Functional outcomes and survival analysis of modular endoprostheses following resection of upper extremity tumors: a retrospective clinical study

BACKGROUND: Advances in chemotherapy and radiotherapy have significantly improved patient survival. Furthermore, advancements in implant technology have enabled the successful application of endoprostheses in many cases in which reconstruction via biological methods is not feasible. This study aimed to assess implant survival, overall patient survival, and functional outcomes in patients who underwent upper extremity tumor resection. METHODS: This study had a retrospective design. Patients who underwent resection and endoprosthetic reconstruction between 2011 and 2020 were evaluated. After applying the inclusion and exclusion criteria, 90 patients were included in this study. Factors potentially influencing endoprosthesis and patient survival were identified and analyzed. Functional assessment was performed by measuring the Musculoskeletal Tumor Society (MSTS) scores of patients during outpatient clinic follow-ups. RESULTS: The mean follow-up period was 36 ± 19.4 months. Implant failure occurred in eight of the 90 patients, resulting in a total endoprosthesis survival rate of 91.1%. Among the eight patients with implant failure, aseptic loosening was observed in two, infection in four, and tumor progression in two cases. During the study period, 37 patients died, resulting in an overall patient survival rate of 58.8%. The mean MSTS score for functional assessment was 22.1 ± 2.564. Studies in the literature suggest that the use of synthetic meshes contributes to improved functional outcomes. The mean MSTS score was 23.2 ± 2.370 for patients with synthetic mesh, compared to 21.5 ± 2.575 for those without, a statistically significant difference (P = 0.005). The overall patient survival rate was 58.8%. Two of the 90 patients underwent amputation, and the limb survival rate was 97.7%. The notably higher implant survival rate compared to patient survival and high limb survival rates indicate favorable outcomes consistent with the intended use of endoprosthetic reconstructions. CONCLUSION: Modular endoprostheses are a preferred successful reconstruction method following upper extremity tumor resections owing to their long-term survival and low complication rates. LEVEL OF EVIDENCE: Level IV.