Aim

In patients with bone sarcoma, placing mega prostheses in the proximal tibia is associated with high rates of infection. In studies with small numbers of patients and short follow-up periods, silver-coated mega prostheses have been reported to lead to reduced infection rates. To the best of our knowledge, this study is the largest one that has compared the infection rates with titanium versus silver-coated mega prostheses in patients treated for sarcomas in the proximal tibia.

The aim of this study was to define the treatment criteria for patients with recurrent chondrosarcoma. We reviewed the data of 77 patients to examine the influence of factors such as the intention of treatment (curative/palliative), extent of surgery, resection margins, status of disease at the time of local recurrence and the grade of the tumour. A total of 70 patients underwent surgery for recurrent chondrosarcoma. In seven patients surgery was not a viable option. Metastatic disease occurred in 41 patients, appearing synchronously with the local recurrence in 56% of cases. For patients without metastasis at the time of local recurrence, the overall survival at a mean follow-up after recurrence of 67 months (0 to 289) was 74% (5 of 27) compared with 19% (13 of 50) for patients with metastasis at or before the development of the recurrence. Neither the type/extent of surgery, site of tumour, nor the resection margins for the recurrent tumour significantly influenced the overall survival.

With limited survival for patients with metastatic disease at the time of local recurrence (0% for patients with grade III and de-differentiated chondrosarcoma), palliative treatment, including local radiation therapy and debulking procedures, should be discussed with the patients to avoid long hospitalisation and functional deficits. For patients without metastasis at the time of local recurrence, the overall survival of 74% justifies an aggressive approach including wide resection margins and extensive reconstruction.

Although the recurrence rate of giant cell tumors of bone (GCTB) is relatively high exact data on treatment options for the recurrent cases is lacking. The possible surgical procedures range from repeated intralesional curettage to wide resection.

214 patients with histologically certified GCTB have been treated at the authors department from 1980 to 2007. 67 patients with at least one local recurrence were included in this study. The mean follow-up was 77.3 months. The data was evaluated according the re-recurrence rate with regard to the surgical procedure for the recurrence.

The mean time until the first local recurrence was 22.0 months; the mean number of recurrences per patient was 1.4. The recurrence occurred in 69.7 % (46 out of 66 patients) within the first two years. If after intralesional procedures (curettage or intralesional resection) no adjunct was used the re-recurrence rate was 58.8 % (10 out of 17 patients) and decreased to 21.7 % (5 out of 23 patients) if a combination of all adjuncts (PMMA + burring) was used. The likelihood of re-recurrence was reduced by the factor 5.508 which was clearly significant (p = 0.016). In case of wide resection no re-recurrence occurred. Seven patients (10.5 %) developed pulmonary metastases. Fourteen patients (20.9 %) finally received an endoprosthesis; 12 due to tumor recurrence, 2 due to secondary arthritis.

Recurrent GCTB can be treated by further curettage with additional burring and cementing with an acceptable re-recurrence rate of 21.7 %. The rate of patients finally needing an endoprosthesis is 20.9 %. Due to the high rate of pulmonary metastases recurrent GCTB may be considered as a severe disease.

A revision of a first generation KMFTR prosthesis due to stem breakage is a problem oncologic surgeons are regularly faced with. We designed an adapter which allows us to connect new MUTARS components to the original KMFTR devices. Thus it is possible to bypass an exchange of the whole prosthesis.

We used this adapter in 10 patients. Time of revision was in average 16.6 years after primary implantation of the KMFTR prostheses. Reasons for revision were femoral stem breakage (n = 5), breakage of the tibial component (n = 3) and periprosthetic fracture (n = 2, one femoral, one tibial).

The femoral stem (3 cases) and the tibial stem (2 cases) as well as the tibial plateau and body (2 cases) could be replaced by MUTARS parts and conjoined with the remaining KMFTR devices. Three cases were converted to MUTARS total femur.

Postoperative complications were one aseptic loosening and one cone-dislocation. Pre-incidence function was restored in all cases. The average Musculoskeletal-Tumour-Society-Score was 82.9% of normal function.

The results show that the new adapter facilitates to restore pre-incidental extremity function by performing a relatively modest revision.