Outcomes of Megaprosthetic Reconstruction After Tumor Resection of the Distal Femur and Proximal Tibia: A Single-Center Retrospective Study of 241 Cases
Journal of Clinical Medicine, vol.15, no.10, 2026 (SCI-Expanded, Scopus)
- Publication Type: Article / Article
- Volume: 15 Issue: 10
- Publication Date: 2026
- Doi Number: 10.3390/jcm15103955
- Journal Name: Journal of Clinical Medicine
- Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Chemical Abstracts Core, EMBASE, Academic Search Ultimate (EBSCO), Health Research Premium Collection (ProQuest)
- Keywords: amputation, bone sarcoma, distal femur, Henderson classification, Kaplan–Meier, limb salvage, megaprosthesis, proximal tibia, revision-free survival, surgical margin
- Gazi University Affiliated: Yes
Abstract
Background: Megaprosthetic reconstruction is the standard of care for limb salvage after tumor resection around the knee, but the full burden of unplanned revision surgery is rarely reported as a structured composite outcome. We evaluated 241 consecutive patients over 21 years at a tertiary orthopedic oncology center. Methods: This retrospective cohort included 241 patients (160 distal femur, 78 proximal tibia, three combined) treated between 2003 and 2024. Revision-free survival (RFS, composite of any unplanned revision or amputation) and amputation-free survival were estimated by Kaplan–Meier analysis; independent predictors were identified by Cox regression. A pre-specified major-event composite (amputation, implant removal, or recurrence resection) was used for sensitivity analysis. Results: Mean age was 34.9 ± 19.5 years; mean follow-up was 120.2 months. Negative resection margin (R0) was achieved in 85.5% (206/241). Unplanned revision was required in 25 patients (10.4%); overall limb salvage was 92.9%. Five-year RFS was 73.8% (distal femur) vs. 65.0% (proximal tibia; p = 0.084), and 5-year limb salvage was 88.9% vs. 84.3% (p = 0.081). Surgical margin was strongly associated with outcome: 5-year RFS 75.4% (R0) vs. 48.7% (R1/R2; p < 0.001); 5-year limb salvage 90.6% vs. 71.5% (p = 0.003). On exploratory multivariate Cox analysis, proximal tibia site and positive margin were associated with worse revision-free survival; within the proximal tibia subgroup, absence of gastrocnemius flap coverage was also associated with worse outcome (interpreted with caution given the small flap subgroup, n = 11, and limited event count). Conclusions: In this single-center series, megaprosthetic reconstruction around the knee achieved acceptable revision-free survival and limb salvage. Surgical margin status was the strongest independent predictor of both endpoints, reinforcing the well-established importance of oncologic margin quality and site-specific soft tissue strategies.