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Peer-reviewedCC BY 4.0Cancers

Survival, Failure Modes, and Risk Factors After Limb Salvage Surgery with Modular Megaprosthetic Reconstruction

  • Panayiotis Gavriil1
  • Vasileios Karampikas1
  • Stavros Goumenos1,2
  • Anastasios Roustemis1
  • Ioannis Trikoupis1
  • Philippos Orfanos3
  • Pagona Lagiou3,4
  • Sotirios Tsiodras5
  • Vasileios Kontogeorgakos1
  • Panayiotis Papagelopoulos1
5 affiliations
  1. 1First Department of Orthopaedics, ATTIKON University General Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
  2. 2Leeds Major Trauma Centre, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
  3. 3Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece
  4. 4Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
  5. 5Fourth Department of Internal Medicine, ATTIKON University General Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
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Abstract

Background/Objectives: Modular megaprosthetic reconstruction is a central limb-salvage strategy after major skeletal resection, but long-term outcomes remain limited. This study aimed to evaluate patient and implant survival, complication burden, Henderson failure modes, and associated risk factors. Methods: We retrospectively analyzed 340 consecutive patients undergoing modular megaprosthetic reconstruction at a tertiary referral center from 2003 to 2024 for primary malignant bone tumors, metastatic disease, or complex revision- or trauma-related indications. Kaplan–Meier methods estimated patient, implant, and complication-free survival. Implant failure and first recorded Henderson failure modes were additionally assessed using competing-risk methods. Cox regression evaluated risk factors, with multivariable modelling focused on Type IV infection. Results: Median follow-up was 5 years. Patient survival was 71.4% at 5 years and 61.3% at 10 years and was poorer in metastatic disease (p < 0.001). Implant survival was 78.0% and 70.3%, respectively. Complications occurred in 133 patients (39.1%). Type IV infection was the most frequent first failure mode (49, 14.4%), followed by Type I soft-tissue failure (40, 11.8%). The cumulative incidence of infection was 14.6% at 5 years and 15.3% at 10 years. Previous surgeries at the operative site (hazard ratio [HR] 2.30 per additional surgery, 95% confidence interval [CI] 1.90–2.80), operative time (HR 1.005/min, 95% CI 1.002–1.008), and diabetes mellitus (HR 2.30, 95% CI 1.25–4.25) were independently associated with infection and remained significant after expanded adjustment. Conclusions: Implant survival remained 70.3% at 10 years, but complications were frequent. Infection was the dominant first failure mode, and prior local surgery, longer operative time, and diabetes identified higher-risk patients. These findings support individualized risk assessment, preventive planning, and long-term surveillance.

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Cite

BibTeXRIS
BibTeX
@article{gavriil2026survival,
  title = {{Survival, Failure Modes, and Risk Factors After Limb Salvage Surgery with Modular Megaprosthetic Reconstruction}},
  author = {Panayiotis Gavriil and Vasileios Karampikas and Stavros Goumenos and Anastasios Roustemis and Ioannis Trikoupis and Philippos Orfanos and Pagona Lagiou and Sotirios Tsiodras and Vasileios Kontogeorgakos and Panayiotis Papagelopoulos},
  journal = {Cancers},
  year = {2026},
  month = oct,
  doi = {10.3390/cancers18203278},
  url = {https://www.mdpi.com/2072-6694/18/20/3278},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Survival, Failure Modes, and Risk Factors After Limb Salvage Surgery with Modular Megaprosthetic Reconstruction
AU  - Panayiotis Gavriil
AU  - Vasileios Karampikas
AU  - Stavros Goumenos
AU  - Anastasios Roustemis
AU  - Ioannis Trikoupis
AU  - Philippos Orfanos
AU  - Pagona Lagiou
AU  - Sotirios Tsiodras
AU  - Vasileios Kontogeorgakos
AU  - Panayiotis Papagelopoulos
PY  - 2026
DA  - 2026/10/01
JO  - Cancers
DO  - 10.3390/cancers18203278
UR  - https://www.mdpi.com/2072-6694/18/20/3278
AB  - Background/Objectives: Modular megaprosthetic reconstruction is a central limb-salvage strategy after major skeletal resection, but long-term outcomes remain limited. This study aimed to evaluate patient and implant survival, complication burden, Henderson failure modes, and associated risk factors. Methods: We retrospectively analyzed 340 consecutive patients undergoing modular megaprosthetic reconstruction at a tertiary referral center from 2003 to 2024 for primary malignant bone tumors, metastatic disease, or complex revision- or trauma-related indications. Kaplan–Meier methods estimated patient, implant, and complication-free survival. Implant failure and first recorded Henderson failure modes were additionally assessed using competing-risk methods. Cox regression evaluated risk factors, with multivariable modelling focused on Type IV infection. Results: Median follow-up was 5 years. Patient survival was 71.4% at 5 years and 61.3% at 10 years and was poorer in metastatic disease (p < 0.001). Implant survival was 78.0% and 70.3%, respectively. Complications occurred in 133 patients (39.1%). Type IV infection was the most frequent first failure mode (49, 14.4%), followed by Type I soft-tissue failure (40, 11.8%). The cumulative incidence of infection was 14.6% at 5 years and 15.3% at 10 years. Previous surgeries at the operative site (hazard ratio [HR] 2.30 per additional surgery, 95% confidence interval [CI] 1.90–2.80), operative time (HR 1.005/min, 95% CI 1.002–1.008), and diabetes mellitus (HR 2.30, 95% CI 1.25–4.25) were independently associated with infection and remained significant after expanded adjustment. Conclusions: Implant survival remained 70.3% at 10 years, but complications were frequent. Infection was the dominant first failure mode, and prior local surgery, longer operative time, and diabetes identified higher-risk patients. These findings support individualized risk assessment, preventive planning, and long-term surveillance.
SN  - 2072-6694
ER  -