Tumour Endoprosthesis Reconstruction
(Tumour Arthroplasty/ Endoprosthesis/ Megaprosthetic reconstruction)
- A megaprosthesis/endoprosthesis is a large metallic device designed to replace the excised length of bone and the adjacent joint.
- Presently, modular designs which allow great degree of freedom for surgeons to assemble the prosthesis intra-operatively and result in excellent reconstruction.
- Custom made designs are also used specific to the needs of the patient
What is Tumour Endoprosthesis?
- The prosthetic joint is of fixed or modified hinge design to substitute for the stability normally provided by the capsular and ligamentous structures that were sacrificed by the sarcoma removal.
- The prosthesis is fixed to the host bones with or without polymethylmethacrylate cement depending on age, bone involved and strength of the host bone.
- Special attention is paid during closure to ensure that the prosthesis is fully covered by a healthy muscle and soft tissue envelope.
- This provides the reconstruction immediate stability and allows rapid mobilization of the patient following surgery.
What is Expandable Megaprosthesis/ Endoprosthesis?
- Children in age group between 7 – 13 years have growth potential.
- Removal of sarcoma usually involves adjacent growth plate removal which results in a considerable short limb after maturity.
- Advancements in Endoprosthetic designs have allowed expandable endoprosthesis in children which allow lengthening in stages.
- These endoprosthesis are custom made and fixed specifically based on age and remaining host bone and growth potential.
- They incorporate a mechanism which allows expansion or lengthening either in an Invasive or Non-Invasive manner.
- Invasive manner requires the child to be admitted for one day and the endoprosthesis is lengthened manually by a small incision under anesthesia.
- Non-Invasive method involves placement of the limb in a specifically designed Magnetic coil and lengthened by the mechanism without need for any intervention.
- These are performed in a regular interval of 6 months or more depending on remaining growth.
What are the complications involved in tumour endoprosthesis (megaprosthetic) reconstruction?
- Components of arthroplasty undergo phenomenon of wear and tear in the body gradually until the components degrade and require to be changed.
- Complications associated with megaprosthetic/endoprosthetic reconstructions are as follows in decreasing order
- Periprosthetic infection
- Failure of muscle and soft tissue cover
- Aseptic loosening, fracture of components, wear of bushing
- General complications involved in all major limb and pelvic surgeries such as neurovascular injury, deep vein thrombosis, pulmonary embolism, tourniquet related complications and extensive blood loss intra or post operative.
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