Ultra-short stem intercalary prosthetic reconstruction for joint preservation in metaphyseal tumor management: a retrospective review of twenty-five cases

Abstract

Purpose: This study evaluates the outcomes, survival, and ASL incidence of ultra-short stem intercalary prosthetic reconstruction for tumors involving the metaphysis of bone. Methods: A retrospective analysis of 25 patients treated at two centers with wide resection for primary or metastatic bone tumors (femur, tibia, humerus) followed by reconstruction using ultra-short stem intercalary prostheses combined extracortical plates. Clinical outcomes were assessed using the Visual Analogue Scale (VAS) and Musculoskeletal Tumor Society (MSTS) score. Survival rates were calculated using the Kaplan–Meier method, and complications were classified according to the Henderson system. Results: The mean follow-up was 20.2 months (range, 3–101 months). The average length of the ultra-short stems was 41.3 ± 9.6 mm. Mean operative time was 164 ± 61.3 min, blood loss averaged 646.4 ± 375.5 ml and the mean defect size was 122 ± 52.1 mm. Postoperative VAS scores were significantly lower than preoperative levels (P < 0.05). The mean MSTS score was 24.2 ± 3.5 (range, 15–29). Kaplan–Meier analysis revealed prosthesis survival rates at 1, 2, 3, and 5 years of 91.7%, compared to patient survival rates of 74.5%, 52.7%, 52.7%, and 52.7%. Postoperative complications occurred in 12% of patients (3/25), including one case of aseptic loosening (ASL), and two patients required reoperation. Conclusions: Ultra-short stem intercalary prostheses with extracortical plates provide a viable, effective option for reconstruction of short bone stumps after tumor resection, offering improved functional outcomes and acceptable prosthesis failure rates.