Segmental endoprosthesis replacement in a resource-constrained setting

Purpose: Indications for the use of endoprosthesis have continued to expand over the years, especially as an alternative to ablative surgery. This mode of treatment which was initially limited to orthopaedic oncology is now being applied in complex trauma with significant bone loss and end-stage arthroplasty. However, use of endoprosthesis in a resource-constrained setting such as sub-Saharan Africa is limited by various factors. These factors include high cost of endoprosthesis, restricted availability of appropriate equipment and the requisite trained specialists in the field. Methods: Twelve patients who had segmental endoprosthetic replacement for various aetiologies were studied in this case series. Resection lengths, complications and functional outcomes were noted. Results: The resection length varied between 12 and 27 cm. Using the Henderson classification system, one patient (8.3%) had a Type 1A complication, one had a Type 3A complication (8.3%), and two patients had Type 4A complications (16.6%). Functional outcomes were graded using the MusculoSkeletal Tumour Society scoring system, and scores were good to excellent in ten patients, moderate in one and poor in one patient. Conclusion: Early results indicate fair outcomes; however, factors limiting the use of endoprosthesis still persist. These include high cost of endoprosthesis, restricted availability of appropriate equipment and the requisite trained specialists in the field. © 2020, Istituto Ortopedico Rizzoli.