Amputation Following Oncologic Endoprosthetic Limb Salvage

Background/Aim: Endoprosthetic reconstruction has become a primary means of limb salvage for oncologic resection of primary or metastatic disease to avoid amputation. The purpose of this study was to determine the rate at which limb salvage procedures using endoprosthesis ultimately required amputation. Patients and Methods: The total joint registry from a single institution was queried for patients who underwent primary endoprosthesis placement for oncologic indications. Results: A total of 586 implants in 561 patients were included for analysis. Amputations occurred in 14 patients, and in 9 amputations were the only reoperation following reconstruction. The indication for amputation was most commonly infection (n=7, 50%) and recurrence (n=5, 35%). Mean time to amputation was 71 months for all indications, with a 10-year cumulative incidence of amputation of 2.9%. Distal femoral and proximal tibial endoprostheses were associated with higher rates of amputation (p<0.001). Conclusion: Overall, the rate of amputation following endoprosthetic reconstruction was low with proximal tibia and distal femoral replacements associated with a higher risk of amputation. Amputation for infection tended to occur as late, whereas amputation for local recurrence typically occurred early.