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Journal of Bone and Joint Surgery - British Volume, Vol 89-B, Issue 10, 1352-1355.
doi: 10.1302/0301-620X.89B10.19233  
Copyright © 2007 by British Editorial Society of Bone and Joint Surgery
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The risks and benefits of radiotherapy with massive endoprosthetic replacement

L. M. Jeys, MSc(Ortho. Engin.), FRCS(Tr&Orth), Consultant Orthopaedic Surgeon1; J. S. Luscombe, FRCS(Tr&Orth), Specialist Registrar1; R. J. Grimer, FRCS, Consultant Orthopaedic Surgeon1; A. Abudu, FRCS(Tr&Orth), Consultant Orthopaedic Surgeon1; R. M. Tillman, FRCS(Tr&Orth), Consultant Orthopaedic Surgeon1; and S. R. Carter, FRCS, Consultant Orthopaedic Surgeon1

1 Royal Orthopaedic Hospital Oncology Service, Bristol Road South, Northfield, Birmingham B31 2AP, UK.

Correspondence should be sent to Mr L. M. Jeys; e-mail: lee.jeys{at}btclick.com

Between 1966 and 2001, 1254 patients underwent excision of a bone tumour with endoprosthetic replacement. All patients who had radiotherapy were identified. Their clinical details were retrieved from their records.

A total of 63 patients (5%) had received adjunctive radiotherapy, 29 pre-operatively and 34 post-operatively. The mean post-operative Musculoskeletal Tumor Society scores of irradiated patients were significantly lower (log-rank test, p = 0.009). The infection rate in the group who had not been irradiated was 9.8% (117 of 1191), compared with 20.7% (6 of 29) in those who had pre-operative radiotherapy and 35.3% (12 of 34) in those who radiotherapy post-operatively. The infection-free survival rate at ten years was 85.5% for patients without radiotherapy, 74.1% for those who had pre-operative radiotherapy and 44.8% for those who had post-operative radiotherapy (log-rank test, p < 0.001). The ten-year limb salvage rate was 89% for those who did not have radiotherapy and 76% for those who did (log-rank test, p = 0.02).

Radiotherapy increased the risk of revision (log-rank test, p = 0.015). A total of ten amputations were necessary to control infection, of which nine were successful. Radiotherapy may be necessary for the treatment of a bone sarcoma but increases the risk of deep infection for which amputation may be the only solution.




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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General