An international group ofresearchers has met every 2 years since 1981 to examine the progress made in limb salvage techniques and the perspectives of this field of surgery. In 1989 the Fifth International Symposium On Limb Salvage (ISOLS) was held in Saint Malo and was attended by more than 300 participants from 34 different countries. The 105 papers presented, grouped under eleven main headings, have been included in this book. Limb salvage has indeed progressed in the years since the first symposium. Initially it essentially concerned tumours and the main aim was to salvage the diseased limb through non-mutilating surgery without jeopardizing the patient's prospects of survival. Now, with a confirmed high rate of 5-year disease-free survival, new goals can be set: improvement of the functional results and of the survival of our reconstructions. How can this be achieved: - By favouring muscle reattachment on the prosthesis, for instance through the use of a bone allograft-sleeved composite prosthesis? - By improving the survival of the arthroplasty through the develop ment of a more biological fixation of its stems? - By limiting the side effects of the necessary adjuvant treatments on the function of the allograft as well as on the fixation of the prosthesis? In addition, limb salvage procedures now concern not only primary tumours (and metastases, which must be treated using the same osteosynthetic and prosthetic techniques), but also reconstructive orthopaedic surgery as a whole.

1 Allografts

The Clinical Use of Frozen Cadaveric Allografts in the Management of Bone Tumors: An Overview
Morphological Investigations of Osteochondral Allografts
Isotope Metabolism and Biochemistry of Massive Osteoarticular Allografts
The Development of a Size and Shape Matching Index for Osteochondral Allografts
Radiation Sterilized Bone Allografts: Banking Procedure and Clinical Results After 150 Massive Allografts
Allograft Replacement in Aggressive and Malignant Bone Tumors: A Long-Term Study
Massive Intercalary Allografts in the Reconstruction of Segmental Bone Defects
Osteoarticular Allograft Reconstruction of the Proximal Humerus Following Limb-Sparing Surgery
Allografts in Bone Tumor Surgery: Short-Term Results
Technical Aspects and Surgical Complications of Segmental Allografts Following Segmental Resections of Malignant Bone Tumors
Complications of Fresh Frozen Bone Allografts for Tumor Reconstruction and Their Management
Segmental Allograft Reconstruction Concomitant with Neoadjuvant Chemotherapy
Evaluation of Allograft Fixation
Chemotherapy Effect on the Clinical Results of Allograft Transplantation in the Treatment of Malignant Bone Tumors
Bone Union in Allografts: Chemotherapy Considerations
Treatment of Complications in Intercalary and Terminal Allografts
Complications in Hemipelvic Resection/Allograft Reconstruction for Bone Sarcomas: Are They Prohibitive to Limb Salvage?
2 Innovative Materials and Devices
Benign Aggressive Bone Lesions: Marginal Resection plus Methylmethacrylate - A Long-Term Appraisal
Polymethylmethacrylation in the Treatment of Giant Cell Tumors
Acrylic Cementation Techniques in the Treatment of Metaphyseal Tumors of Bone
Antimitotic-Loaded Acrylic Cement
Bioartificial Hydroxyapatite Implants
Reconstruction of Bone Defects
Calcium Hydroxyapatite Ceramic: Use in Bone Tumor Surgery
Implant of Biphasic Ceramic (Tricalcium Phosphate/Hydroxyapatite) in Cystic Cavities After Bone Tumor Curettage: Preliminary Results
3 Soft Tissue and Bone Transfer in Limb Salvage
Orthopaedic and Plastic Reconstruction of Large Bone and Soft Tissue Defects
Functional Coverage of the Shoulder Through Transfer of a Latissimus Dorsi Musculocutaneous Flap After Wide Excision of Malignant Bone Tumors
Free Tissue Transfer in Conjunction with Limb-Sparing Prosthetic Replacement for Sarcomas Around the Knee
Reconstructive Plastic Procedures in Recurrent Soft Tissue Sarcomas of the Extremities
Free Vascularized Fibular Graft for Skeletal Defect Reconstruction After Tumor Resection
Local Pedicular Vascularized Bone Graft in Reconstruction Around the Knee
Treatment of Tibial Defects and Nonunions Using Ipsilateral Vascularized Fibular Transposition
4 Prostheses: Long-Term Follow-Up. Effect of Adjuvant Treatments
Intramedullary Fixation of Massive Prostheses Using Acrylic Cement: A Retrieval Study
Long-Term Radiographic Evaluation of Massive Proximal Femoral Replacements
Segmental Total Hip and Knee Replacement: A Long-Term Review
Polyethylene Endoprostheses for the Treatment of Malignant Bone Tumors: A Long-Term Follow-Up Study
Long-Term Follow-Up of Walldius-Hinged Total Knee Arthoplasties
Endoprosthetic Replacements of the Proximal Tibia
The Effect of Chemotherapy on Uncemented Prosthetic Replacements
Effects of Adjuvant Local X-Ray Therapy on the Functional Result of Prosthetic Knee Replacement for Malignant Bone Tumors
Summary
5 Innovative Prostheses
A Challenge to Osteointegrable Tumor Prosthesis
The Bone-Cement Interface in Long-Standing Prosthetic Implants
Histomorphological Findings in Different Cementless Anchored Humerus Prostheses
Comparison of Autogenous Cortical Graft and Demineralized Allogenic Bone Matrix (DABM) in the Fixation of Segmental Prosthesis
Experience with Extracortical Fixation of Large Segmental Prostheses and Description of a Modular Segmental Replacement System (MSRS)
Design Characteristics of Knee Joints for Limb Salvage Devices
Effect of Therapeutic Irradiation on Extracortical Fixation and Bone Ingrowth in an Autogenously Bone Grafted Segmental Defect Prosthesis
Telemetry of Strain In Vivo from a Proximal Femoral Replacement
Hemipelvic Endoprosthetic Replacements
6 Composite Prostheses and Soft Tissues Reattachment
Composite Prostheses in Malignant Tumors: Rationale and Preliminary Results of 42 Cases
Muscle Reattachment - Especially the Gluteal Muscles- After Proximal Femoral Resection and Replacement by Tumor Prosthesis
Dacron Fabric Enveloped Alumina Ceramic Prosthesis for Large Bone Defects
Allograft Prosthetic Composite Arthoplasty for Limb Salvage and Revision Arthroplasty
Radiation Sterilized Proximal Femur Massive Allografts After Tumor Surgery: A Preliminary Report
Allograft-Prostljesis Combinations in Limb Salvage Surgery
Contribution of Allografts in Prosthetic Surgery
Allograft with Patellar Tendon in Reconstructive Procedures After Upper Tibia Resection
Incidence of Adjuvant Radiotherapy and Chemotherapy and Infection in Massive Composite Allograft Prostheses
7 Failures of Prostheses
Introduction: Reoperation Following Prosthetic Replacement
Reoperation of Failed Prosthetic Replacement for Limb Salvage
Salvage Procedures for Failed Total Hip Prostheses Implanted After Tumor Resection
Management of the Failed Segmental Knee Replacement
An Individualized Design Approach for Revising Total Knee Hinges
Management of Failed Endoprosthetic Implants: The UCLA Experience
Management of Failed Segmental Hip and Knee Implants
Management of Failed Megaprostheses After Limb-Saving Surgery
Influence of Chemotherapy on Perioperative Complications in Limb-Salvage Surgery for Bone Tumors
Conclusion: Reoperation Following Prosthetic Replacement
8 Limb Salvage in Pediatric Surgery
Limb Salvage in Pediatric Patients (Round Table)
Effect of Chemotherapy on Growth in the Skeletally Immature Individual
Van Nes Rotationplasty in Skeletally Immature Patients with Malignant Sarcoma of the Lower Extremity
Lymph Scintigraphy in Patients After Rotationplasty
Adaptation of the Ankle Joint After Rotationplasty in Children
Arthrodeses After Malignant Bone Tumor Resection in Children
Reconstruction After Large Bone Shaft Resection for Humerus, Femur, and Tibia Sarcomas: Autograft or Allograft Reconstitution?
Cemented Prosthetic Replacement for Children with Primary Bone Sarcomas: Results and Growth Problems
Bone Allografts for Tumors and Other Reconstructions in Children
Growing Endoprosthetic Replacements for Malignant Tumors
The Expandable Adjustable Prosthesis: An Alternative to Amputation in Growing Children with Malignant Tumors of the Extremities
Expandable Endoprostheses for the Skeletally Immature: The Initial UCLA Experience
Endoprostheses in Children - First Results
Remodelling of Bone Around Massive Prostheses Used in Growing Patients
In Vitro and In Vivo Experiments of a Lengthening Element for a Modular Femur Endoprosthetic System
Conclusions of Limb Salvage in Pediatric Patients (Round Table)
9 Innovative Procedures
Limb Salvage with the Intraoperatively Irradiated Tumor Tissues Preserved In Situ in Osteosarcoma
Limb Conservation in Primary Bone Tumors by Resection, Extracorporeal Irradiation and Reimplantation: Results and Complications of the Technique in 27 Patients
Developments of Interlocking Nailings in Limb Salvage Surgery: Endolock and TD Nails
Segmental Resection of Thigh for Osteosarcoma of Distal Part of Femur
En Bloc Sacral Resection or Total Sacrectomy
Prosthetic Reconstruction Following Internal Hemipelvectomy: Clinical Results and Improvement of Pelvic Tumor Prosthesis
Reconstruction of the Tibia by Dual Grafting: Report of Three Cases
Primary Stabilization Procedures for Large Osteoperiosteal Gaps Following Tumor Resections
10 Metastases
Treatment of Metastatic Disease Involving the Proximal Femur and Hip Joint
Use of Megaprostheses in the Treatment of Metastatic Bone Disease
Pitfalls in the Management of Metastatic Disease of the Femur
Metastatic Carcinoma of the Spine with Neurological Complications: An Autopsy Review
Surgical Treatment of Vertebral Metastases
Score Assessment on Metastatic Bone Tumor for Operative Treatment
Allograft Reconstruction for Bone Metastases
Prosthetic Replacement in the Treatment of Bone Metastases
Vertebral Metastasis - Natural History and Treatment
Surgical Treatment of Bone Metastases
11 Imaging (Joint Session GETO-ISOLS)
Role of Electroradiography in the Evaluation of Preoperative Treatment for Primary Malignant Bone Tumors
Magnetic Resonance Imaging in Evaluating In Vivo Response to Neoadjuvant Chemotherapy for Osteogenic Sarcomas
Radiographic Evaluation of the Response of Osteosarcoma to Induction Chemotherapy
Recurrence Detection of Malignant Mesenchymal Neoplasms in MRI and CT
Contribution of Magnetic Resonance Imaging in the Evaluation of Tumor Extension and in the Follow-Up During Chemotherapy in an Undifferentiated Osteogenic Sarcoma: A Case Report
Osteosarcoma: Evaluation of Prognosis by Flow Cytometry
High Resolution Radiography of Bone Tumor Resection Specimens
Single Photon Emission Computed Tomography (SPECT) Analysis of Allograft Revascularization
Suitability of MRI for the Selection of Osteochondral Allograft Bone.