Functional Outcomes and Survivorship of Revision Surgery for Failed Tumor Endoprostheses in the Lower Extremity

Background: Limb salvage with endoprostheses is the standard of care for lower extremity bone tumors. Despite improvements, failure modes such as aseptic loosening and mechanical failure necessitate complex revision surgery.
Objective: This study aimed to evaluate the functional outcomes and survivorship of revision surgery for failed tumor endoprostheses.
Methods: A retrospective and prospective analysis of 23 patients who underwent revision surgery for failed lower extremity tumor endoprostheses between 2021 and 2026 was conducted. Failure was classified using the Henderson classification system. The primary outcome was the postoperative Musculoskeletal Tumor Society (MSTS) score. Secondary outcomes included complication rates and implant survivorship that was analyzed using Kaplan-Meier curves.
Results: The mean patient age was 27.7 ± 9.7 years. The most common failure modes were mechanical failure (63.1%), including periprosthetic fracture (30.4%) and implant breakage (26.1%), and aseptic loosening (30.4%). The mean postoperative MSTS score was 27.78 ± 1.93. Superficial infection occurred in one patient (4.3%). There were no deep infections, tumor recurrences, or deaths. One patient eventually required amputation following a complication. Kaplan-Meier analysis indicated a mean implant survival time of 13.9 years (95% CI: 11.2 - 16.7) post-revision.
Conclusion: Revision surgery for failed tumor endoprostheses, while challenging, leads to excellent functional outcomes and good medium-term implant survivorship. Aseptic loosening and structural failure are the most common indications for revision and can be successfully managed with a variety of advanced revision strategies.