Complications report

At ISOLS 2024 in Brisbane, a survey revealed persistent ambiguity in how users interpret “failure” and apply the classification more broadly. Most respondents felt that, given advances in reconstruction techniques and management options, the field should move beyond the term “failure” toward a more inclusive framework that captures the full range of adverse events. In response, ISOLS convened a dedicated workgroup, with three core members including Dr. Henderson, who is well known to practice orthopedic oncologists across the globe.

Since 2011, the Henderson classification has provided orthopedic oncology with a methodology for reporting adverse outcomes from limb-sparing operations performed for musculoskeletal tumors. A 2014 revision expanded the classification system to include allograft constructs, and the system has underpinned most of the literature on reconstruction failure ever since.

The workgroup is engaging the wider orthopedic oncology community to shape a revised classification. After several meetings to set a road map, we formed specialty-specific subgroups, each led by an experienced senior surgeon, to review recent literature on modes of failure, identify ambiguities in the current system, evaluate alternative classification language and conceptual frameworks, and identify clinical scenarios the existing framework fails to address satisfactorily. 

Our ultimate goal is to hold a general session at the 2026 ISOLS meeting, where members will vote on summary statements through a Delphi process.

With the Vienna meeting three months away, work has entered its most intensive phase as the core group finalizes the voting questions in close collaboration with the subgroups.

We are deeply grateful to the ISOLS Board and leadership for their steadfast support, and we have been genuinely moved by the engagement of senior ISOLS members and leading figures across orthopedic oncology.

We look forward to seeing you in Vienna this September to exchange ideas and reach shared conclusions.