumor recurrences. In the arthroplasty group, 1 patient had a persistent low grade infection on the latest follow-up. The post-operative JOA score was 61(mean). Complications included 3 cases of aseptic loosening, 2 deep infections, 2 implant failures, 1 superficial infection, 1 valgus deformity, and 1 soft tissue defect.Conclusion: Early results of the KLS implant system are encouraging, with comparable clinical outcomes to other systems in the literature. A longer follow-up study with increased numbers of patients is necessary to further validate the functional outcomes and prosthesis survival using the KLS system for limb salvage surgery.
Psychosocial and functional outcomes in long-term survivors of osteosarcoma: A comparison of limb-salvage surgery and amputation
