Dr. Randall on the Evolution of Limb Salvage Technologies in Bone Sarcomas

R. Lor Randall, MD, FACS, The David Linn Endowed Chair for Orthopaedic Surgery, professor and chair, Department of Orthopaedic Surgery, University of California Davis Health, discusses the evolution of limb salvage technologies in bone sarcomas.

Cemented stem and press-fit implants were useful limb salvage technologies initially; however, over time, stress shielding causes many of these endoprostheses to become loose at the stem interface, Randall explains. This loosening eventually causes the limb to fail and cause pain, fractures, and other morbid complications.

Before the integration of neoadjuvant and adjuvant chemotherapy, patients with bone sarcomas were likely to succumb to their disease, so short-term benefits from limb salvage technology were usually sufficient. However, chemotherapy had prolonged survival so that patients were outliving their disease, Randall says. Therefore, limb salvage technologies that caused eventual orthopedic disease needed to be improved upon.

As such, compressive osseointegration is a novel technique that harnesses Wolff’s law to allow the bone to adapt and grow in response to physical force, Randall concludes.