{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T18:24:28Z","timestamp":1791829468826,"version":"4.3.4"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2021,9,13]],"date-time":"2021-09-13T00:00:00Z","timestamp":1631491200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,9,13]],"date-time":"2021-09-13T00:00:00Z","timestamp":1631491200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004434","name":"Universit\u00e0 degli Studi di Firenze","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004434","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Orthop Trauma Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Megaprosthesis represent the most commonly used limb salvage method after musculoskeletal tumor resections. Nevertheless, they are burdened by high complication rate, requiring several surgical revisions and eventually limb amputation. The aims of this study were to evaluate the effect of rescuing the limb with subsequent revisions on complication rates (a), incidence of amputations (b), and whether complications reduce functional outcome after the first surgical revision (c).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed 444 lower limb megaprosthesis implanted for primary musculoskeletal tumors or metastatic lesions, from February 2000 to November 2017. 59 patients received at least one revision megaprosthesis surgery. MSTS score was used to assess final functional results. Complication-revision-amputation free survival rates were calculated both at 5 and 10\u00a0years of follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Complication free survival, revision free survival and amputation free survival at 10\u00a0years were 47% and 53%, 61% and 67%, 90% and 86% among all 444 patients and the group of 59 revised patients, respectively. The incidence of further complications after the first complication was 26% in the group treated with no subsequent revision surgeries and 51% in the group with at least one revision surgery. We found a trend of inverse linear relationship between the number of complications needing subsequent revision surgeries and the final MSTS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The number of further revision surgeries after limb salvage with megaprosthesis increases the incidence of complications. Repeated surgical revisions, in particular after infection, increase the amputation rate. The most frequent causes of failure were structural failures and infections. MSTS score was superior for patients undergoing limb salvage than amputees. However, MSTS progressively decreased with multiple revisions becoming inferior to the functional score of an amputated patient.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00402-021-04165-8","type":"journal-article","created":{"date-parts":[[2021,9,13]],"date-time":"2021-09-13T11:03:03Z","timestamp":1631530983000},"page":"763-771","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Salvage of limb salvage in oncological reconstructions of the lower limb with megaprosthesis: how much to push the boundaries?"],"prefix":"10.1007","volume":"143","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9604-2042","authenticated-orcid":false,"given":"Matteo","family":"Innocenti","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Muratori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Foschi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saverio","family":"Bartolini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Scorianz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guido","family":"Scoccianti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico Andrea","family":"Campanacci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,9,13]]},"reference":[{"key":"4165_CR1","doi-asserted-by":"crossref","unstructured":"Ferguson PC (2005) Surgical considerations for management of distal extremity soft tissue sarcomas. Curr Opin Oncol","DOI":"10.1097\/01.cco.0000166651.38417.c8"},{"key":"4165_CR2","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-014-3699-2","author":"E Pala","year":"2015","unstructured":"Pala E, Trovarelli G, Calabr\u00f2 T et al (2015) Survival of modern knee tumor megaprostheses: failures, functional results, and a comparative statistical analysis. Clin Orthop Relat Res. https:\/\/doi.org\/10.1007\/s11999-014-3699-2","journal-title":"Clin Orthop Relat Res"},{"key":"4165_CR3","doi-asserted-by":"crossref","unstructured":"Ahlmann ER, Menendez LR, Kermani C, Gotha H (2006) Survivorship and clinical outcome of modular endoprosthetic reconstruction for neoplastic disease of the lower limb. J Bone Jt Surg Ser B","DOI":"10.1302\/0301-620X.88B6.17519"},{"key":"4165_CR4","doi-asserted-by":"publisher","DOI":"10.23750\/abm.v88i2-S.6523","author":"E Pala","year":"2017","unstructured":"Pala E, Trovarelli G, Angelini A et al (2017) Megaprosthesis of the knee in tumor and revision surgery. Acta Biomed. https:\/\/doi.org\/10.23750\/abm.v88i2-S.6523","journal-title":"Acta Biomed"},{"key":"4165_CR5","unstructured":"Calder\u00f3n SAL, Kuechle J, Raskin KA, Hornicek FJ (2018) Lower extremity megaprostheses in orthopaedic oncology. J Am Acad Orthop Surg"},{"key":"4165_CR6","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.96B11.34747","author":"ER Henderson","year":"2014","unstructured":"Henderson ER, O\u2019Connor MI, Ruggieri P et al (2014) Classification of failure of limb salvage after reconstructive surgery for bone tumours: a modified system including biological and expandable reconstructions. Bone Jt J. https:\/\/doi.org\/10.1302\/0301-620X.96B11.34747","journal-title":"Bone Jt J"},{"key":"4165_CR7","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000223978.36831.39","author":"G Gosheger","year":"2006","unstructured":"Gosheger G, Gebert C, Ahrens H et al (2006) Endoprosthetic reconstruction in 250 patients with sarcoma. Clin Orthop Relat Res. https:\/\/doi.org\/10.1097\/01.blo.0000223978.36831.39","journal-title":"Clin Orthop Relat Res"},{"key":"4165_CR8","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-005-0009-1","author":"J Hardes","year":"2006","unstructured":"Hardes J, Gebert C, Schwappach A et al (2006) Characteristics and outcome of infections associated with tumor endoprostheses. Arch Orthop Trauma Surg. https:\/\/doi.org\/10.1007\/s00402-005-0009-1","journal-title":"Arch Orthop Trauma Surg"},{"key":"4165_CR9","doi-asserted-by":"crossref","unstructured":"Henderson ER, Groundland JS, Pala E et al (2011) Failure mode classification for tumor endoprostheses: retrospective review of five institutions and a literature review. J Bone Jt Surg Ser A","DOI":"10.2106\/JBJS.J.00834"},{"key":"4165_CR10","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.C.01222","author":"LM Jeys","year":"2005","unstructured":"Jeys LM, Grimer RJ, Carter SR, Tillman RM (2005) Periprosthetic infection in patients treated for an orthopaedic oncological condition. J Bone Jt Surg Ser A. https:\/\/doi.org\/10.2106\/JBJS.C.01222","journal-title":"J Bone Jt Surg Ser A"},{"key":"4165_CR11","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-001-0328-y","author":"SH Lee","year":"2002","unstructured":"Lee SH, Oh JH, Lee KS et al (2002) Infection after prosthetic reconstruction in limb salvage surgery. Int Orthop. https:\/\/doi.org\/10.1007\/s00264-001-0328-y","journal-title":"Int Orthop"},{"key":"4165_CR12","doi-asserted-by":"publisher","DOI":"10.1002\/jso.23414","author":"E Pala","year":"2013","unstructured":"Pala E, Henderson ER, Calabr\u00f2 T et al (2013) Survival of current production tumor endoprostheses: complications, functional results, and a comparative statistical analysis. J Surg Oncol. https:\/\/doi.org\/10.1002\/jso.23414","journal-title":"J Surg Oncol"},{"key":"4165_CR13","doi-asserted-by":"crossref","unstructured":"Enneking WF, Dunham W, Gebhardt MC et al (1993) A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. In: Clinical Orthopaedics and Related Research","DOI":"10.1097\/00003086-199301000-00035"},{"key":"4165_CR14","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2019.09.030","author":"MA Smolle","year":"2020","unstructured":"Smolle MA, Friesenbichler J, Bergovec M et al (2020) How is the outcome of the Limb Preservation SystemTM for reconstruction of hip and knee? Orthop Traumatol Surg Res. https:\/\/doi.org\/10.1016\/j.otsr.2019.09.030","journal-title":"Orthop Traumatol Surg Res"},{"key":"4165_CR15","doi-asserted-by":"publisher","DOI":"10.1155\/2016\/9079041","author":"F Donati","year":"2016","unstructured":"Donati F, Di Giacomo G, D\u2019Adamio S et al (2016) Silver-coated hip megaprosthesis in oncological limb savage surgery. Biomed Res Int. https:\/\/doi.org\/10.1155\/2016\/9079041","journal-title":"Biomed Res Int"},{"key":"4165_CR16","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-200202000-00022","author":"RJ Grimer","year":"2002","unstructured":"Grimer RJ, Belthur M, Chandrasekar C et al (2002) Two-stage revision for infected endoprostheses used in tumor surgery. Clin Orthop Relat Res. https:\/\/doi.org\/10.1097\/00003086-200202000-00022","journal-title":"Clin Orthop Relat Res"},{"key":"4165_CR17","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.98B6.37417","author":"RJ Grimer","year":"2016","unstructured":"Grimer RJ, Aydin BK, Wafa H et al (2016) Very long-term outcomes after endoprosthetic replacement for malignant tumours of bone. Bone Jt J. https:\/\/doi.org\/10.1302\/0301-620X.98B6.37417","journal-title":"Bone Jt J"},{"key":"4165_CR18","doi-asserted-by":"crossref","unstructured":"Unwin PS, Cannon SR, Grimer RJ et al (1996) Aseptic loosening in cemented custom-made prosthetic replacements for bone tumours of the lower limb. J Bone Jt Surg Ser B","DOI":"10.1302\/0301-620X.78B1.0780005"},{"key":"4165_CR19","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-014-3736-1","author":"R Capanna","year":"2015","unstructured":"Capanna R, Scoccianti G, Frenos F et al (2015) What was the survival of megaprostheses in lower limb reconstructions after tumor resections? Clin Orthop Relat Res. https:\/\/doi.org\/10.1007\/s11999-014-3736-1","journal-title":"Clin Orthop Relat Res"}],"container-title":["Archives of Orthopaedic and Trauma Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00402-021-04165-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00402-021-04165-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00402-021-04165-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,13]],"date-time":"2023-02-13T19:13:53Z","timestamp":1676315633000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00402-021-04165-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,13]]},"references-count":19,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["4165"],"URL":"https:\/\/doi.org\/10.1007\/s00402-021-04165-8","relation":{},"ISSN":["1434-3916"],"issn-type":[{"value":"1434-3916","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,13]]},"assertion":[{"value":"27 May 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 September 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 September 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Therefore, no benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All patients accepted the proposed treatment and follow-up after an adequate information and written consent. The study and follow-up, respecting the criteria of the Declaration of Helsinki, have been approved by Institutional Review Board of Azienda Ospedaliera Universitaria Careggi (AOUC) Department of Surgery and Translational Medicine. The Institutional Review Board accepted the proposal of the study, and all selected patients were properly informed before surgery about the treatment and follow-up visits after discharge.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}}]}}