Audit of Surgical Complications Post-limb Salvage Procedures for Aggressive Bone Tumours at a Developing Tumour Unit

BackgroundThe incidence of malignant bone tumours remains relatively low in our setting.However, our patients typically present late with large tumour volumes, making limb-salvage procedures difficult and prone to post-operative complications.Due to a paucity of literature in a clinical context similar to ours, we elected to assess complications experienced by our cohort of patients. Aim & settingWe aimed to study complications experienced by our patient cohort post-limb salvage and tumour prosthesis replacement for aggressive bone tumours.This study was set at the Chris Hani Baragwanath Academic Hospital Teaching Hospital in Johannesburg from January 2017 to December 2024. MethodsWe conducted a retrospective review of records of patients who underwent limb salvage for aggressive musculoskeletal tumours at our hospital.Patients with aggressive bone tumours treated at a different unit and those who underwent revision surgery were excluded from the study.Demographic data, pathology factors, and surgery factors were extracted for analysis.Descriptive statistics were computed using Stata 18 (StataCorp LLC, College Station, Texas). ResultsA total of 20 patient records met the inclusion criteria for review.The majority of the patients were of African descent, with all age groups having an equal distribution of the burden of disease: five (0-17 years), five (18-24 years), five (25-34 years), and five (> 35 years).Osteosarcoma accounted for 45% (9/20) of diagnoses, followed by giant cell tumour (GCT) of bone.Our cohort showed a significant predilection for lower-limb involvement, with the latter accounting for 90%(18/20) of cases.Seventy percent of our patients experienced complications, with a majority of complications being prosthesis-related, such as prosthetic joint infection (PJIs) and instability. ConclusionThe use of limb-salvage surgery with tumour prosthesis implants for malignant bone tumours is a significant achievement in bone tumour care; however, not without complications.Neurovascular injury, muscle weakness and PJIs have a predilection for the lower limb, while prosthetic instability is likely following proximal humerus resection and replacement joint.Early presentation and meticulous soft-tissue preservation could reduce our complication rate. ContributionThe findings highlight our experience treating aggressive bone tumours with limb-salvage surgery in our clinical context.