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Fukushima T, Okita Y, Watanabe N, Yokota S, Nakano J, Tanaka Y, Kawai A. Progress in muscle strength of the reconstructed knee and quality of life of the patient after knee rotationplasty: A case report. Prosthet Orthot Int 2023; 47:651-654. [PMID: 37498771 DOI: 10.1097/pxr.0000000000000253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 06/09/2023] [Indexed: 07/29/2023]
Abstract
Knee rotationplasty (KRP) is a function-preserving surgery that serves as an alternative to above-knee amputation in patients diagnosed with malignant bone and soft tissue tumors around the knee joint. However, the short-term progress of the reconstructed knee in terms of muscle strength is unclear after KRP. This case report describes the progress of a 37-year-old man diagnosed with synovial sarcoma in the distal femur, 1 year after undergoing KRP. Changes in muscle strength of the reconstructed knee and physical function are reported. Physical therapy was started on postoperative day 1 after the KRP, and mobilization proceeded step-by-step with sitting, wheelchair transfer, and crutch walking. Active and passive range-of-motion exercises of the reconstructed knee were started on postoperative day 5. The isometric reconstructed knee extension strength, 10-m walk test, timed up and go test, Musculoskeletal Tumor Society score, Toronto Extremity Salvage Score, and quality of life (QOL) were evaluated. One month postoperatively, muscle strength had increased, and at 6 and 12 months postoperatively, isometric knee extension strength and physical function had improved. Furthermore, activities of daily living and QOL gradually improved over the course of the 12 months. Our case shows the previously unknown course of reconstructed knee muscle strength in the early post-KRP period, with corresponding improvements in physical function, activities of daily living, and QOL.
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Affiliation(s)
- Takuya Fukushima
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
- Faculty of Rehabilitation, Kansai Medical University, Osaka, Japan
| | - Yusuke Okita
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
| | - Noriko Watanabe
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
| | - Shota Yokota
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
| | - Jiro Nakano
- Faculty of Rehabilitation, Kansai Medical University, Osaka, Japan
| | - Yohei Tanaka
- Department of Rehabilitation Medicine, JR Tokyo General Hospital, Tokyo, Japan
| | - Akira Kawai
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
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Filis P, Varvarousis D, Ntritsos G, Dimopoulos D, Filis N, Giannakeas N, Korompilias A, Ploumis A. Rotationplasty outcomes assessed by gait analysis following resection of lower extremity bone neoplasms. Bone Jt Open 2023; 4:817-824. [PMID: 37907080 PMCID: PMC10618047 DOI: 10.1302/2633-1462.411.bjo-2023-0101.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
Aims The standard of surgical treatment for lower limb neoplasms had been characterized by highly interventional techniques, leading to severe kinetic impairment of the patients and incidences of phantom pain. Rotationplasty had arisen as a potent limb salvage treatment option for young cancer patients with lower limb bone tumours, but its impact on the gait through comparative studies still remains unclear several years after the introduction of the procedure. The aim of this study is to assess the effect of rotationplasty on gait parameters measured by gait analysis compared to healthy individuals. Methods The MEDLINE, Scopus, and Cochrane databases were systematically searched without time restriction until 10 January 2022 for eligible studies. Gait parameters measured by gait analysis were the outcomes of interest. Results Three studies were eligible for analyses. Compared to healthy individuals, rotationplasty significantly decreased gait velocity (-1.45 cm/sec; 95% confidence interval (CI) -1.98 to -0.93; p < 0.001), stride length (-1.20 cm; 95% CI -2.31 to -0.09; p < 0.001), cadence (-0.83 stride/min; 95% (CI -1.29 to -0.36; p < 0.001), and non-significantly increased cycle time (0.54 sec; 95% CI -0.42 to 1.51; p = 0.184). Conclusion Rotationplasty is a valid option for the management of lower limb bone tumours in young cancer patients. Larger studies, with high patient accrual, refined surgical techniques, and well planned rehabilitation strategies, are required to further improve the reported outcomes of this procedure.
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Affiliation(s)
- Panagiotis Filis
- Department of Medical Oncology, University of Ιoannina, Ιoannina, Greece
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Dimitrios Varvarousis
- Division of Physical Medicine and Rehabilitation, Department of Surgery, University of Ioannina Medical School, Ioannina, Greece
| | - Georgios Ntritsos
- Department of Informatics and Telecommunications, University of Ioannina, Arta, Greece
| | - Dimitrios Dimopoulos
- Division of Physical Medicine and Rehabilitation, Department of Surgery, University of Ioannina Medical School, Ioannina, Greece
| | - Nikolaos Filis
- Medical School, University of Ioannina, Ιoannina, Greece
| | - Nikolaos Giannakeas
- Department of Informatics and Telecommunications, University of Ioannina, Arta, Greece
| | - Anastasios Korompilias
- Division of Orthopaedic Surgery, Department of Surgery, University of Ioannina Medical School, Ioannina, Greece
| | - Avraam Ploumis
- Division of Physical Medicine and Rehabilitation, Department of Surgery, University of Ioannina Medical School, Ioannina, Greece
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Gaillard J, Fouasson-Chailloux A, Eveno D, Bokobza G, Da Costa M, Heidar R, Pouedras M, Nich C, Gouin F, Crenn V. Rotationplasty Salvage Procedure as an Effective Alternative to Femoral Amputation in an Adult With a History of Osteosarcoma: A Case Report and Review. Front Surg 2022; 8:820019. [PMID: 35071319 PMCID: PMC8776644 DOI: 10.3389/fsurg.2021.820019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/16/2021] [Indexed: 12/29/2022] Open
Abstract
Rotationplasty or Borggreve-Van Ness surgery is lower limb salvage surgery, indicated mainly in the management of femoral bone sarcoma and congenital femur malformations in children. It can also be an interesting surgery option for managing chronic osteoarticular infections, or in cases of non union when curative therapy is no longer an option, as an alternative to femoral amputation. The principle of this surgery is to remove the affected knee and to apply a rotation of 180° to the distal part of the lower limb in order to give the ankle the function of a neo-knee. With the help of an adapted prosthesis, the aim is to allow patients to resume their social and professional activities by keeping most of their lower limb, thus avoiding the known complications of amputation (ghost limb pain, proprioceptive deficit, psychological disorders). Nevertheless, this surgery is complex and exceptional, with vascular, infectious, and psychological risks - the chimeric aspect of the lower limb may cause significant ill-being for the patient. This article reports the case of a 38-year-old patient consulting for management of a complex septic distal femoral non-union following osteosarcoma considered as being in remission. The patient underwent rotationplasty surgery on his left lower limb, with very good functional results and no surgical revision to date. In light of this particular case, we propose a didactic overview of the literature data concerning this surgery, especially in adulthood.
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Affiliation(s)
- Jean Gaillard
- Orthopedics and Trauma Department, University Hospital Hotel-Dieu, CHU de Nantes, Nantes, France
| | - Alban Fouasson-Chailloux
- Physical and Rehabilitation Department, University Hospital Saint Jacques, CHU de Nantes, Nantes, France
| | - Dominique Eveno
- Physical and Rehabilitation Department, Maubreuil & La Tourmaline, Saint-Herblain, France
| | - Guillaume Bokobza
- Physical and Rehabilitation Department, Maubreuil & La Tourmaline, Saint-Herblain, France
| | - Marta Da Costa
- Physical and Rehabilitation Department, Maubreuil & La Tourmaline, Saint-Herblain, France
| | - Romain Heidar
- Anesthesia and Resuscitation Department, University Hospital Hotel-Dieu, CHU de Nantes, Nantes, France
| | - Marie Pouedras
- Orthopedics and Trauma Department, University Hospital Hotel-Dieu, CHU de Nantes, Nantes, France
| | - Christophe Nich
- Orthopedics and Trauma Department, University Hospital Hotel-Dieu, CHU de Nantes, Nantes, France
- Laboratoire d'étude des Sarcomes Osseux et Remodelage des Tissus Calcifiés, PhyOs, INSERM UMR 1238, Université de Nantes, Nantes, France
| | - François Gouin
- Department of Surgery, Centre de lutte Contre le CancerLéon Bérard, Lyon, France
| | - Vincent Crenn
- Orthopedics and Trauma Department, University Hospital Hotel-Dieu, CHU de Nantes, Nantes, France
- Laboratoire d'étude des Sarcomes Osseux et Remodelage des Tissus Calcifiés, PhyOs, INSERM UMR 1238, Université de Nantes, Nantes, France
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Lex JR, Adlan A, Tsoi K, Evans S, Stevenson JD. Frequency and reason for reoperation following non-invasive expandable endoprostheses: A systematic review. J Bone Oncol 2021; 31:100397. [PMID: 34712555 PMCID: PMC8529098 DOI: 10.1016/j.jbo.2021.100397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/08/2021] [Accepted: 10/03/2021] [Indexed: 11/25/2022] Open
Abstract
Implant failure is the most common reason for revision of growing prostheses. Maximum prosthesis growth with a residual LLD is the most common mode of failure. Functional outcomes are good, but 1/ 5 patients have a persistent LLD over 2 cm.
Background Non-invasive expandable endoprostheses (NIEPR) utilize an external electromagnetic field to drive an innate mechanical gearbox. This lengthens the extremity following oncological resections in children with a predicted limb length discrepancy (LLD), facilitating limb-salvage. This review was conducted to assess NIEPR implant survival rates and identify modes of implant failure unique to these prostheses. Methods Medline, EMBASE and the Cochrane Library databases were searched for all manuscripts evaluating implant survival of NIEPRs implanted into skeletally immature patients following resection of extremity sarcomas. Minimum follow-up of 12 months or implant failure was required for inclusion. Failures were classified using the latest ISOLS classification and exact implant-specific failure modality was also identified. Results 19 studies met inclusion criteria. Mean age was 10.0 years (7.7 – 11.4 years). The most common locations for NIEPR implantation were the distal femur (343, 76.7%) and proximal tibia (53, 119%). Mean follow-up was 65.3 months (19.4 – 163 months). The overall implant revision rate was 46.2% (0 – 100%); implant specific revisions included maximal prosthesis lengthening with persistent LLD (10.4%), failed extension mechanism (6.1%), implant fracture (7.7%), hinge fracture (1.4%) and bushing wear (0.9%). Persistent clinically significant (>20 mm) LLD at final follow-up was present in 19.2% (0 – 50%) of patients. The mean MSTS score was 85.1% (66.7–96.3%) at final follow-up. Conclusion Implant-related failures are the most common reason for NIEPR revision. Implant reliability appears to be improved with current designs. A sub-classification to the current classification system based on implant-specific failures for NIEPRs is proposed.
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Affiliation(s)
- Johnathan R Lex
- The Royal Orthopaedic Hospital, Oncology Department, Birmingham, West Midlands B31 2AP, UK.,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Amirul Adlan
- The Royal Orthopaedic Hospital, Oncology Department, Birmingham, West Midlands B31 2AP, UK
| | - Kim Tsoi
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada.,University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada
| | - Scott Evans
- The Royal Orthopaedic Hospital, Oncology Department, Birmingham, West Midlands B31 2AP, UK
| | - Jonathan D Stevenson
- The Royal Orthopaedic Hospital, Oncology Department, Birmingham, West Midlands B31 2AP, UK.,Aston University Medical School, Aston University, Birmingham, UK
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