Limb-salvage surgery for aggressive bone tumours at Chris Hani Baragwanath Academic Hospital results in a high post-operative complication rate, primarily driven by prosthetic joint infections and instability. Retrospective findings detail outcomes from a specialized cohort treated between January 2017 and December 2024.
Modern Techniques Save Limbs but Carry Mechanical Risks
- Limb Salvage vs. Amputation: Modern orthopaedic techniques aim to save limbs using modular tumour prosthetic devices rather than amputation, though they carry mechanical risks.
- Prosthetic Complications: The majority of post-surgical issues involve prosthetic joint infections (PJIs) or instability.
- Late Presentation: Patients in this cohort typically arrive with large tumour volumes, which complicates limb-salvage procedures and extends operating times.
Retrospective Clinical Audit at Chris Hani Baragwanath Academic Hospital
Between January 2017 and December 2024, a specialized tumour unit at Chris Hani Baragwanath Academic Hospital in Johannesburg conducted a retrospective review of patients undergoing limb-salvage procedures. The analysis captured 20 patient records that met inclusion criteria, evaluating demographic data, pathological factors, and surgical metrics using Stata 18 software.
The burden of disease showed an equal distribution across all age brackets within the small cohort: five patients aged 0 to 17, five aged 18 to 24, five aged 25 to 34, and five older than 35 years. The majority of individuals identified were of African descent. Osteosarcoma accounted for 45 percent of diagnoses (nine cases), followed by giant cell tumour (GCT) of bone. Lower-limb involvement dominated the dataset, representing 90 percent or 18 out of 20 total cases.
High Rates of Prosthetic Infection and Mechanical Instability
Surgical intervention for bone sarcomas successfully achieves good oncological outcomes in over 90 percent of cases when paired with chemotherapy and radiation. However, structural reconstruction introduces hardware-related vulnerabilities. Overall, the majority of patients in the Johannesburg cohort experienced post-operative complications.
The audit revealed distinct anatomical patterns in how these complications manifest. Neurovascular injury, muscle weakness, and prosthetic joint infections showed a clear predilection for the lower limb. Conversely, prosthetic instability occurred likely following proximal humerus resection and replacement joint. Researchers noted that large primary tumour volumes—with Phillias et al. reporting an average osteosarcoma tumour volume of 1114 cm3 at presentation—compound intra-operative blood loss and create challenges for the treating surgeon.
| Clinical Parameter | Audit Finding |
|---|---|
| Study Period | January 2017 – December 2024 |
| Total Cohort Size | 20 patient records |
| Most Common Diagnosis | Osteosarcoma (45%) |
| Lower-Limb Involvement | 90% (18/20 cases) |
| Overall Complication Rate | Seventy percent |
Prior Revision Surgeries Exclude Patients from This Cohort
Individuals who have undergone prior revision surgeries or received treatment at a different unit were excluded from this specific cohort.
Future Treatment Strategies in Resource-Constrained Settings
The findings emphasize the ongoing clinical challenges of managing aggressive bone tumours in this clinical context. While modular tumour prosthetic devices successfully preserve limb function and avoid amputations, the incidence of hardware-associated failure demands refined perioperative protocols. Investigators highlight that promoting early presentation and maintaining meticulous soft-tissue preservation techniques remain critical steps toward lowering complication rates in similar specialized units.
References
- Audit of Surgical Complications Post-limb Salvage Procedures for Aggressive Bone Tumours at a Developing Tumour Unit.
- Phillias et al.: Tumour volume analysis in primary malignant bone tumours.
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