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Geiger EJ, Kendal JK, Greyson MA, Moghaddam MM, Jones NF, Bernthal NM. Hip Preservation and Capanna Reconstruction for Pediatric Proximal Femur Ewing Sarcoma: A Report of 2 Cases. JBJS Case Connect 2024; 14:01709767-202406000-00042. [PMID: 38820206 DOI: 10.2106/jbjs.cc.23.00644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
CASE This is a first report describing preservation of the femoral head by transcervical resection of proximal femoral Ewing sarcoma in 2 pediatric patients. A unique Capanna reconstruction supported joint salvage. At 1 year, Pediatric Outcomes Data Collection Instrument and Pediatric Toronto Extremity Salvage Score outcomes were excellent. Surveillance magnetic resonance imaging was without evidence of recurrence or impaired perfusion to the femoral head. CONCLUSION We demonstrate the feasibility of hip joint preservation and maintenance of femoral head viability after transcervical resection of pediatric proximal femur bone sarcomas while preserving the medial circumflex femoral artery. This technique may be a preferred option over joint sacrifice and endoprosthetic replacement in young patients when tumor margins permit.
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Affiliation(s)
- Erik J Geiger
- Department of Orthopaedic Surgery, University of Miami, Miami, Florida
| | - Joseph K Kendal
- Department of Orthopaedic Surgery, University of Calgary, Calgary, Alberta, California
| | - Mark A Greyson
- Division of Plastic and Reconstructive Surgery, University of Colorado, Aurora, Colorado
| | - Matthew M Moghaddam
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Neil F Jones
- Department of Orthopaedic Surgery, University of California-Los Angeles, Los Angeles, California
| | - Nicholas M Bernthal
- Department of Orthopaedic Surgery, University of California-Los Angeles, Los Angeles, California
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Combining Shelf Osteotomy With Proximal Femoral Reconstruction After Oncologic Resection. Tech Orthop 2022. [DOI: 10.1097/bto.0000000000000610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Saglam F, Baysal O, Sirin E, Sofulu O, Kesimer MD, Erol B. Is bipolar hemiarthroplasty an appropriate type of hip articulation following proximal femoral or total femoral resections for musculoskeletal malignancies? Arch Orthop Trauma Surg 2022; 142:331-341. [PMID: 34091707 DOI: 10.1007/s00402-021-03980-3] [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] [Received: 01/13/2021] [Accepted: 05/26/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Different approaches are applied for reconstruction in patients with a musculoskeletal malignancy which require a proximal femoral or total femoral resection. We aimed to evaluate the treatment outcomes of patients who underwent a proximal femoral or total femoral resection due to bone and soft tissue tumors and had an endoprosthetic reconstruction by a bipolar hemiarthroplasty type of hip articulation. METHODS We retrospectively identified 133 patients who underwent a proximal femoral or total femoral endoprosthetic replacement after resection of a bone or soft tissue malignancy. There were 74 male and 59 female patients, with a mean age of 55.02 ± 16.92 years (range 11-84 years) and a median follow-up of 24.47 ± 24.45 months (range 6-164 months). Patient demographics, surgical, and oncological data were recorded. Acetabular wear was measured using the classification proposed by Baker. Functional assessment was performed using the Musculoskeletal Tumor Society (MSTS) functional score. RESULTS There was no statistically significant difference among primary diagnostic groups in terms of gender, prosthesis type, trochanter major resection, local recurrence, complication/revision rate, and MSTS Score (p > 0.05, for each parameter). On the other hand, a statistically significant difference was detected in terms of degree of acetabular erosion among diagnostic groups (p < 0.001); the acetabular erosion rate (AER) was found to be lower in patients with metastatic carcinoma than in patients with a diagnosis of primary bone or soft tissue sarcoma. The univariable analysis revealed that the effect of age, primary diagnosis, localization, follow-up time, and presence and number of distant organ metastasis variables on AER were found to be statistically significant (p = 0.018, p = 0.035, p = 0.002, p = 0.007, p = 0.031, p = 0.040, respectively). CONCLUSION In patients who undergo a proximal femoral or a total femoral resection due to a musculoskeletal tumor, bipolar hemiarthroplasty is an adequate type of hip articulation method, since it does not affect the revision requirements and functional outcomes of patients with acetabular erosion.
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Affiliation(s)
- Fevzi Saglam
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Sakarya University, Sağlık Caddesi No: 195, Adapazarı, Sakarya, Turkey.
| | - Ozgur Baysal
- Department of Orthopaedics and Traumatology, Marmara University Pendik Training and Research Hospital, 34890, Pendik, İstanbul, Turkey
| | - Evrim Sirin
- Department of Orthopaedics and Traumatology, Marmara University Pendik Training and Research Hospital, 34890, Pendik, İstanbul, Turkey
| | - Omer Sofulu
- Department of Orthopaedics and Traumatology, Marmara University Pendik Training and Research Hospital, 34890, Pendik, İstanbul, Turkey
| | - Mehmet Deniz Kesimer
- Department of Orthopaedics and Traumatology, Marmara University Pendik Training and Research Hospital, 34890, Pendik, İstanbul, Turkey
| | - Bulent Erol
- Department of Orthopaedics and Traumatology, Marmara University Pendik Training and Research Hospital, 34890, Pendik, İstanbul, Turkey
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Imaging following surgery for primary appendicular bone tumours. Skeletal Radiol 2021; 50:1527-1555. [PMID: 33481074 DOI: 10.1007/s00256-021-03712-z] [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] [Received: 10/07/2020] [Revised: 12/22/2020] [Accepted: 01/10/2021] [Indexed: 02/02/2023]
Abstract
Primary bone tumours are uncommon, with sarcomas accounting for < 0.2% of all malignancies. The survival rate of primary bone sarcomas has significantly improved due to (neo)adjuvant therapy, while improved surgical techniques and development of new prostheses have shifted the surgical focus from amputation to limb preservation in the vast majority of patients. A wide variety of surgical options are available for the treatment of primary bone tumours which depend upon histological diagnosis, their appearance at the time of presentation and response to any (neo)adjuvant therapy as required. This review is intended to help radiologists familiarise themselves with the management of primary appendicular bone tumours and expected normal postoperative appearances for the various surgical techniques, and to recognise potential complications.
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Zhu D, Fu J, Wang L, Guo Z, Wang Z, Fan H. Reconstruction with customized, 3D-printed prosthesis after resection of periacetabular Ewing's sarcoma in children using "triradiate cartilage-based" surgical strategy:a technical note. J Orthop Translat 2021; 28:108-117. [PMID: 33868923 PMCID: PMC8022806 DOI: 10.1016/j.jot.2020.12.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/15/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022] Open
Abstract
Background Surgery for Ewing sarcoma involving acetabulum in children is challenging. Considering the intrinsic structure of immature pelvis, trans-acetabular osteotomy through triradiate cartilage might be applied. The study was to describe the surgical technique and function outcomes of trans-acetabular osteotomy through triradiate cartilage and reconstruction with customized, 3D-printed prosthesis. Methods Two children with periacetabular ES were admitted to our hospital. The pre-operative imaging showed the triradiate cartilage was not penetrated or wholly affected by tumor. After neoadjuvant chemotherapy, the tumor was excised by trans-acetabular osteotomy basing on “triradiate cartilage strategy” and the acetabulum was reconstructed with the customized, 3D-printed prosthesis. The prosthesis was designed in Mimics software basing on the images from CT, optimized by topology technique, and examined in FE model. After implantation, the oncological and functional outcomes were evaluated with radiography, CT, and MSTS score. Results The operation time and intra-operative blood loss in these two children were 3.5h, 2.5h and 300 ml, 600 ml, respectively. The postoperative specimen showed the tumor was en bloc removed with safe margin. In the latest follow-up (48 months and 24 months), both patients were free of disease and had satisfactory function according to MSTS score. The radiography indicated the prosthesis fit the defect well without loosening. Conclusion The customized, 3D-printed prosthesis could provide optimal reconstruction of pelvic ring and satisfactory hip function after trans-acetabular osteotomy in children. The translational potential of this article This study provides promising results of implantation of customized 3D printing prosthesis in children’s pelvic sarcoma, which may bring a new design method for orthopaedic implants.
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Affiliation(s)
- Dongze Zhu
- Department of Orthopedic Surgery, Xi-jing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Jun Fu
- Department of Orthopedic Surgery, Xi-jing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Ling Wang
- State Key Laboratory for Manufacturing System Engineering, Xi'an Jiaotong University, Xi'an, 710054, China
| | - Zheng Guo
- Department of Orthopedic Surgery, Xi-jing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Zhen Wang
- Department of Orthopedic Surgery, Xi-jing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Hongbin Fan
- Department of Orthopedic Surgery, Xi-jing Hospital, Air Force Medical University, Xi'an, 710032, China
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Jones LC, Kaste SC, Karol SE, DeFeo B, Kim HKW, Neel MD, Levin AS. Team approach: Management of osteonecrosis in children with acute lymphoblastic leukemia. Pediatr Blood Cancer 2020; 67:e28509. [PMID: 32860663 DOI: 10.1002/pbc.28509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 11/08/2022]
Abstract
With current treatments for acute lymphoblastic leukemia (ALL), the overall prognosis for survival is favorable. Increasing emphasis is placed on recognizing and managing the long-term consequences of ALL and its treatment, particularly involving osteonecrosis. Early osteonecrosis diagnosis and management may improve outcomes and is best accomplished through coordinated teams that may include hematologic oncologists, radiologists, orthopedic surgeons, physical therapists, and the patient and their family. Magnetic resonance imaging is the "gold standard" for diagnosis of early-stage and/or multifocal osteonecrosis. Treatments for osteonecrosis in ALL patients are risk stratified and may include observation, corticosteroid or chemotherapy adjustment, and pharmaceutical or surgical approaches.
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Affiliation(s)
- Lynne C Jones
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sue C Kaste
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee.,Leukemia/Lymphoma Division, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Seth E Karol
- Leukemia/Lymphoma Division, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Brian DeFeo
- Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Harry K W Kim
- Center for Excellence in Hip Disorders, Texas Scottish Rite Hospital for Children, UT Southwestern Medical Center, Dallas, Texas
| | - Michael D Neel
- Division of Orthopaedics, St. Jude Children's Research Hospital, Memphis, TN
| | - Adam S Levin
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Keyser B, Banda A, Mercuri L, Warburton G, Sullivan S. Alloplastic total temporomandibular joint replacement in skeletally immature patients: a pilot survey. Int J Oral Maxillofac Surg 2020; 49:1202-1209. [DOI: 10.1016/j.ijom.2020.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 02/02/2020] [Accepted: 02/04/2020] [Indexed: 01/02/2023]
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Ulici A, Sterian AG, Tevanov I, Carp M, Dusca A, Cosma D. Aggressive development of an aneurysmal bone cyst of the proximal femur in a paediatric patient: a case report. J Int Med Res 2017; 46:538-545. [PMID: 28835150 PMCID: PMC6011312 DOI: 10.1177/0300060517722244] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We report development of an aneurysmal bone cyst (ABC) that was located in the proximal region of the femur in an 11-year-old girl. Over a period of 30 weeks, the ABC showed fulminant local progression, with destruction of the bone, which led to an abrupt loss of function of the left hip. The standard tumour treatment protocol was followed. We performed embolisation of the tumour followed by a biopsy, which confirmed the diagnosis of ABC. The outcome was negative with total destruction of the proximal third of the femur, despite repeating the embolisation. Because of the unfavourable local progression, a second biopsy was performed and we reconfirmed the initial diagnosis. The final decision regarding the therapeutic approach was total hip arthroplasty with femoral reconstruction with a prosthesis. Following this treatment, the patient’s outcome was favourable, with complete recovery of function and no local relapse.
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Affiliation(s)
- Alexandru Ulici
- 1 155400 Department of Paediatric Orthopaedic Surgery , Emergency Hospital for Children "Grigore Alexandrescu", Bucharest, Romania
| | - Alin Gabriel Sterian
- 1 155400 Department of Paediatric Orthopaedic Surgery , Emergency Hospital for Children "Grigore Alexandrescu", Bucharest, Romania
| | - Iulia Tevanov
- 1 155400 Department of Paediatric Orthopaedic Surgery , Emergency Hospital for Children "Grigore Alexandrescu", Bucharest, Romania
| | - Madalina Carp
- 1 155400 Department of Paediatric Orthopaedic Surgery , Emergency Hospital for Children "Grigore Alexandrescu", Bucharest, Romania
| | - Andrei Dusca
- 1 155400 Department of Paediatric Orthopaedic Surgery , Emergency Hospital for Children "Grigore Alexandrescu", Bucharest, Romania
| | - Dan Cosma
- 2 Department of Orthopaedics and Trauma, Rehabilitation Clinical Hospital Cluj-Napoca, University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Morris CD, Wustrack RL, Levin AS. Limb-Salvage Options in Growing Children with Malignant Bone Tumors of the Lower Extremity. JBJS Rev 2017; 5:e7. [DOI: 10.2106/jbjs.rvw.16.00026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Abstract
Reconstruction options in children after bone tumor resection are as varied as they are challenging. Advances in biologic and endoprosthetic design have led to many choices, all of which must be considered in the context of prognosis, treatment limitations, and patient/family expectations. The current experience and results of limb-sparing surgery following bone sarcoma resection in growing children are discussed, including allograft, autograft, and metallic prostheses alone and in combination, especially as they pertain to the knee. In some cases, the ablative options of amputation and rotationplasty must be seen as equal and, at times, superior choices to limb salvage.
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Mercuri LG, Swift JQ. Considerations for the Use of Alloplastic Temporomandibular Joint Replacement in the Growing Patient. J Oral Maxillofac Surg 2009; 67:1979-90. [DOI: 10.1016/j.joms.2009.05.430] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Accepted: 05/06/2009] [Indexed: 10/20/2022]
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Chandrasekar CR, Grimer RJ, Carter SR, Tillman RM, Abudu A, Jeys LM. Unipolar proximal femoral endoprosthetic replacement for tumour. ACTA ACUST UNITED AC 2009; 91:401-4. [DOI: 10.1302/0301-620x.91b3.21666] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We undertook a cemental unipolar proximal femoral endoprosthetic replacement in 131 patients with a mean age of 50 years (2 to 84). Primary malignant tumours were present in 54 patients and 67 had metastatic disease. In addition, eight patients had either lymphoma or myeloma and two had non-oncological disorders. The mean follow-up was 27 months (0 to 180). An acetabular revision was required later in 14 patients, 12 of whom had been under the age of 21 years at the time of insertion of their original prosthesis. The risk of acetabular revision in patients over 21 years of age was 8% at five years compared with 36% in those aged under 21 years. All the unipolar hips in this younger age group required revision within 11 years of the initial operation. We conclude that unipolar replacement should not be used in younger patients and should be avoided in patients with a life expectancy of more than five years.
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Affiliation(s)
| | - R. J. Grimer
- Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK
| | - S. R. Carter
- Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK
| | - R. M. Tillman
- Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK
| | - A. Abudu
- Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK
| | - L. M. Jeys
- Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK
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