Influence of chemotherapy on perioperative complications in limb salvage surgery for bone tumors

From 1970 to 1986, 304 patients underwent limb salvage resections for 271 malignant and 33 benign tumors of the extremities. Reconstruction was with a prosthesis or nonbiologic spacer. Nonmechanical complications were analyzed to determine the influence of the site and method of reconstruction and the use of chemotherapy on their incidence and severity. There were 82 shoulder resections, 53 proximal femur resections, and 169 knee resections. No chemotherapy was used in 115 patients; neoadjuvant therapy was used in 128 patients and adjuvant therapy was used in 61. There were 120 complications. The most common complication was infection (36 of 304 patients; 11.8%), which led to amputation in eight patients. Resections about the knee led to more complications than the other sites, particularly if reconstructed with a large cement spacer. Patients who did not receive any chemotherapy had a 25.2% (29 of 115) incidence of complications and those who received adjuvant treatment had a 32.8% (20 of 61) incidence. This compares with a 55.4% (71 of 128) incidence in the neoadjuvant group. After neoadjuvant chemotherapy, reconstruction with an uncemented prosthesis led to the fewest complications.