Table 11.
Summary of the results of different studies comparing the outcome following use of megaprosthesis and allograft prosthesis composite for the reconstruction of massive skeletal defects in different anatomic sites.
| Authors & Anatomic site | Megaprosthesis |
APC |
||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| No. of patients | Mean Follow-up | Outcome | Results | Survival | No. of patients | Mean Follow-up | Outcome | Results | Survival | |
| Michiel et al.121 | 14 | 10 y | 21% complications | 1 revision | 88% at 5 years | 10 | 10 y | 40% complications | 3 revisions | 60% at 5 years |
| Proximal Humerus | ||||||||||
| Benedetti et al.122 | 10 | 118 m | MMT = 4/5 (hip abductors) | – | 10 | 60 m | MMT = 4/5 (hip abductors) | – | – | |
| Proximal Femur | MSTS = 87% | MSTS = 90% | ||||||||
| Gait: Lower cadence | Gait: Higher cadence | |||||||||
| Anract et al.123 | 20 | – | Higher incidence of limp and use of crutches | – | 73 + 11 % at 5 years and 0% at 10 years | 21 | Lower incidence of limp and use of crutches | Allograft resorption seen in 50% cases without affecting the function | 77 + 12% at 5 and 10 years | |
| Proximal Femur | ||||||||||
| Farid et al.124 | 52 | 146 m | 2 infections | – | 86% at 10 years | 20 | 76 m | 1 infection | – | 86% at 10 years |
| Proximal Femur | 10% aseptic loosening | 10% non-union | ||||||||
| MSTS = 70% | MSTS = 82% | |||||||||
| HAS = 2.8/5 | HAS = 4.6/5 | |||||||||
| Zehr et al.125 | 17 (18 MPs) | MSTS = 80% | 8revisions | 58% at 10 years | 16(18APCs) | MSTS = 87% | 1 revised to rotationplasty | 76% at 10 years | ||
| Proximal Femur | 47% complications | 18% complications | 1 hip disarticulation | |||||||
| 2 deaths from disease | ||||||||||
| 2 stem breakage | 1 persistent nonunion | |||||||||
| 1 loosening | ||||||||||
| 1 infection | ||||||||||
| 1 recurrence | ||||||||||
| 3 instability | ||||||||||
| Zimel et al.126 | 47 | 7 y | 11% recurrence | 9 deaths from disease | 87% at 10 years | 38 (Condyle sparing allograft) | 7 y | 18% recurrence | 8 deaths from disease | 81% at 10 years |
| Distal Femur | 53% alive with no disease | 68% alive with no disease | ||||||||
| 17% alive with disease | 11 % alive with disease | |||||||||
| Muller et al.127 | 23 | 62 m | ISLOS Score: | 5 failures: | 78.8% at 10 years | 19 | 62 m | ISLOS Score: | 4 failures: | 93.7% at 10 years |
| Proximal Tibia | 6 Excellent | 1 amputation | 10 Excellent | 1 amputation | ||||||
| 11 Good | 4 implant removal | 11 Good | 2 implant removal | |||||||
| 1 Fair | 1 Fair | 1 change of inlay | ||||||||
| Wunder et al.128 | 64 (50 DF, 14 PT) | Minimum 3 years | MSTS = 26.3 | 2 infection | 91% at 3 years | 11 (6 DF, 5 PT) | 4 infection | MSTS = 20 | 22% at 3 years | |
| Knee | 4 prosthesis breakage | 5 allograft fracture | ||||||||
| 1 loosening | ||||||||||
Abbreviations: y = years, m = months, MMT = Manual Muscle Test, MSTS = Musculoskeletal Tumor Society Score, HAS = Hip Abductor Strength, MP = Megaprosthesis, ISLOS = International Society of Limb Salvage, DF = Distal Femur, PT = Proximal Tibia.