Fixation of Endoprostheses in Tumour Replacement Gordon Blunn and Melanie Coathup Contents Introduction ....................................... 4119 Survivorship and Aseptic Loosening of Massive Endo-Prosthetic Replacements ............... 4120 Fixation in Young Patients ....................... 4121 Re-Modelling of Bone Around Endo-Prosthetic Intramedullary Stems ......................... 4121 Bony Bridging ..................................... 4122 Extracortical Fixation ............................ 4126 Fixation Using Compression ..................... 4129 Fixation of Soft Tissues to Implant Surfaces ........................................ 4129 Conclusions ........................................ 4131 References ......................................... 4131 Abstract With the use and of neo-adjuvant chemother- apy and early diagnosis of bone tumours the survival of patients with bone cancer has sig- nificantly increased. This means that more patients are surviving the disease and therefore require lasting solutions for the limb recon- struction. Presently for these patients there are several possibilities following surgical removal of the cancer; one is to have an amputation, the second is to reconstruct the bone which is being removed at surgery using a massive allograft, and the third is to use a segmental implant to replace the diseased bone. This third option is often used in combination with a joint replace- ment. Combinations of implants together with allograft are becoming more popular. This chapter reviews the fixation of endoprosthetic implants used to treat bone cancers. Keywords Bone bridging  Bone re-modelling around endoprostheses  Bone tumours  Compression fixation  Endoproshesis  Extra-cortical fixa- tion  Fixation and loosening  Fixation of soft tissues to endoprostheses Introduction Importantly it has been shown that the reconstruc- tion of the limb using either massive segmental endoprostheses or with a structural allograft does not increase the risk of recurrence of the disease G. Blunn (*)  M. Coathup John Scales Centre for Biomedical Engineering, Institute of Orthopaedics and Musculo-Skeletal Science, University College London, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK e-mail: g.blunn@ucl.ac.uk; m.coathup@ucl.ac.uk G. Bentley (ed.), European Surgical Orthopaedics and Traumatology, DOI 10.1007/978-3-642-34746-7_184, # EFORT 2014 4119