From amputation to limb salvage reconstruction: evolution and role of the endoprosthesis in musculoskeletal oncology

Abstract

In 1943, Austin Moore developed the first endoprosthesis fashioned from Vitallium, providing the first alternative to traditional amputation as primary treatment of bone tumors. The success of the Vitallium endoprosthesis has since then led to the development of new materials and designs further advancing limb salvage and reconstructive surgery. Combined with the advent of chemotherapy use and imaging advances, conservative treatment of musculoskeletal tumors has expanded greatly. As the implantable options increased with the development of the Lewis expandable adjustable prosthesis and the noninvasive Phenix Growing prosthesis, receiving the diagnosis of a bone tumor no longer equates to automatic limb loss. Our review details the history and development of endoprostheses throughout orthopedic oncology in the treatment of musculoskeletal tumors.

Fig. 1

Plain radiograph of the original vitallium endoprosthesis from Moore and Bohlman [5]. Reprinted with permission from JBJS

Fig. 2

Photograph of the original vitallium endoprosthesis upon autopsy from Moore and Bohlman [5]. Reprinted with permission from JBJS

Fig. 3

Photograph of the different modular components comprising a humeral implant to ensure the best fit for the patient from Funovics et al. [54]. Reprinted with permission from JBJS

Fig. 4

Image of REPIPHYSIS expandable prosthesis. Reprinted with permission by Wright Medical Technology, Arlington, Tennessee

Fig. 5

Anteroposterior (a) and lateral (b) radiographs of a pediatric patient with a REPIPHYSIS endoprosthesis