ArticleInternational orthopaedics2026
Limb salvage for long-bone sarcomas: a comparative of clinical outcomes and cost-effectiveness analysis of biological versus endoprosthetic reconstruction.
Article in International orthopaedics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeEndoprosthetic reconstruction (EPR) and biological reconstruction (BR) are the two primary methods for limb-salvage surgery in long-bone sarcomas. Comparative data on clinical outcomes and cost-effectiveness are lacking. This study aimed to compare EPR versus BR for long‑bone sarcomas in terms of these outcomes.
methodsWe performed a retrospective cohort study of 1657 patients who underwent limb-salvage surgery for long‑bone sarcomas (2008-2023) at a single center. After propensity score matching, 70 BR patients were matched to 157 EPR patients. We compared perioperative outcomes, complications, MSTS-93 functional scores, and survival endpoints. A lifetime cost-effectiveness analysis from a Chinese healthcare perspective was performed using a Markov model.
resultsBR was associated with greater blood loss (797 vs. 443 mL) and longer operative time (7.0 vs. 4.2 h; both P < 0.001). The cumulative complication rate within the first three postoperative years was higher in the BR group (28.6% vs. 15.3%; P = 0.019); however, the total complication rates were similar between the two groups (31.4% vs. 27.4%; P = 0.498) at final follow-up. The MSTS scores were higher in the EPR group at six months (22.2 vs. 17.7; P < 0.001), but higher in the BR group at final follow-up (24.9 vs. 22.6; P < 0.001). No significant differences were observed in overall survival (OS), disease-free survival (DFS), revision-free survival (RFS), and implant survival (IS). BR had lower implant costs (¥53,269 vs. ¥89,960; P < 0.001) and total hospitalization costs (¥94,224 vs. ¥122,586; P < 0.001), and was associated with lifetime cost savings of ¥82,690, an additional 2.44 QALYs, and an ICER of -¥33,964 per QALY.
conclusionBoth EPR and BR effectively address long-bone defects post-tumour resection. Compared with EPR, BR had longer operative time and more early complications, but fewer intermediate-term complications and better functional outcomes. BR also had lower costs and favourable cost‑effectiveness.
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