Massive prostheses for malignant bone tumours of the limbs.

The goals of surgeons who treat primary bone tumours of the arms and the legs are the survival of the patient and the salvage of a functional limb. Various methods of limb salvage have been used for more than a century for benign and low-grade malignant tumours. Since the early 1980s, advances in neo-adjuvant chemotherapy have led to an extension of these methods to high-grade sarcomas of bone. Reconstructive operations include the use of autografts, allografts, prosthetic implants, and modified amputations. The most frequent method is the use of a massive endoprosthesis which may be modular or custom-built. A typical custom-made implant for use in a proximal tibial and knee resection is shown in Figure 1; it is designed for intramedullary cementing, which is the most common method of fixation. When considering whether surgery for limb-salvage is justified, it is usual to consider long-term oncological results and compare them with the historical results after amputation. Comparisons can be made in four broad areas: 1) the overall survival of patients; 2) the early and late morbidity for each type of reconstruction; 3) the function of the salvaged limb and its maintenance over a prolonged period of follow-up; and 4) the quality of life in patients having limb salvage and those having an amputation.