Survival, Failure Modes, and Risk Factors After Limb Salvage Surgery with Modular Megaprosthetic Reconstruction

Background/Objectives: Modular megaprosthetic reconstruction is a central limb-salvage strategy after major skeletal resection, but long-term outcomes remain limited. This study aimed to evaluate patient and implant survival, complication burden, Henderson failure modes, and associated risk factors.

Methods

We retrospectively analyzed 340 consecutive patients undergoing modular megaprosthetic reconstruction at a tertiary referral center from 2003 to 2024 for primary malignant bone tumors, metastatic disease, or complex revision- or trauma-related indications. Kaplan–Meier methods estimated patient, implant, and complication-free survival. Implant failure and first recorded Henderson failure modes were additionally assessed using competing-risk methods. Cox regression evaluated risk factors, with multivariable modelling focused on Type IV infection.