Limb salvage is widely practiced as standard of care in most cases of extremity bone sarcoma. Allograft and endoprosthesis reconstructions are the most widely utilized modalities for the reconstruction of large segment defects; however, complication rates remain high. Aseptic loosening and infection remain the most common modes of failure. Implant integration, soft-tissue function, and infection prevention are crucial for implant longevity and function. Macroalterations and microalterations in implant design are reviewed in this manuscript. Tissue engineering principles using nanoparticles, cell-based, and biological augments have been utilized to develop implant coatings that improve osseointegration and decrease infection. Similar techniques have been used to improve the interaction between soft tissues and implants. Tissue engineered constructs used in combination with, or in place of, traditional reconstructive techniques may represent the next major advancement in orthopedic oncology reconstructive science, although preclinical results have yet to achieve durable translation to the bedside.
Departmet of Orthopaedic Surgery, David Geffen School of Medicine at University of California, Los Angeles
N.M.B.: has or may receive payments or benefits from Onkos (Parsippany, NJ) not related to this work. Research reported in this publication was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Numbers T32AR059033 and 5K08AR069112-01. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The remaining authors declare that they have nothing to disclose.
For reprint requests, or additional information and guidance on the techniques described in the article, please contact Nicholas M. Bernthal, MD, at or by mail at Orthopaedic Center–Santa Monica UCLA, 1250 16th Street, Suite 2100, Santa Monica, California 90404. You may inquire whether the author(s) will agree to phone conferences and/or visits regarding these techniques.