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Scanferla R, Scolari F, Muratori F, Tamburini A, Delcroix L, Scoccianti G, Beltrami G, Innocenti M, Campanacci DA. Joint-Sparing Resection around the Knee for Osteosarcoma: Long-Term Outcomes of Biologic Reconstruction with Vascularized Fibula Graft Combined with Massive Allograft. Cancers (Basel) 2024; 16:1672. [PMID: 38730624 PMCID: PMC11083935 DOI: 10.3390/cancers16091672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
(1) Background: We aim to address the following questions. What was the complication rate of vascularized fibula graft (VFG) combined with massive allograft in patients treated with joint-sparing resection around the knee for a high-grade osteosarcoma? What was the long-term survivorship of VFG free from revision and graft removal? What were the functional results as assessed by the Musculoskeletal Tumor Society (MSTS) score? (2) Methods: 39 patients treated in our unit for osteosarcoma around the knee with intercalary resection and reconstruction with VFG combined with massive allograft were included; 26 patients underwent intercalary tibial resection, while 13 underwent intercalary femoral resection. (3) Results: Mean Follow-Up was 205 months (28 to 424). Complications that required surgery were assessed in requiring surgical revision in 19 patients (49%) after a mean of 31 months (0 to 107), while VFG removal was necessary in three patients (8%). The revision-free survival of the reconstructions was 59% at 5 years and 50% at 10 to 30 years. The overall survival of the reconstructions was 95% at 5 to 15 years and 89% at 20 to 30 years. The mean MSTS score was 29.3 (23 to 30). (4) Conclusions: VFG represents an effective reconstructive option after joint-sparing intercalary resection around the knee for osteosarcoma.
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Affiliation(s)
- Roberto Scanferla
- Department of Orthopaedic Oncology and Reconstructive Surgery, Careggi University Hospital, Largo Palagi 1, 50139 Florence, Italy; (F.S.); (F.M.); (G.S.); (D.A.C.)
| | - Federico Scolari
- Department of Orthopaedic Oncology and Reconstructive Surgery, Careggi University Hospital, Largo Palagi 1, 50139 Florence, Italy; (F.S.); (F.M.); (G.S.); (D.A.C.)
| | - Francesco Muratori
- Department of Orthopaedic Oncology and Reconstructive Surgery, Careggi University Hospital, Largo Palagi 1, 50139 Florence, Italy; (F.S.); (F.M.); (G.S.); (D.A.C.)
| | - Angela Tamburini
- Department of Paediatric Oncology, Meyer University Hospital, Viale Gaetano Pieraccini 24, 50139 Florence, Italy;
| | - Luca Delcroix
- Department of Plastic Surgery, Careggi University Hospital, Largo Palagi 1, 50139 Florence, Italy;
| | - Guido Scoccianti
- Department of Orthopaedic Oncology and Reconstructive Surgery, Careggi University Hospital, Largo Palagi 1, 50139 Florence, Italy; (F.S.); (F.M.); (G.S.); (D.A.C.)
| | - Giovanni Beltrami
- Department of Paediatric Orthopaedics, Meyer University Hospital, Viale Gaetano Pieraccini 24, 50139 Florence, Italy;
| | - Marco Innocenti
- Department of Plastic Surgery, Rizzoli Orthopaedic Insitute, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy;
| | - Domenico Andrea Campanacci
- Department of Orthopaedic Oncology and Reconstructive Surgery, Careggi University Hospital, Largo Palagi 1, 50139 Florence, Italy; (F.S.); (F.M.); (G.S.); (D.A.C.)
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Campanacci DA, Scanferla R, Marsico M, Scolari F, Scoccianti G, Beltrami G, Delcroix L, Innocenti M, Capanna R. Intercalary Resection of the Tibia for Primary Bone Tumors: Are Vascularized Fibula Autografts With or Without Allografts a Durable Reconstruction? Clin Orthop Relat Res 2024; 482:00003086-990000000-01525. [PMID: 38513152 PMCID: PMC11124688 DOI: 10.1097/corr.0000000000003007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 01/23/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Reconstruction with vascularized fibula grafts (VFG) after intercalary resection of sarcoma may offer longevity by providing early graft-host union and fracture healing. The ability of the fibula to hypertrophy under mechanical stress, as well as vascularized bone in the area, may also be advantageous, given that soft tissues may be compromised because of resection, chemotherapy, or radiation therapy. VFG with a massive allograft combines the primary mechanical stability of the graft with the biological potential of the vascularized fibula; however, complications and the durability of this combined reconstruction are not well described. QUESTIONS/PURPOSES (1) What was the proportion of complications after reconstruction with VFG, with or without allografts? (2) What was the functional result after surgical treatment as assessed by the Musculoskeletal Tumor Society (MSTS) score? (3) What was the survivorship of these grafts free from revision and graft removal? METHODS Between 1988 and 2021, 219 patients were treated at our institution for a primary malignant or aggressive benign bone tumor of the tibia with en bloc resection. Of those, 54% (119 of 219) had proximal tibial tumors with epiphyseal involvement and were treated with either intra-articular resection and reconstruction with an osteoarticular allograft, allograft-prosthesis composite (APC), or modular prosthesis according to age, diagnosis, and preoperative or postoperative radiotherapy. Nine percent (20) of patients had distal tibial tumors that were treated with intra-articular resection and reconstruction with ankle arthrodesis using allogenic or autologous grafts, and 0.5% (1 patient) underwent total tibial resection for extensive tumoral involvement of the tibia and reconstruction with an APC. Thirty-six percent (79) of patients had a metadiaphyseal bone tumor of the tibia and were treated with intercalary joint-sparing resection. We routinely use reconstruction with VFG after intercalary tibial resection for primary malignant or aggressive benign bone tumors in patients with long life expectancy and high functional demands and in whom at least 1 cm of residual bone stock of the proximal or distal epiphysis can be preserved. By contrast, we routinely use intercalary massive allograft reconstruction in short resections or in patients with metastatic disease who do not have long life expectancy. We avoid VFG in patients with tibial bone metastasis, patients older than 70 years, or primary bone tumors in patients who may undergo postoperative radiotherapy; in these patients, we use alternative reconstructive methods such as intercalary prostheses, plate and cement, or intramedullary nailing with cement augmentation. According to the above-mentioned indications, 6% (5 of 79) of patients underwent massive allograft reconstruction because they were young and had intercalary resections shorter than 7 cm or had metastatic disease at diagnosis without long life expectancy, whereas 94% (74) of patients underwent VFG reconstruction. The median age at operation was 16 years (range 5 to 68 years). The diagnosis was high-grade osteosarcoma in 22 patients, Ewing sarcoma in 19, adamantinoma in 16, low-grade osteosarcoma in five, fibrosarcoma in three, malignant fibrous histiocytoma and Grade 2 chondrosarcoma in two, and malignant myoepitelioma, angiosarcoma of bone, malignant peripheral nerve sheath tumor of bone, squamous cell carcinoma secondary to chronic osteomyelitis, and desmoplastic fibroma in one patient each. Median follow-up was 12.3 years (range 2 to 35 years). The median tibial resection length was 15 cm (range 7 to 27 cm), and the median fibular resection length was 18 cm (range 10 to 29 cm). VFG was used with a massive allograft in 55 patients, alone in 12 patients, and combined with allogenic cortical bone struts in seven patients. We used VFG combined with a massive allograft in patients undergoing juxta-articular, joint-sparing resections that left less than 3 cm of residual epiphyseal bone, for intra-epiphyseal resections, or for long intercalary resections wherein the allograft can provide better mechanical stability. In these clinical situations, the combination of a VFG and massive allograft allows more stable fixation and better tendinous reattachment of the patellar tendon. VFG was used with cortical bone struts in distal tibia intercalary resections where the narrow diameter of the allograft did not allow concentric assembling with the fibula. Finally, VFG alone was often used after mid- or distal tibia intercalary resection in patients with critical soft tissue conditions because of previous surgery, in whom the combination with massive allograft would result in a bulkier reconstruction. We ascertained complications and MSTS scores by chart review, and survivorship free from revision and graft removal was calculated using the Kaplan-Meier estimator. In our study, however, the occurrence of death as a competing event was observed in a relatively low proportion of patients, and only occurred after the primary event of interest had already occurred. Considering the nature of our data, we did not consider death after the primary event of interest as a competing event. RESULTS In all, 49% (36 of 74) of patients experienced complications and underwent operative treatment. There were 45 complications in 36 patients. There was one instance of footdrop secondary to common peroneal nerve palsy, four wound problems, one acute vein thrombosis of the VFG pedicle and one necrosis of the skin island, two episodes of implant-related pain, 10 nonunions, six fractures, six deep infections, nine local recurrences, one Achilles tendon retraction, one varus deformity of the proximal tibia with postoperative tibial apophysis detachment, one knee osteoarthritis, and one hypometria. The median MSTS score was 30 (range 23 to 30); the MSTS score was assessed only in patients in whom the VFG was retained at the final clinical visit, although if we had considered those who had an amputation, the overall score would be lower. Revision-free survival of the reconstructions was 58% (95% confidence interval 47% to 70%) at 5 years, 52% (95% CI 41% to 65%) at 10 and 15 years, and 49% (95% CI 38% to 63%) at 20 and 30 years. Eight patients underwent VFG removal because of complications, with an overall reconstruction survival of 91% (95% CI 84% to 98%) at 5 years and 89% (95% CI 82% to 97%) at 10 to 30 years. CONCLUSION VFG, alone or combined with an allograft, could be considered in reconstructing a lower extremity after intercalary resections of the tibia for primary bone tumors, and it avoids the use of a large endoprosthesis. However, this procedure was associated with frequent, often severe complications during the first postoperative years and complication-free survival of 58% at 5 years. Nearly 10% of patients ultimately had an amputation. For patients whose reconstruction succeeded, the technique provides a durable reconstruction with good MSTS scores, and we believe it is useful for active patients with long life expectancy. Fractures, frequently observed in the first 5 years postoperatively, might be reduced using long-spanning plate fixation, and that appeared to be the case in our study. Nonbridging fixation can be an option in intraepiphyseal resection when a spanning plate cannot be used or in pediatric patients to enhance fibula hypertrophy and remodeling. We did not directly compare VFG with or without allografts to other reconstruction options, so the decision to use this approach should be made thoughtfully and only after considering the potential serious risks. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Domenico Andrea Campanacci
- Department of Orthopaedic Oncology and Reconstructive Surgery, Careggi University Hospital, Florence, Italy
| | - Roberto Scanferla
- Department of Orthopaedic Oncology and Reconstructive Surgery, Careggi University Hospital, Florence, Italy
| | - Mariagrazia Marsico
- Department of Orthopaedic Oncology and Reconstructive Surgery, Careggi University Hospital, Florence, Italy
| | - Federico Scolari
- Department of Orthopaedic Oncology and Reconstructive Surgery, Careggi University Hospital, Florence, Italy
| | - Guido Scoccianti
- Department of Orthopaedic Oncology and Reconstructive Surgery, Careggi University Hospital, Florence, Italy
| | - Giovanni Beltrami
- Department of Paediatric Orthopaedics, Meyer University Hospital, Florence, Italy
| | - Luca Delcroix
- Department of Plastic Surgery, Careggi University Hospital, Florence, Italy
| | - Marco Innocenti
- Department of Plastic Surgery, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Rodolfo Capanna
- Orthopaedic Clinic, Cisanello University Hospital, Pisa, Italy
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Liu L, Deng XQ, Zhao YJ, Ma RX, Yang L, Song KX, Zhang JY, Hu YC. Modular intercalary prosthetic reconstruction for malignant and metastatic tumours of the proximal femur. Sci Rep 2024; 14:5867. [PMID: 38467756 PMCID: PMC10928187 DOI: 10.1038/s41598-024-56645-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/08/2024] [Indexed: 03/13/2024] Open
Abstract
To illustrate the surgical technique and explore clinical outcomes of the reconstruction for the malignant and metastatic bone tumour of proximal femur with metallic modular intercalary prosthesis. Sixteen patients who underwent modular intercalary prosthetic reconstruction after tumour resection were included from April 2012 and October 2020. Prosthesis and screws parameters, resected bone length and residual bone length, clinical outcomes and survivorship were analyzed. All patients were followed up for an average of 19 months (range 1-74). In our series, 12 patients died of the progression of the primary disease at the final follow-up. The cumulative survivorship since the treatment of proximal femoral metastasis was 78.6% (11 patients) at 6 months and 38.5% (5 patients) at 1 year. The mean MSTS score was 22.25 ± 4.55 among all patients. There were no cases of loosening or breakage of the prostheses, plates or screws, despite the various measurements of prostheses and residual bones. Modular intercalary prosthetic reconstruction was an effective method for malignant tumour of the proximal femur, including the advantages of providing early pain relief, quickly restoring postoperative function, required a short operation time, and preserving the adjacent joints.
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Affiliation(s)
- Lu Liu
- Graduate School, Tianjin Medical University, 22 Qixiangtai Road, Tianjin, China
- Xing'anmeng People's Hospital, 66 Hanshan West Street, Ulanhot, Inner Mongolia, China
| | - Xiao-Qiang Deng
- Xing'anmeng People's Hospital, 66 Hanshan West Street, Ulanhot, Inner Mongolia, China
| | - Yong-Jie Zhao
- Binzhou Medical University Hospital, 661 Huanghe 2 Road, Binzhou, China
| | - Rong-Xing Ma
- Graduate School, Tianjin Medical University, 22 Qixiangtai Road, Tianjin, China
| | - Li Yang
- Beijing Jishuitan Hospital Guizhou Hospital, 206 Sixian Street, Guiyang, Yunnan, China
| | - Kun-Xiu Song
- Binzhou Medical University Hospital, 661 Huanghe 2 Road, Binzhou, China
| | - Jing-Yu Zhang
- Department of Bone Tumor and Soft Tissue Oncology, Tianjin Hospital, 406 Jiefang Southern Road, Tianjin, China.
| | - Yong-Cheng Hu
- Department of Bone Tumor and Soft Tissue Oncology, Tianjin Hospital, 406 Jiefang Southern Road, Tianjin, China.
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Miwa S, Yamamoto N, Hayashi K, Takeuchi A, Igarashi K, Bangcoy MLS, Taniguchi Y, Morinaga S, Asano Y, Tsuchiya H. Graft Survivals after Reconstruction Using Tumor-Bearing Frozen Bone in the Extremities. Cancers (Basel) 2023; 15:3926. [PMID: 37568742 PMCID: PMC10417529 DOI: 10.3390/cancers15153926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Tumor-bearing frozen autografts have been widely used for reconstruction of bone defects caused by tumor resection. However, some patients undergo removal of the grafted bone due to surgical site infection, tumor recurrence, or fractures of the grafted bone. In this retrospective cohort study, predictive factors for graft survival were investigated in 123 patients who underwent reconstructions using a tumor-bearing frozen autograft after bone tumor resection of the extremities. To determine the independent predictors of graft survival, the association between various parameters and graft survival was investigated. The graft survival rates were 83.2% at 5 years and 70.2% at 10 years. Among the 123 frozen autografts, 25 (20.3%) were removed because of complications. In univariate analyses, male sex, BMI of ≥23.6, tibia, and chemotherapy were significantly associated with poor graft survival, whereas the pedicle/hemicortical freezing procedure was significantly associated with better graft survival. Multivariate analysis using the Cox proportional hazards regression model revealed that BMI of ≥23.6 (HR, 3.4; p = 0.005), tibia (HR, 2.3; p = 0.047), and freezing procedure (HR, 0.3; p = 0.016) were independently associated with graft survival. Based on the results, pedicle or hemicortical freezing techniques are recommended in cases where these techniques can be applied.
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Affiliation(s)
- Shinji Miwa
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8640, Japan
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Pu F, Yu Y, Shao Z, Wu W, Feng J, Chen F, Zhang Z. Clinical efficacy of customized modular prosthesis in the treatment of femoral shaft metastases. Front Oncol 2023; 13:1115898. [PMID: 37091177 PMCID: PMC10117919 DOI: 10.3389/fonc.2023.1115898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 03/17/2023] [Indexed: 04/09/2023] Open
Abstract
PurposeTo examine clinical outcomes of a specialized modular prosthesis used to fill a bone deficiency following removal of femoral shaft metastases.MethodsEighteen patients with femoral shaft metastases who underwent en bloc resection and implantation of a personalized modular prosthesis between December 2014 and December 2019 were retrospectively analyzed. Pain, limb function, and quality of life were evaluated using the visual analog scale (VAS), Musculoskeletal Tumor Society (MSTS) scale, International Society of Limb Salvage (ISOLS) scoring system, Karnofsky Performance Status (KPS) scale, and Nottingham Health Profile (NHP) scale. The Kaplan–Meier technique was used to analyze patient survival.ResultsThe operation duration was 90–150 min (mean, 115 min), and the osteotomy length was 9–16 cm (mean, 11.72 cm). The patients were followed for 12–62 months (mean, 25.28 months). The VAS and NHP ratings were lower at 3, 6, and 12 months after surgery than before surgery, while the MSTS, ISOLS, and KPS scores were higher after surgery than they had been before. These differences were statistically significant (P<0.05). The survival period was between 7 and 62 months (mean, 20.89 months), and the rates of survival at 1-year and 2-year were 72.22% and 27.78%, respectively. Except for two patients with aseptic prosthesis loosening during the follow-up period, there were no problems.ConclusionEn bloc excision and implantation of a personalized modular prosthesis can reduce pain and improve the ability of patients with femoral shaft metastases to perform daily activities, thereby improving their quality of life.
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Kapoor L, Singh H, Sahoo B, Banjara R, Kumar VS, Bakhshi S, Sharma DN, Khan SA. Factors affecting the incorporation of extracorporeally irradiated autograft for the treatment of bone tumours-a retrospective analysis from a tertiary referral centre. Int Orthop 2023; 47:1361-1372. [PMID: 36847800 DOI: 10.1007/s00264-023-05730-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/06/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Re-implantation of the tumor bearing autograft following extracorporeal radiation therapy (ECRT) has been established as an oncologically safe biological reconstruction technique following resection of bone sarcomas. However, factors affecting the ECRT graft-host bone incorporation have not been fully investigated. An insight into the factors that influence graft incorporation can circumvent the complications and increase graft survival. METHODS A total of 96 osteotomies in 48 patients with intercalary resections of primary extremity bone sarcomas (mean age 15.8 years, mean follow-up 42.1 months) were analyzed retrospectively for factors ECRT autograft-host bone union. RESULTS On univariate analysis, age < 20 years, metaphyseal osteotomy site, V-shaped diaphyseal osteotomy, and use of additional plate at diaphyseal osteotomy had a significantly faster time to union, while gender, tumour type, bone involved, resection length, chemotherapy, type of fixation, and use of intra-medullary fibula did not influence union time. In multivariate analysis, V-shaped diaphyseal osteotomy and use of additional plate at diaphyseal ostetomy were the independent factors with favourable time to union. None of the analyzed factors was found to have a significant effect on the union rate. The major complications were non-union in 11.4% patients, graft failure in 2.1%, infection in 12.5%, and soft tissue local recurrences in 14.5% patients. CONCLUSION Modified diaphyseal osteotomy and augmentation of the stability of the reconstruction using additional small plates enhance the incorporation of ECRT autograft.
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Affiliation(s)
- Love Kapoor
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Hargovind Singh
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Bismaya Sahoo
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Roshan Banjara
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | | | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Daya Nand Sharma
- Department of Radiation Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Shah Alam Khan
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, 110029, India
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Zhang Y, Lu M, Hu X, Li Z, Wang J, Gong T, Zhou Y, Luo L, Min L, Tu C. Three-dimensional-printed porous prosthesis for the joint-sparing reconstruction of the proximal humeral tumorous defect. Front Bioeng Biotechnol 2023; 10:1098973. [PMID: 36714618 PMCID: PMC9877454 DOI: 10.3389/fbioe.2022.1098973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/30/2022] [Indexed: 01/15/2023] Open
Abstract
Background: Tumorous bone defect reconstructions of the proximal humerus with joint sparing is a challenge. Numerous reconstruction methods have been proposed but the proximal residual humerus is commonly sacrificed because of its extremely short length. To preserve the proximal humerus and improve clinical outcomes, we designed a three-dimensional (3D) printed uncemented prosthesis with a porous structure to treat tumorous bone defects of the proximal humerus. Methods: Our analysis included seven patients treated between March 2018 and July 2019. A 3D model was established, and related data were obtained, including the diameter of the humeral head, the resection length, and the residual length. A prosthesis was designed and fabricated based on these data. Functional and oncologic outcomes were recorded, and complications and osseointegration were evaluated. Results: The mean age of the patients was 20.3 years, and the median follow-up period was 26 months. The lengths of the residual proximal humerus were 17.9 mm on average. All the patients had preserved humeral heads and most of the rotator cuff was intact. The average postoperative range of motion (ROM) of the affected shoulder was 83.8°; flexion was 82.5°, extension was 43.8°, and adduction was 16.3°. The average Musculoskeletal Tumor Society score (MSTS) was 94.3%. Good osseointegration was observed on the interface between the bone and prosthesis. Conclusion: A 3D printed porous prosthesis with cone-like structures successfully achieved joint-sparing reconstruction of proximal humeral tumorous defects with satisfying functional outcomes. The preservation of the rotator cuff and humeral head plays an essential role in the function of the shoulder joint.
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Affiliation(s)
- Yuqi Zhang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Minxun Lu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Xin Hu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Zhuangzhuang Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Jie Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Taojun Gong
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Yong Zhou
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Li Luo
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Li Min
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
| | - Chongqi Tu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan province, Chengdu, Sichuan, China
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Huang S, Ji T, Tang X, Guo W. Novel axial compressive endoprosthesis ACE can enhance metaphyseal fixation and facilitate osseointegration: A biomechanical study. Front Bioeng Biotechnol 2022; 10:1004849. [DOI: 10.3389/fbioe.2022.1004849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Metaphyseal fixation for endoprosthetic reconstruction after bone tumor resection is difficult due to the short residual bone length and reverse funnel shape of the metaphysis. In the current study, 3D-printed axial compressive endoprosthesis (ACE) with a short stem and intramedullary axial compressive mechanism is proposed to improve metaphyseal fixation. The rationales of ACE are that 1) intramedullary axial compress enhances the stability of endoprosthesis and facilitates bone ingrowth at the osteotomy site; 2) 3D printed porous metallic surface at osteotomy surface and stem allows bone ingrowth to achieve osseointegration.Methods: A biomechanical study was performed to explore the initial stability using Sawbones. A diaphysis and metaphyseal segmental defect were created and four fixation structures were simulated: 1) ACE; 2) ACE + lateral plate; 3) stem prosthesis + unilateral plate; 4) stem prosthesis + bilateral plates. Bending and torsional stiffness were determined with a material testing machine. The relationship between the torque of the compression nut and the axial compression force of the bone-implant surface was measured using a round gasket load sensor.Results: ACE + lateral plate was the stiffest in the bending test (sagittal 324.3 ± 110.8 N/mm, coronal 307.7 ± 8.7 N/mm). ACE + lateral plate and stem prosthesis + bilateral plates had the highest torsional stiffness (10.9 ± 1.3 Nm/° and 10.7 ± 0.2 Nm/° respectively). The bending stiffness of ACE was equivalent to stem prosthesis + bilateral plates (sagittal 196 ± 10 N/mm vs. 200 ± 7 N/mm, coronal 197 ± 14 N/mm vs. 209 ± 3 N/mm), but the torsional stiffness of ACE was inferior to stem prosthesis + bilateral plates (6.1 ± 1.3 Nm/° vs. 10.7 ± 0.2 Nm/°). Stem prosthesis + unilateral plate was the least stiff both in bending and torsion. The relationship between torque (T/Nm) and axial pressure (F/N) was F = 233.5T.Conclusion: The axial compressive design of ACE enhances primary stability and facilitates osseointegration, which provides an alternative option of metaphyseal fixation for endoprosthetic reconstruction.
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Fan J, Ma Z, Li M, Xiao X, Lu Y, Huang M, Ji C, Wang Z, Chen G, Li J. Intercalary tibial reconstruction with frozen tumor-bearing autograft in combination with ipsilateral fibula in limb-salvage surgery. J Plast Reconstr Aesthet Surg 2022; 75:3149-3154. [DOI: 10.1016/j.bjps.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 05/04/2022] [Accepted: 06/07/2022] [Indexed: 11/29/2022]
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Streitbürger A, Hardes J, Nottrott M, Guder WK. Reconstruction survival of segmental megaendoprostheses: a retrospective analysis of 28 patients treated for intercalary bone defects after musculoskeletal tumor resections. Arch Orthop Trauma Surg 2022; 142:41-56. [PMID: 32860566 PMCID: PMC8732859 DOI: 10.1007/s00402-020-03583-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 08/16/2020] [Indexed: 12/04/2022]
Abstract
INTRODUCTION Intercalary endoprosthetic reconstructions have been reserved for patients with a limited life expectancy due to reports of high rates of early mechanical and reconstruction failure. MATERIALS AND METHODS In this study, we retrospectively analyzed 28 patients who underwent intercalary endoprosthetic reconstruction of the femur (n = 17) or tibia (n = 11) regarding reconstruction survival and causes of complications and reconstruction failure. RESULTS A total of 56 stems were implanted in this collective, 67.9% of which were implanted using cementation. Eight different stem designs were implanted. The mean patient age at the time of operation was 42.3 years. The mean bone defect needing reconstruction measured 18.5 cm. Resection margins were clear in 96.4% of patients. Of twenty-six complications, five were not implant-associated. We observed infection in 10.7% (n = 3) and traumatic periprosthetic fracture in 3.6% (n = 1) of cases. The most frequent complication was aseptic stem loosening (ASL) (53.8%; n = 14) occurring in eight patients (28.6%). The metaphyseal and meta-diaphyseal regions of femur and tibia were most susceptible to ASL with a rate of 39.1% and 31.3% respectively. No ASLs occurred in epiphyseal or diaphyseal location. Overall reconstruction survival was 43.9% and 64.3% including patients who died of disease with their implant intact. Overall limb survival was 72.7%. CONCLUSIONS Proper planning of segmental reconstructions including stem design with regard to unique anatomical and biomechanical properties is mandatory to address the high rates of ASL in metaphyseal and metadiaphyseal stem sites. With continued efforts of improving stem design in these implantation sites and decreasing rates of mechanical failure, indications for segmental megaendoprostheses may also extend to younger patients with the localized disease for their advantages of early weight bearing and a lack of donor-site morbidity.
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Affiliation(s)
- Arne Streitbürger
- Department of General and Tumor Orthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany.
- Department of Orthopedic Oncology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany.
| | - Jendrik Hardes
- Department of General and Tumor Orthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
- Department of Orthopedic Oncology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Markus Nottrott
- Department of General and Tumor Orthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
- Department of Orthopedic Oncology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Wiebke K Guder
- Department of General and Tumor Orthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
- Department of Orthopedic Oncology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
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11
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Haddad BI, Alisi MS, Yasin MS, Hamdan MQ, Abu Hassan Frcs FO. Lower Limb Reconstruction Using Tibial Strut Autograft after Resection of Primary Malignant Bone Tumors in Skeletally Immature Patients. Arch Bone Jt Surg 2021; 9:567-577. [PMID: 34692941 DOI: 10.22038/abjs.2021.54365.2714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/13/2021] [Indexed: 11/06/2022]
Abstract
Background Reconstruction of large bone defects in skeletally immature patients remains a surgical challenge. We report the long-term clinical outcomes of a novel surgical technique for lower limb reconstruction using the tibia as a strut autograft following resection of primary malignant bone tumors in skeletally immature patients. Methods We retrospectively reviewed the medical records of six patients diagnosed with lower limb primary bone sarcoma. All patients underwent tumor resection and reconstruction using tibial strut autograft. The radiological and clinical outcomes including complications at the recipient and donor sites were assessed. Results The mean age at presentation was ten years (range 6-15 years). Two cases had osteosarcoma and four had Ewing sarcoma. The mean length of the resected tumor and tibial autografts were 20.83 and 19.33 cm respectively. Union at both ends was achieved in five grafts while one graft achieved union only at the distal end. The mean time for union of the proximal and distal junctions was 4 and 8.8 months respectively. The mean follow-up period was 8.4 years (range 14 months-20 years). One patient developed a foot drop, and three patients underwent subsequent joint arthrodesis (2 knees and 1 ankle). The mean musculoskeletal tumor society functional score was 80.8%. Two patients had clinically significant leg-length discrepancy that needs further lengthening procedure. Four patients survived with no evidence of disease and two patients died due to their primary oncologic disease. All donor sites regenerated, with the earliest signs of new bone formation at (2-4) weeks post-operatively. Conclusion Reconstruction using non-vascularized tibia strut autograft after resection of primary malignant lower limb bone tumors can be a viable alternative method for reconstructing large bone defects in the immature skeleton.
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Affiliation(s)
- Bassem I Haddad
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Mohammed S Alisi
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Mohamad S Yasin
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Mohammad Q Hamdan
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Freih O Abu Hassan Frcs
- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan
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12
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Wang J, An J, Lu M, Zhang Y, Lin J, Luo Y, Zhou Y, Min L, Tu C. Is three-dimensional-printed custom-made ultra-short stem with a porous structure an acceptable reconstructive alternative in peri-knee metaphysis for the tumorous bone defect? World J Surg Oncol 2021; 19:235. [PMID: 34365976 PMCID: PMC8349501 DOI: 10.1186/s12957-021-02355-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/01/2021] [Indexed: 02/08/2023] Open
Abstract
Background Long-lasting reconstruction after extensive resection involving peri-knee metaphysis is a challenging problem in orthopedic oncology. Various reconstruction methods have been proposed, but they are characterized by a high complication rate. The purposes of this study were to (1) assess osseointegration at the bone implant interface and correlated incidence of aseptic loosening; (2) identify complications including infection, endoprosthesis fracture, periprosthetic fracture, leg length discrepancy, and wound healing problem in this case series; and (3) evaluate the short-term function of the patient who received this personalized reconstruction system. Methods Between September 2016 and June 2018, our center treated 15 patients with malignancies arising in the femur or tibia shaft using endoprosthesis with a 3D-printed custom-made stem. Osseointegration and aseptic loosening were assessed with digital tomosynthesis. Complications were recorded by reviewing the patients’ records. The function was evaluated with the 1993 version of the Musculoskeletal Tumor Society (MSTS-93) score at a median of 42 (range, 34 to 54) months after reconstruction. Results One patient who experienced early aseptic loosening was managed with immobilization and bisphosphonates infusion. All implants were well osseointegrated at the final follow-up examination. There are two periprosthetic fractures intraoperatively. The wire was applied to assist fixation, and the fracture healed at the latest follow-up. Two patients experienced significant leg length discrepancies. The median MSTS-93 score was 26 (range, 23 to 30). Conclusions A 3D-printed custom-made ultra-short stem with a porous structure provides acceptable early outcomes in patients who received peri-knee metaphyseal reconstruction. With detailed preoperative design and precise intraoperative techniques, the reasonable initial stability benefits osseointegration to osteoconductive porous titanium, and therefore ensures short- and possibly long-term durability. Personalized adaptive endoprosthesis, careful intraoperative operation, and strict follow-up management enable effective prevention and treatment of complications. The functional results in our series were acceptable thanks to reliable fixation in the bone-endoprosthesis interface and an individualized rehabilitation program. These positive results indicate this device series can be a feasible alternative for critical bone defect reconstruction. Nevertheless, longer follow-up is required to determine whether this technique is superior to other forms of fixation.
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Affiliation(s)
- Jie Wang
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China.,Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jingjing An
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China.,Department of Operating Room, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, People's Republic of China
| | - Minxun Lu
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China.,Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yuqi Zhang
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China.,Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jingqi Lin
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yi Luo
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China.,Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yong Zhou
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China.,Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Li Min
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China.,Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Chongqi Tu
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China. .,Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
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13
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El Beaino M, Wang WL, Alaraj SF, Gugala Z, Lin PP. Osteofibrous dysplasia and adamantinoma: A summary of diagnostic challenges and surgical techniques. Surg Oncol 2021; 38:101626. [PMID: 34280695 DOI: 10.1016/j.suronc.2021.101626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 12/11/2022]
Abstract
Osteofibrous dysplasia is an indolent benign fibro-osseous tumor, while adamantinoma is a locally aggressive biphasic malignancy with epithelial and fibro-osseous components. Predominantly arising in the tibial diaphysis of children and young adults, both tumors are resistant to chemotherapy and radiation. Wide surgical resection is regarded as the mainstay of therapy for adamantinoma, and limb-salvage reconstructive procedures can achieve good functional outcomes, albeit with non-negligible rates of complications. This review discusses emerging advances in the pathogenesis, histogenesis, and diagnosis of these entities and presents advantages and limitations of the most common surgical techniques used for their management.
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Affiliation(s)
- Marc El Beaino
- Department of Orthopaedic Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA; School of Public Health, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA.
| | - Wei-Lien Wang
- Department of Pathology and Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sami F Alaraj
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX, USA
| | - Zbigniew Gugala
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX, USA
| | - Patrick P Lin
- Department of Orthopaedic Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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14
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Errani C, Tsukamoto S, Almunhaisen N, Mavrogenis A, Donati D. Intercalary reconstruction following resection of diaphyseal bone tumors: A systematic review. J Clin Orthop Trauma 2021; 19:1-10. [PMID: 34040979 PMCID: PMC8138587 DOI: 10.1016/j.jcot.2021.04.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/11/2021] [Accepted: 04/30/2021] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION The options for the reconstruction of diaphyseal defects following the resection of bone tumors include biological or prosthetic implants. The purpose of our study was to evaluate different types of intercalary reconstruction techniques, including massive bone allograft, extracorporeal devitalized autograft, vascularized free fibula, and modular prosthesis. METHODS We performed a systematic review of articles using the terms diaphyseal bone tumor and intercalary reconstruction. All the studies reporting the non-oncological complications such as infection, nonunion and fracture of the intercalary reconstructions were included. We excluded articles published before 2000 or did not involve humans in the study. Case reports, reviews, technique notes and opinion articles were also excluded based on the abstracts. Thirty-three articles included in this review were then studied to evaluate failure rates, complications and functional outcome of different surgical intercalary reconstruction techniques. RESULTS Nonunion rates of allograft ranged 6%-43%, while aseptic loosening rates of modular prosthesis ranged 0%-33%. Nonunion rates of allograft alone and allograft with a vascularized fibula graft ranged 6%-43% and 0%-33%, respectively. Fracture rates of allograft alone and allograft with a vascularized fibula graft ranged 7%-45% and 0%-44%, respectively. Infection rates of allograft alone and allograft with a vascularized fibula graft ranged 0%-28% and 0%-17%, respectively. All of the allograft (range: 67%-92%), extracorporeal devitalized autograft including irradiation (87%), autoclaving (70%), pasteurization (88%), low-heat (90%) or freezing with liquid nitrogen (90%), and modular prosthesis (range: 77%-93%) had similar Musculoskeletal Tumor Society functional scores. Addition of a vascularized fibula graft to allograft did not affect functional outcome [allograft with a vascularized fibula graft (range: 86%-94%) vs. allograft alone (range: 67%-92%)]. CONCLUSION Aseptic loosening rates of modular prosthesis seem to be less than nonunion rates of allograft. Adding a vascularized fibula graft to allograft seems to increase bone union rate and reduce the risk of fractures and infections, though a vascularized fibula graft needs longer surgical time and has the disadvantage of donor site morbidity. These various intercalary reconstruction techniques with or without a vascularized fibula autograft had similar functional outcome.
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Affiliation(s)
- Costantino Errani
- Orthopaedic Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy,Corresponding author. Orthopaedic Service, IRCCS Istituto Ortopedico Rizzoli, via pupilli n1, 40136, Bologna, Italy.
| | - Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | | | - Andreas Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Davide Donati
- Orthopaedic Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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15
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Pu F, Zhang Z, Wang B, Liu J, Shao Z. En bloc resection and intercalary prosthesis implantation for the treatment of humeral diaphyseal bone metastases. Int Orthop 2021; 45:281-8. [PMID: 33025082 DOI: 10.1007/s00264-020-04845-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/30/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the short-term clinical efficacy and complications of en bloc resection and intercalary prosthesis implantation for the treatment of humeral diaphyseal bone metastases. METHODS A total of 21 patients with humeral diaphyseal bone metastases treated with en bloc resection and intercalary prosthesis implantation from August 2014 to August 2019 were retrospectively analysed. The visual analogue scale (VAS), Musculoskeletal Tumour Society (MSTS) scale, International Society of Limb Salvage (ISOLS) scoring system, Karnofsky Performance Status (KPS) scale, and Nottingham Health Profile (NHP) scale were used to assess pain, limb function, and quality of life. Survival of the patients was analysed using the Kaplan-Meier method. RESULTS The patients were followed up for 12-57 months (mean: 22 months); the operative time was 68-114 minutes (mean: 76.24 min); the osteotomy length was 6.5-10 cm (mean: 8.02 cm); and the intra-operative blood loss was 95-125 ml (mean: 104.71 ml). At three, six and 12 months after surgery, the VAS and NHP scores were lower, whereas the MSTS, ISOLS, and KPS scores were higher than those before surgery, and the differences were statistically significant (P < 0.05). The survival time was four to 24 months (mean: 19.46 months). Thesix month and one year survival rates were 80.95% and 52.38%, respectively. During the follow-up period, no complications occurred except for aseptic prosthesis loosening in one patient. CONCLUSIONS En bloc resection and intercalary prosthesis implantation can reduce pain, improve limb function, prolong survival time, and improve quality of life in patients with humeral diaphyseal bone metastases.
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Vermeersch N, Peters B, Somville J, Van Landuyt K, Thiessen F, Tondu T. Massive femur defect after Ewing's sarcoma resection reconstructed with a free vascularised fibular graft in a four-year-old girl. Acta Chir Belg 2020; 120:193-197. [PMID: 30418095 DOI: 10.1080/00015458.2018.1534398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Ewing's sarcoma is the second most common primary malignant bone tumour in children. Depending on localisation and extent, massive bone defects remain when curative surgery is performed. Whereas in the past, limb amputation was often unavoidable to obtain curative resection, nowadays different limb saving reconstructive options are available.Case report: We report the successful reconstruction of a massive femur defect with a free vascularised fibular graft (FVFG) after Ewing's sarcoma resection in a four-year-old girl. Both the age of the patient and the extensive graft hypertrophy makes this case exceptional.Conclusion: Femur reconstruction with a FVFG is a rarely performed and complex procedure in young children. It is an excellent reconstructive technique for large long bone defects, which can avoid limb amputation without compromising oncologic outcome.
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Affiliation(s)
- Nicolas Vermeersch
- Department of Plastic and Reconstructive Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Benjamin Peters
- Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
| | - Johan Somville
- Department of Orthopaedic Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Koenraad Van Landuyt
- Department of Plastic and Reconstructive Surgery, Ghent University Hospital, Ghent, Belgium
| | - Filip Thiessen
- Department of Plastic and Reconstructive Surgery, Antwerp University Hospital, Antwerp, Belgium
- Department of Plastic and Reconstructive Surgery, Ziekenhuis Netwerk Antwerpen, Antwerp, Belgium
| | - Thierry Tondu
- Department of Plastic and Reconstructive Surgery, Antwerp University Hospital, Antwerp, Belgium
- Department of Plastic and Reconstructive Surgery, Ziekenhuis Netwerk Antwerpen, Antwerp, Belgium
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Zhang JF, Hu YC, Wang BC, Wang L, Wang H, Li Y, Yan M, Liu HT. 3D Finite Element Analysis of the Modular Prosthesis with Tooth Mechanism of the Femoral Shaft. Orthop Surg 2020; 12:946-956. [PMID: 32383353 PMCID: PMC7307257 DOI: 10.1111/os.12685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 03/03/2020] [Accepted: 03/11/2020] [Indexed: 11/28/2022] Open
Abstract
Objectives To evaluate the mechanical properties and provide a theoretical basis of a diaphyseal prosthesis with tooth mechanism using the finite element analysis method from the point of view of biomechanics. Methods A 3D digital femur model was generated based on a 28‐year‐old healthy man's femoral computed tomography (CT) data in Mimics 17.0 and the customized diaphyseal prostheses with/without tooth mechanism were designed in SolidWorks 2016. The 3D femur model after 8 cm osteotomy in the middle of its shaft and the prostheses with/without tooth mechanism was imported into Abaqus 2016 and the finite element analysis models were established. Three biomechanical tests (compression test, torsion test, and 3P‐bending test) under broken load were simulated in FEA to evaluate the performance of the prostheses. Results The stress distributions of the two prostheses were similar and the maximum von Mises stresses placed on them were very close in each test. The maximum von Mises stresses on the prosthesis with tooth mechanism were 31.55, 319.7, and 447.4 MPa, respectively, and those on the prosthesis without tooth mechanism were 26.26, 300.4, and 455.2 MPa, respectively, in the compression, torsion, and 3P‐bending tests. The maximum von Mises stresses on them were far below the ultimate tensile strength or ultimate compressive strength of the titanium alloy. Conclusions The diaphyseal prosthesis with tooth mechanism is helpful to adjust the rotation of the long bone during operation. Compared with the conventional diaphyseal prosthesis (without tooth mechanism), the diaphyseal prosthesis with tooth mechanism also has a good biomechanical performance and does not increase the risk of prosthetic failure.
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Affiliation(s)
- Jian-Feng Zhang
- Department of Osteopathy, The Second Hospital of Tangshan, Tangshan, China
| | - Yong-Cheng Hu
- Department of Orthopaedic Oncology, Tianjin Hospital, Tianjin, China
| | - Bao-Cang Wang
- Department of Osteopathy, The Second Hospital of Tangshan, Tangshan, China
| | - Lei Wang
- Department of Trauma Surgery, The Second Hospital of Tangshan, Tangshan, China
| | - Hui Wang
- Department of Osteopathy, The Second Hospital of Tangshan, Tangshan, China
| | - Yong Li
- Department of Osteopathy, The Second Hospital of Tangshan, Tangshan, China
| | - Ming Yan
- Department of Osteopathy, The Second Hospital of Tangshan, Tangshan, China
| | - Hong-Tao Liu
- Department of Osteopathy, The Second Hospital of Tangshan, Tangshan, China
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Zhao D, Tang F, Min L, Lu M, Wang J, Zhang Y, Zhao K, Zhou Y, Luo Y, Tu C. Intercalary Reconstruction of the "Ultra-Critical Sized Bone Defect" by 3D-Printed Porous Prosthesis After Resection of Tibial Malignant Tumor. Cancer Manag Res 2020; 12:2503-2512. [PMID: 32308487 PMCID: PMC7152541 DOI: 10.2147/cmar.s245949] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 03/13/2020] [Indexed: 02/05/2023] Open
Abstract
Purpose This study aimed to evaluate the early stability, limb function, and mechanical complications of 3D-printed porous prosthetic reconstruction for "ultra-critical sized bone defects" following intercalary tibial tumor resections. Methods This study defined an "ultra-critical sized bone defect" in the tibia when the length of segmental defect in the tibia was >15.0 cm or >60% of the full tibia and the length of the residual fragment in proximal or distal tibia was between 0.5 cm and 4.0 cm. Thus, five patients with "ultra-critical sized bone defects" following an intercalary tibial malignant tumor resection treated with 3D-printed porous prosthesis between June 2014 and June 2018 were retrospectively reviewed. Patient information, implants design and fabrication, surgical procedures, and early clinical outcome data were collected and evaluated. Results Among the five patients, three were male and two were female, with an average age of 30.2 years. Pathological diagnoses were two osteosarcomas, one Ewing sarcoma, one pseudo-myogenic hemangioendothelioma, and one undifferentiated pleomorphic sarcoma . The average length of the bone defects following tumor resection was 22.8cm, and the average length of ultra-short residual bone was 2.65cm (range=0.6cm-3.8cm). The mean follow-up time was 27.6 months (range=14.0-62.0 months). Early biological fixation was achieved in all five patients. The average time of clinical osseointegration at the bone-porous interface was 3.2 months. All patients were reported to be pain free and have no limitations in their walking distance. No prosthetic mechanical complications were observed. Conclusion Reconstruction of the "ultra-critical sized bone defect" after an intercalary tibial tumor resection using 3D-printed porous prosthesis achieved satisfactory overall early biological fixation and limb function. Excellent primary stability and the following rigid biological fixation were key factors for success. The outcomes of this study were supposed to support further clinical application and evaluation of 3D-printed porous prosthetic reconstruction for "ultra-critical sized bone defects" in the tibia.
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Affiliation(s)
- Dingyun Zhao
- Department of Orthopeadics, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Fan Tang
- Department of Orthopeadics, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Li Min
- Department of Orthopeadics, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Minxun Lu
- Department of Orthopeadics, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Jie Wang
- Department of Orthopeadics, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Yuqi Zhang
- Department of Orthopeadics, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Kun Zhao
- Department of Orthopeadics, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, People's Republic of China.,Department of Orthopeadics, Tianjin Fifth Central Hospital, Tianjin 300450, People's Republic of China
| | - Yong Zhou
- Department of Orthopeadics, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Yi Luo
- Department of Orthopeadics, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Chongqi Tu
- Department of Orthopeadics, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
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Salunke AA, Shah J, Chauhan TS, Parmar R, Kumar A, Koyani H, Garg N, Bhole M, Merja M, Pandit J, Pandya S, Kamani M. Reconstruction with biological methods following intercalary excision of femoral diaphyseal tumors. J Orthop Surg (Hong Kong) 2020; 27:2309499018822242. [PMID: 30798734 DOI: 10.1177/2309499018822242] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIM The aim of this study was to assess outcomes of biological (nonvascularized fibula grafts and extracorporeal irradiated autologous bone grafts) methods used for reconstruction of intercalary defects after resection of femoral diaphyseal tumors. MATERIALS AND METHODS This study included 28 patients who had undergone intercalary resection in femoral diaphyseal tumors between 2011 and 2016. The mean follow-up period was 24 months (range 12-57 months). RESULTS The mean union time for diaphyseo-diaphyseal union was 10.5 and 11 months in nonvascularized fibula group and extracorporeal radiotherapy (ECRT) group, respectively. The mean union time for metaphyseo-diaphyseal union was 6.5 months in both nonvascularized fibula and ECRT groups. Six patients had distant metastasis, and one patient had local recurrence. The mean Musculoskeletal Tumor Society score was 28 at the last follow-up. Two patients had surgical site infection in the nonvascularized fibula group. Implant failure was found in one patient of the ECRT group requiring revision surgery. Three patients had nonunion (two from the nonvascularized fibula group and one from the ECRT group). CONCLUSION The present study indicates that the biological reconstruction modalities provide good functional outcomes in diaphyseal tumors of femur. Nonvasularized fibula and ECRT-treated autografts reconstruction provides good results, and union timing is comparable. The outcomes of the current study are promising as compared to the results in the reviewed literature. The reconstruction method depends on the resources available at the oncological center and the conversance with the method of the treating surgeon.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Mayur Kamani
- Department of Surgical Oncology, Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India
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Lee JH, Han CS, Baek JH. Onlay vascularized fibular grafting as a salvage procedure for the management of nonunion after reconstruction of the femur following tumor resection. J Orthop Surg (Hong Kong) 2019; 26:2309499018802490. [PMID: 30270728 DOI: 10.1177/2309499018802490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The femur is prone to nonunion after biologic reconstruction following tumor resection, due to high bending forces. Nonunion at the host-graft junction is difficult to treat since the graft is in an avascular state. We aimed to investigate the clinical and radiographic results of an onlay free vascularized fibular grafting (VFG) as a salvage procedure for nonunion management after biologic reconstruction of the femur following bone tumor resection. METHODS We retrospectively reviewed 10 patients (8 men and 2 women, median age: 15.5 years, range: 10-47) who underwent an onlay VFG for nonunion after intercalary reconstruction of the femur using an allograft ( n = 7) or pasteurized autograft ( n = 3), following tumor resection. The median follow-up period after VFG was 85.7 (24.6-163.5) months. RESULTS The median time to union between the host bone and the VFG osteotomy sites was 3.5 (2.8-4.5) months. The median time to union at the host-graft junctions was 10.6 (6.6-12.7) months. Two postoperative complications requiring revision surgery occurred in two patients: one graft fracture and one deep infection with synchronous graft fracture. Internal fixation was required in the patient with graft fracture. The patient with the infection and synchronous graft fracture was treated using debridement, antibiotics, and an external fixator. The median Musculoskeletal Tumor Society functional score was 88% (60-97%) at the final follow-up. CONCLUSION Onlay VFG as a salvage procedure for nonunion of a biologic intercalary reconstruction of the femur after tumor resection is a useful treatment option.
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Affiliation(s)
| | | | - Jong Hun Baek
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
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Zhao J, Xu M, Zheng K, Yu X. Limb salvage surgery with joint preservation for malignant humeral bone tumors: operative procedures and clinical application. BMC Surg 2019; 19:57. [PMID: 31146705 PMCID: PMC6543608 DOI: 10.1186/s12893-019-0519-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/21/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND However, the application of limb salvage with joint preservation is controversial. The purpose of this study is to propose a selection strategy of joint-sparing operative procedures for humeral malignancies based on tumor origin, site and bone strength. METHODS The medical data of 28 patients with humeral malignancies treated at our institute from January 2010 to December 2016 were analyzed retrospectively. The patients had a median age of 51 years (range, 8-82 years). Bone strength scoring system was utilized to evaluated bone strength of the tumor. Four joint-sparing surgical methods were performed on selected patients. Evaluation of limb function was based on the Musculoskeletal Tumor Society scoring system. Two-sample t-test was used to compare patient group data such as bone strength score and postoperative Musculoskeletal Tumor Society score. RESULTS The mean follow-up period for the 7 patients with primary malignancies was 45 months (range, 15-66 months). One patient died due to recurrence and lung metastasis, while the remaining 6 patients (6/7, 85.7%) survived without recurrence. For the 21 patients with metastases, 5 survived with tumors, with an average survival time of 25.8 months (range, 9-48 months). The rest died from progression of the primary tumors. The mean bone strength score for the biological reconstruction group and non-biological reconstruction group was respectively 9.7 ± 1.3 and 12.9 ± 1.2. A significant difference between the 2 groups (p < 0.05) was found. Mean postoperative Musculoskeletal Tumor Society score was respectively 27.2 ± 1.8 and 26.1 ± 1.7 for the 2 groups. There was no significant difference between the 2 groups (p > 0.05). Non-oncological complications included fracture (1), aseptic loosening (1) and radial nerve injury (1). CONCLUSIONS Alcohol devitalized autograft replantation is applicable for diaphyseal humeral primary malignancies, with a good response to chemotherapy and a low bone strength score (≤10). In situ microwave ablation is suitable for diaphyseal and (or) metaphyseal low-grade malignant bone tumors or metastases with a low bone strength score (≤10). Intercalary prosthetic reconstruction is preferred for diaphyseal metastases with a high bone strength score (> 10).
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Affiliation(s)
- Jie Zhao
- Department of Orthopedics, The PLA 960th Hospital of China, 25#, Shifan Road, Jinan, 250031, China.,First Clinical Medical College, Shandong University of Traditional Chinese Medicine, 4655#, Daxue Road, Jinan, 250355, China
| | - Ming Xu
- Department of Orthopedics, The PLA 960th Hospital of China, 25#, Shifan Road, Jinan, 250031, China
| | - Kai Zheng
- Department of Orthopedics, The PLA 960th Hospital of China, 25#, Shifan Road, Jinan, 250031, China
| | - Xiuchun Yu
- Department of Orthopedics, The PLA 960th Hospital of China, 25#, Shifan Road, Jinan, 250031, China.
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Ippolito JA, Martinez M, Thomson JE, Willis AR, Beebe KS, Patterson FR, Benevenia J. Complications following allograft reconstruction for primary bone tumors: Considerations for management. J Orthop 2018; 16:49-54. [PMID: 30662238 DOI: 10.1016/j.jor.2018.12.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 12/09/2018] [Indexed: 11/19/2022] Open
Abstract
Introduction The aim of this study was to investigate complication rates and types following allograft reconstruction and discuss unique considerations for management. Methods Seventy-four consecutive patients underwent large segment allograft reconstruction following resection of primary musculoskeletal tumors from 1991 to 2016. Mean patient age was 32 ± 20 years (range, 5-71 years). Minimum follow-up was 2 years unless patients were lost to disease prior. Mean follow-up was 105 months. Results Thirty-five patients had complications requiring subsequent surgery at a mean of 30 months (range, 1-146 months) post-operatively. Individual complication rates were 29%, 50%, and 42% for Allograft Prosthetic Composite, Intercalary, and Osteoarticular allograft reconstruction, respectively. Risk factors for complication included age less than 30 (OR 4.5; p = 0.002), male gender (OR 2.8; p = 0.031), chemotherapy (OR 4.4; p = 0.003), lower extremity disease (OR 3.4; p = 0.025). In patients with complications, limb-retention rate was 91% and mean MSTS scores were 23.6. Conclusion Despite considerable complication rates, management with a systematic approach results in successful outcomes with limb-retention greater than 90% and mean MSTS scores of 79%. In carefully selected patients, allografts provide a reliable method of reconstruction with treatable complications occurring at a mean of 30 months.
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Affiliation(s)
- Joseph A Ippolito
- Rutgers New Jersey Medical School Department of Orthopaedics, 140 Bergen Street, ACC D1610, Newark, NJ, 07103, USA
| | - Maximilian Martinez
- Rutgers New Jersey Medical School Department of Orthopaedics, 140 Bergen Street, ACC D1610, Newark, NJ, 07103, USA
| | - Jennifer E Thomson
- Rutgers New Jersey Medical School Department of Orthopaedics, 140 Bergen Street, ACC D1610, Newark, NJ, 07103, USA
| | - Alexander R Willis
- Rutgers New Jersey Medical School Department of Orthopaedics, 140 Bergen Street, ACC D1610, Newark, NJ, 07103, USA
| | - Kathleen S Beebe
- Rutgers New Jersey Medical School Department of Orthopaedics, 140 Bergen Street, ACC D1610, Newark, NJ, 07103, USA
| | - Francis R Patterson
- Rutgers New Jersey Medical School Department of Orthopaedics, 140 Bergen Street, ACC D1610, Newark, NJ, 07103, USA
| | - Joseph Benevenia
- Rutgers New Jersey Medical School Department of Orthopaedics, 140 Bergen Street, ACC D1610, Newark, NJ, 07103, USA
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Pruksakorn D, Kongthavonskul J, Teeyakasem P, Phanphaisarn A, Chaiyawat P, Klangjorhor J, Arpornchayanon O. Surgical outcomes of extracorporeal irradiation and re-implantation in extremities for high grade osteosarcoma: A retrospective cohort study and a systematic review of the literature. J Bone Oncol 2018; 14:100210. [PMID: 30581725 PMCID: PMC6299161 DOI: 10.1016/j.jbo.2018.100210] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/03/2018] [Accepted: 12/07/2018] [Indexed: 11/18/2022] Open
Abstract
Diaphyseal resection of ECIR showed the promising outcome in osteosarcoma. Less complications and structural permanence are advantages of DI-ECIR. Tumor recurrence is comparable with other surgical reconstructions.
Purpose To assess the failure rate and mode failure of high-grade osteosarcoma patients who received extracorporeal irradiation and re-implantation (ECIR) in extremities. Patients and Methods For the cohort study, patients who had received ECIR at a single institution between January 1996 and December 2014 were retrospectively evaluated. Characteristics of failure and time to failure were recorded and analyzed. In addition, a systematically search of published literatures regarding the use of ECIR for osteosarcoma was conducted. Failure rates and modes of failure were determined from the pooled data. Results In the cohort study, the overall reconstruction failure was 46% (23 of 50 cases) of which 6% were due to mechanical failure, and 40% were due to non-mechanical failure. In the systematic review, 164 cases reached the criteria for analysis (50 diaphysis, 97 osteochondral of lower extremity, 6 knee resection, and 11 proximal humerus resection). Among those cases, overall failure rate was 29.9% (49 of 164 cases) of which 7.9% were due to mechanical failure, and 22.0% to non-mechanical failure. Diaphyseal resection with intercalary re-implantation had a significantly lower failure rate than osteochondral reconstruction of lower extremity (OR: 2.7, p < 0.02), and knee extra-articular resection osteochondral re-implantation (OR: 10.5, p < 0.01). Conclusions Diaphyseal resection and extracorporeal irradiation of intercalary re-implantation offer the most promising outcome among other type of reconstructions. Availability of graft, fewer structural complications, and biological permanence are advantages of this reconstruction method.
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Affiliation(s)
- Dumnoensun Pruksakorn
- Orthopedic Laboratory and Research Network (OLARN), Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Biomedical Engineering Institute, Chiang Mai University, Thailand.,Excellence Center in Osteology Research and Training Center (ORTC), Chiang Mai University, Thailand
| | | | - Pimpisa Teeyakasem
- Orthopedic Laboratory and Research Network (OLARN), Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Areerak Phanphaisarn
- Orthopedic Laboratory and Research Network (OLARN), Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Parunya Chaiyawat
- Orthopedic Laboratory and Research Network (OLARN), Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Jeerawan Klangjorhor
- Orthopedic Laboratory and Research Network (OLARN), Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Olarn Arpornchayanon
- Orthopedic Laboratory and Research Network (OLARN), Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Orthopedic Surgery Division, Bangkok Chiang Mai Hospital, Chiang Mai, Thailand
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Zhao J, Yu XC, Xu M, Zheng K, Hu YC, Wang F, Lun DX. Intercalary prosthetic reconstruction for pathologic diaphyseal humeral fractures due to metastatic tumors: outcomes and improvements. J Shoulder Elbow Surg 2018; 27:2013-2020. [PMID: 29779979 DOI: 10.1016/j.jse.2018.03.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/20/2018] [Accepted: 03/25/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is a high aseptic loosening rate for intercalary prosthetic reconstruction for malignant tumors. We evaluated outcomes and complications of intercalary prosthetic reconstruction for pathologic diaphyseal humeral fractures and report the application of an extracortical plate that can prevent early loosening. METHODS We retrospectively analyzed 9 patients who underwent intercalary prosthetic reconstruction for pathologic diaphyseal humeral fractures secondary to metastatic diseases between March 2011 and September 2017. Procedures were intercalary prosthetic reconstruction in 4 patients (group A) and an implanted intercalary prosthesis with a plate in 5 patients (group B). Operative time, blood loss, complications, and functional score were noted. RESULTS Mean operative time for group A and B was 80 ± 14 and 94 ± 5 minutes, respectively; blood loss was 115 ± 26 and 120 ± 31 mL respectively; and follow-up was 11.5 ± 10.1 and 6.2 ± 4.4 months, respectively. At final follow-up, all patients in group A had died, and 3 patients in group B had died; mean survival was 11.5 ± 10.1 and 9.3 ± 1.2 months, respectively. The mean postoperative Musculoskeletal Tumor Society score was 24.5 ± 2.4 and 26.2 ± 0.8, respectively. The mean postoperative American Shoulder and Elbow Surgeons score was 85.5 ± 4.20 and 87 ± 2.6, respectively. There were no significant differences between the 2 groups (P > .05). There was 1 aseptic loosening and 1 radial nerve injury in group A; there were no complications in group B. CONCLUSIONS The intercalary prosthesis yielded satisfactory outcomes in patients with pathologic diaphyseal humeral fractures, and an extracortical plate can prevent early aseptic loosening.
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Affiliation(s)
- Jie Zhao
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Xiu-Chun Yu
- Department of Orthopedics, General Hospital of Jinan Military Commanding Region, Jinan, Shandong, China.
| | - Ming Xu
- Department of Orthopedics, General Hospital of Jinan Military Commanding Region, Jinan, Shandong, China
| | - Kai Zheng
- Department of Orthopedics, General Hospital of Jinan Military Commanding Region, Jinan, Shandong, China
| | - Yong-Cheng Hu
- Department of Bone Oncology, Tianjin Hospital, Tianjin, China
| | - Feng Wang
- Department of Bone Oncology, Tianjin Hospital, Tianjin, China
| | - Deng-Xing Lun
- Department of Spine Surgery, Weifang People's Hospital, Weifang, China
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Zhao K, Wang Y, Lu M, Yao K, Xiao C, Zhou Y, Min L, Luo Y, Tu C. [Progress in repair and reconstruction of large segmental bone tumor defect in distal tibia]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2018; 32:1211-1217. [PMID: 30129350 DOI: 10.7507/1002-1892.201803007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To review the methods of repair and reconstruction of the large segmental bone tumor defect in distal tibia. Methods The related literature of repair and reconstruction of the large segmental bone tumor defect in disatal tibia were reviewed and analyzed from the aspects of the reserved ankle joint and the non-reserved ankle joint. Results The large segmental bone tumor defect in distak tibia is not rare in clinical. In addition to conventional allograft bone transplantation, vascularized autologous fibular transplantation, vascularized fibular allograft, inactivated tumor regeneration, distraction osteogenesis, and bone transport techniques; membrane-induced osteogenesis, artificial tumor stem prosthesis, three-dimensional printed metal trabecular prosthesis, ankle arthrodesis, artificial tumor ankle joint placement surgery are now gradually applied to the repair and reconstruction of large segmental bone defects in the distal tibia. Moreover, due to its long survival time, the function of reconstruction of the bone tumor defect in the distal tibia has also received increasing attention. Conclusion Although the ideal methods of repair and reconstruction of the large segmental bone tumor defect in the distal tibia has not yet been developed, great progress has been achieved. Recently, with the appearance of three-dimensional printing and various preoperative simulation techniques, personalized and precise therapy could become ture, but therapies for the large segmental bone tumor defect in the distal tibia still need to be further explored.
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Affiliation(s)
- Kun Zhao
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Yanling Wang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Minxun Lu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Kai Yao
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Cong Xiao
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Yong Zhou
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Li Min
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Yi Luo
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Chongqi Tu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
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Abstract
BACKGROUND Pasteurized autograft is regarded as a biologic reconstructive option for managing bone defects after tumor resection; however, reports on long-term outcomes from large patient series are scarce. Contrary to previous favorable reports, we have observed many patients with failures, in particular as the duration of followup increased. Because pasteurized autografts are used in many countries as a reconstruction option, we wished to formally evaluate patients who underwent this approach at one specialty center. QUESTIONS/PURPOSES (1) What is the graft survival and what proportion of patients achieved union when pasteurized autografts were used for bone defects after tumor resection? (2) What are the complications and causes of graft removal? (3) What factors are related to the likelihood of union and graft survival? (4) What is the survival and cause of failure by type of pasteurized autograft reconstruction? METHODS Over a 26-year period from 1988 to 2013, we performed 1358 tumor resections in our center. Of these, 353 were reconstructed with pasteurized autograft. Other reconstructions included endoprostheses (508 patients), instant arthrodesis using an intramedullary nail and bone cement (286 patients), allografts (97 patients), and resection only (114 patients). During the period in question, we generally used this approach when tumor showed an osteoblastic pattern and less than one-third cortical destruction in osteolytic tumor. We generally avoided this approach when the tumor showed an extensive osteolytic pattern. We excluded 75 (21% [75 of 353]) patients, 21 (6% [21 of 353]) for incomplete clinical data and 54 (15% [54 of 353]) with a followup < 2 years or those lost to followup leaving 278 autografts eligible. The mean followup was 113 months (range, 25-295 months). Of these 278 patients, 242 patients had primary bone sarcomas, 22 patients had soft tissue tumor invading bone, seven patients had metastatic carcinoma, and seven patients had aggressive benign bone tumors. From a chart review, we obtained the age, sex, location, tumor volume, histologic diagnosis, use of chemotherapy, graft length, fixation modality, type of pasteurized bone used, proportion of union, complications, and oncologic outcome of the patients. In total, 377 junctional sites were assessed for union with serial radiographs. We defined junctions showing union < 2 years as union and > 2 years as delayed union. We grouped our patients into type of pasteurized bone use: pasteurized autograft-prosthesis composites (PPCs) were performed in 149, intercalary grafts in 71, hemicortical grafts in 15, osteoarticular in 12, and fusion of a joint in 31 patients. The endpoint of interest included removal of the autograft with implant loosening, infection, fracture of the graft, or any reoperation resulting in removal. Survival of the graft was determined by Kaplan-Meier plot and intergroup differences were determined using log-rank test. RESULTS Five, 10-, and 20-year survival of 278 autografts was 73% ± 5.5%, 59% ± 6.7%, and 40% ± 13.6%, respectively. Of 278 autografts, 105 (38%) were removed with complications. Cause of removal included infection in 13% (33 patients), nonunion in 7% (18 patients), fracture of graft in 6% (16 patients), resorption of the graft in 5% (14 patients), and local recurrence in 4% (11 patients). Univariate survival analysis revealed that patient age ≤ 15 years (p = 0.027; hazard ratio [HR], 1.541), male sex (p = 0.004; HR, 1.810), and pelvic location (p = 0.05; HR, 2.518) were associated with graft removal. The 20-year survival rate of osteoarticular and hemicortical methods was 92% (95% confidence interval, -15.6% to +8.3%) and 80% ± 20%, respectively. For intercalary and fusion, it was 46% ± 15% and 28% ± 22%, respectively, although for PPC, it was 37% ± 22%. Log-rank survival analysis showed the osteoarticular and hemicortical groups had better graft survival compared with other types of reconstruction (p = 0.028; HR, 0.499). The most prevalent cause of graft removal in three major types of reconstruction was as follows: (1) PPC type was infection (30% [17 of 56]); (2) intercalary graft was infection, nonunion, and local recurrence in even proportions of 29% (86% [24 of 28]); and (3) fusion was infection (35% [six of 17]). Two hundred ten (56%) of 377 junctional sites showed union within 2 years (average, 14 months), 51 (13%) junctions showed delayed union after 2 years (average, 40 months), and the remaining 116 (31%) junctions showed nonunion. Diaphyseal junction (p = 0.029) and male sex (p = 0.004) showed a higher proportion of nonunion by univariate analysis. CONCLUSIONS Compared with the favorable short-term and small cohort reports, survival of pasteurized autograft in this long-term large cohort was disappointing. We believe that pasteurized autograft should be used with caution in children and adolescents, in the pelvic region, and in PPC form. When bone stock destruction is minimal, it is worth considering this approach for small intercalary or distal long bone reconstruction. We believe this procedure is best indicated after hemicortical resection of long bone. LEVEL OF EVIDENCE Level III, therapeutic study.
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Zhao LM, Tian DM, Wei Y, Zhang JH, Di ZL, He ZY, Hu YC. Biomechanical Analysis of a Novel Intercalary Prosthesis for Humeral Diaphyseal Segmental Defect Reconstruction. Orthop Surg 2018; 10:23-31. [PMID: 29484857 DOI: 10.1111/os.12368] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 11/23/2017] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To study the biomechanical properties of a novel modular intercalary prosthesis for humeral diaphyseal segmental defect reconstruction, to establish valid finite element humerus and prosthesis models, and to analyze the biomechanical differences in modular intercalary prostheses with or without plate fixation. METHODS Three groups were set up to compare the performance of the prosthesis: intact humerus, humerus-prosthesis and humerus-prosthesis-plate. The models of the three groups were transferred to finite element software. Boundary conditions, material properties, and mesh generation were set up for both the prosthesis and the humerus. In addition, 100 N or 2 N.m torsion was loaded to the elbow joint surface with the glenohumeral joint surface fixed. Humeral finite element models were established according to CT scans of the cadaveric bone; reverse engineering software Geomagic was used in this procedure. Components of prosthetic models were established using 3-D modeling software Solidworks. To verify the finite element models, the in vitro tests were simulated using a mechanical testing machine (Bionix; MTS Systems Corporation, USA). Starting with a 50 N preload, the specimen was subjected to 5 times tensile (300 N) and torsional (5 N.m) strength; interval time was 30 min to allow full recovery for the next specimen load. Axial tensile and torsional loads were applied to the elbow joint surface to simulate lifting heavy objects or twisting something, with the glenohumeral joint surface fixed. RESULTS Stress distribution on the humerus did not change its tendency notably after reconstruction by intercalary prosthesis whether with or without a plate. The special design which included a plate and prosthesis effectively diminished stress on the stem where aseptic loosening often takes place. Stress distribution major concentrate upon two stems without plate addition, maximum stress on proximal and distal stem respectively diminish 27.37% and 13.23% under tension, 10.66% and 11.16% under torsion after plate allied. CONCLUSION The novel intercalary prosthesis has excellent ability to reconstruct humeral diaphyseal defects. The accessory fixation system, which included a plate and prosthesis, improved the rigidity of anti-tension and anti-torsion, and diminished the risk of prosthetic loosening and dislocation. A finite element analysis is a kind of convenient and practicable method to be used as the confirmation of experimental biomechanics study.
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Affiliation(s)
- Li-Ming Zhao
- Department of Joint Surgery, Ningbo Sixth Hospital, Ningbo, Zhejiang, China
| | - Dong-Mu Tian
- Beijing Weigao Yahua Artificial Joint Development Company, Beijing, China
| | - Yue Wei
- Shandong Weigao Orthopaedic Device Company Limited, Weihai, China
| | - Jun-Hui Zhang
- Department of Joint Surgery, Ningbo Sixth Hospital, Ningbo, Zhejiang, China
| | - Zheng-Lin Di
- Department of Joint Surgery, Ningbo Sixth Hospital, Ningbo, Zhejiang, China
| | - Zhi-Yong He
- Department of Joint Surgery, Ningbo Sixth Hospital, Ningbo, Zhejiang, China
| | - Yong-Cheng Hu
- Department of Orthopaedic Oncology, Tianjin Hospital, Tianjin, China
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Lu M, Li Y, Luo Y, Zhang W, Zhou Y, Tu C. Uncemented three-dimensional-printed prosthetic reconstruction for massive bone defects of the proximal tibia. World J Surg Oncol 2018; 16:47. [PMID: 29510728 PMCID: PMC5840814 DOI: 10.1186/s12957-018-1333-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 02/05/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Currently, it is challenging to treat massive bone defects of proximal tibia. Although numerous methods are available for reconstruction with epiphysis preservation, limitations in knee function and complications are noted with these methods. Our paper describes our attempt to reconstruct a marked defect in the proximal tibia with an uncemented three-dimensional (3D)-printed prosthesis and to evaluate the prosthesis design and short-term outcomes. CASE PRESENTATION A 15-year-old boy with metaphyseal osteosarcoma of the tibia underwent intercalary allograft reconstruction following wide tumour resection with epiphysis preservation. However, chronic allograft rejection and/or infection occurred after the surgery and a sinus tract was formed. The rejection and/or infection process was successfully stopped by the removal of the graft and implantation of an antibiotic-loaded cement spacer; however, the limb function was poor. Because of the irregular shape of the defect and the excessively short length of the residual proximal tibia, we used the 3D printing technology to design and fabricate a personalised prosthesis to reconstruct the defect, with the preservation of the knee joint. At the last follow-up at 26 months, the patient had satisfactory limb function. CONCLUSIONS The 3D-printed prosthesis may be a feasible option in the reconstruction of tibial metaphyseal defects with the preservation of the knee joint. Moreover, it can result in good postoperative function and low complication rates. However, a long-term follow-up is required to clarify its long-term outcomes.
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Affiliation(s)
- Minxun Lu
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, People's Republic of China
| | - Yongjiang Li
- Department of Oncology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yi Luo
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, People's Republic of China
| | - Wenli Zhang
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, People's Republic of China
| | - Yong Zhou
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, People's Republic of China
| | - Chongqi Tu
- Department of Orthopedics, West China Hospital, Sichuan University, No. 37 Guoxuexiang, Chengdu, 610041, People's Republic of China.
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Lun DX, Hu YC, Yang XG, Wang F, Xu ZW. Short-term outcomes of reconstruction subsequent to intercalary resection of femoral diaphyseal metastatic tumor with pathological fracture: Comparison between segmental allograft and intercalary prosthesis. Oncol Lett 2018; 15:3508-3517. [PMID: 29556273 PMCID: PMC5844073 DOI: 10.3892/ol.2018.7804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 11/16/2017] [Indexed: 01/25/2023] Open
Abstract
Reconstruction of bone defects following femoral diaphyseal tumor resection is challenging. Segmental allograft (SA) and intercalary prosthesis (IP) are the most common reconstruction methods for femoral diaphyseal metastatic tumors with pathological fracture. However, whether the complications and functional outcomes differ between SA and IP remains unclear. To compare the clinical outcomes and complications for patients treated with SA reconstruction or IP replacement for femoral shaft tumors, 34 patients who had undergone intercalary resection for metastatic tumor with pathological fracture in the femoral diaphysis were evaluated. Of these, 18 had received SA and 16 IP. There were 11 males, and 24 females, with a mean age of 64.5±11.3 years. The most common sites of primary metastases were lung (26.5%), breast (17.6%) and liver (14.7%). The visual analog scale (VAS), implant-related complications and the Musculoskeletal Tumor Society (MSTS) scores for each patient were collected. The follow-up period for patients ranged from 2 to 27 months. At the most recent follow-up, 28 patients had succumbed to mortality, with a mean survival time of 6.9±3.7 months for the IP group and 7.4±3.0 months for the SA group. Patients with IP had a significantly shorter time to full weight bearing and hospitalization time than those who received SA (P=0.003 and P=0.002, respectively). The rates of overall complications and implant-related complications were significantly lower for IP as compared with SA (18.8 vs. 66.7%, P=0.007; 12.5 vs. 55.6%, P=0.013). The reoperation rate of the SA group was higher than that of the IP group (38.9 vs. 12.5%), however the difference between the two groups was statistically insignificant (P=0.125). MSTS scores were significantly higher for the IP group as compared with the SA group at one month after surgery (IP, 26.7±1.6 vs. SA, 20.3±1.5; P<0.05), without a significant difference at the final follow-up. There were no statistically significant differences in age, sex, length of resection, follow-up time, operative time or blood loss between the two groups. In summary, IP reconstruction may provide improved early functional outcomes and fewer early complications, particularly for patients with a shorter life expectancy due to femoral metastatic tumors with pathological fracture.
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Affiliation(s)
- Deng-Xing Lun
- Graduate School of Tianjin Medical University, Tianjin 300070, P.R. China.,Department of Spine Surgery, Weifang People's Hospital, Weifang, Shandong 261041, P.R. China.,Department of Bone Oncology, Tianjin Hospital, Tianjin 300211, P.R. China
| | - Yong-Cheng Hu
- Department of Bone Oncology, Tianjin Hospital, Tianjin 300211, P.R. China
| | - Xiong-Gang Yang
- Department of Bone Oncology, Tianjin Hospital, Tianjin 300211, P.R. China
| | - Feng Wang
- Department of Bone Oncology, Tianjin Hospital, Tianjin 300211, P.R. China
| | - Zhao-Wan Xu
- Department of Spine Surgery, Weifang People's Hospital, Weifang, Shandong 261041, P.R. China
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Herry Y, Reynaud O, Ferry T, Servien E, Neyret P, Lustig S. Intercalary diaphyseal endoprosthetic reconstruction for tibial septic non-union in an elderly patient: A case report. Orthop Traumatol Surg Res 2017; 103:1217-1220. [PMID: 28970004 DOI: 10.1016/j.otsr.2017.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/11/2017] [Accepted: 09/16/2017] [Indexed: 02/02/2023]
Abstract
The surgical treatment of septic non-union is challenging and carries a high failure rate. Bone defect management and fracture site stabilisation are key treatment objectives. We report the case of a 75-year-old woman who underwent intercalary endoprosthetic reconstruction of a large tibial defect due to septic non-union after two previous treatment failures. The two-stage procedure involved extensive excision of infected tissues and implantation of an antibiotic-loaded cement spacer followed by insertion of an intercalary endoprosthesis. Within only 2 months after the procedure, the patient was able to walk with no assistive device and no limp. After 12 months and 6 months after antibiotic discontinuation, the laboratory tests and imaging studies showed no evidence of infection. Intercalary endoprosthetic reconstruction may be a valid treatment option to avoid amputation for recurrent septic non-union, particularly in elderly patients.
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Affiliation(s)
- Y Herry
- Département de chirurgie orthopédique, CHU de Lyon Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France
| | - O Reynaud
- Département de chirurgie orthopédique, CHU de Lyon Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France
| | - T Ferry
- Service de maladies infectieuses, CHU de Lyon Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France; Centre de référence des infections ostéo-articulaires complexes Rhône-Alpes-Auvergne, hospices civils de Lyon, 69004 Lyon, France
| | - E Servien
- Département de chirurgie orthopédique, CHU de Lyon Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France
| | - P Neyret
- Département de chirurgie orthopédique, CHU de Lyon Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France; Centre de référence des infections ostéo-articulaires complexes Rhône-Alpes-Auvergne, hospices civils de Lyon, 69004 Lyon, France
| | - S Lustig
- Département de chirurgie orthopédique, CHU de Lyon Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France; Centre de référence des infections ostéo-articulaires complexes Rhône-Alpes-Auvergne, hospices civils de Lyon, 69004 Lyon, France; Laboratoire de biomécanique et mécanique des chocs, université Claude-Bernard Lyon 1, 69004 Lyon, France.
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Kowalczyk B, Miklaszewski K, Feluś J. Spontaneous healing of fractures and osteotomy within intercalary allograft reconstruction after distal femur osteosarcoma resection in a child. J Pediatr Orthop B 2017; 26:570-4. [PMID: 27509485 DOI: 10.1097/BPB.0000000000000373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Intercalary biologic reconstructions using allogenic bone grafts remain a useful option in orthopedic oncology; however, these reconstructions are prone to fractures, and treatment is usually required involving surgical interventions. Biologic activity of the implanted allografts remains minimal, but in some cases, spontaneous healing of the graft may occur. We present a report and discussion on two fractures and corrective osteotomy within the implanted allograft that healed with abundant callus without the need for additional surgery. In selected patients, allograft incorporation can be completed to a degree allowing for its biologic activity and spontaneous healing of fractures or osteotomy.
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Tedesco NS, Van Horn AL, Henshaw RM. Long-term Results of Intercalary Endoprosthetic Short Segment Fixation Following Extended Diaphysectomy. Orthopedics 2017; 40:e964-e970. [PMID: 28934543 DOI: 10.3928/01477447-20170918-04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 07/31/2017] [Indexed: 02/03/2023]
Abstract
Intercalary endoprosthetic reconstruction following diaphyseal resection of osseous tumors offers functional advantages through preservation of native joints adjacent to the resected defect. Use of such implants is restricted by the amount of bone available for stem fixation adjacent to the defect. This study aimed to determine whether short osseous segment fixation with acceptable outcomes and complication rate can be reliably achieved with a customized intercalary endoprosthesis following extended diaphysectomy. A retrospective review of prospectively collected data was performed on 6 patients receiving customized anchor plugs for short segment fixation with a double compressive osseointegration intercalary implant to reconstruct segmental defects. Five of the implants were augmented with cement to support fixation in metaphyseal bone. Patient age at surgery ranged from 12 to 86 years. At mean follow-up of 39 months, mean Musculoskeletal Tumor Society functional score was 26.3, with 5 of 6 patients achieving scores of 27 or greater. Stable fixation was achieved in all patients, with the shortest segment of bone 3.7 cm in length. Three mechanical implant failures requiring revision surgery occurred. No patient required revision of the entire implant, secondary adjacent joint replacement, or secondary amputation. No patient exhibited aseptic loosening, and no case was complicated by infection. Excellent functional outcomes were seen with follow-up out to 9 years. This suggests that cement-augmented double compressive osseointegration intercalary endoprosthetic reconstruction can extend the benefits of intercalary replacement to many patients who otherwise might require adjacent joint or physeal sacrifice. However, patients should be counseled on the high risk of implant failure with subsequent need for revision surgery. [Orthopedics. 2017; 40(6):e964-e970.].
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Huang HC, Hu YC, Lun DX, Miao J, Wang F, Yang XG, Ma XL. Outcomes of Intercalary Prosthetic Reconstruction for Pathological Diaphyseal Femoral Fractures Secondary to Metastatic Tumors. Orthop Surg 2017; 9:221-228. [PMID: 28598582 DOI: 10.1111/os.12327] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 03/05/2017] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To evaluate the clinical outcomes and complications of segmental prosthetic reconstruction for pathological diaphyseal femoral fractures secondary to metastatic tumors. METHODS Between 2011 and 2015, we retrospectively evaluated 16 patients (6 men and 10 women; 64.5 ± 11.4 years old at diagnosis) who underwent prosthetic reconstruction after segmental resection of diaphyseal femoral fractures due to metastatic lesions. Visual analog scale (VAS), functional outcomes, implant-related complications, and Mean postoperative Musculoskeletal Tumor Society (MSTS) score for each patient were collected. RESULTS The mean length of bone defect was 10.2 ± 2.6 cm (range, 8-16 cm); follow-up was 9 ± 6.8 months (range, 2-25 months) for all patients, and 24 months (23 and 25 months) for the 2 patients still alive. At final follow-up, 14 patients were dead, indicating a mean survival of 6.9 ± 3.6 months (range, 2-14 months). Mean preoperative VAS score was 8.5 ± 1.0, which decreased to 2.5 ± 1.3 at day 2 postoperatively, indicating significant pain relief (P < 0.05). The MSTS score for lower extremities was 84.6% (range, 73%-90%). The range of motion and function of adjacent joints was within the normal limits in all cases. Three patients (33%) developed complications, including aseptic loosening because of disease progression (1), infection (1), and peri-prosthesis fracture (1). CONCLUSION These findings demonstrated that this approach greatly relieves pain, and yields satisfactory functional outcomes with fewer complications in patients with pathological femoral fractures secondary to metastatic tumors; however, survival was not significantly improved.
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Affiliation(s)
- Hong-Chao Huang
- The Graduate School, Tianjin Medical University, Tianjin, China.,Department of Bone Oncology, Tianjin Hospital, Tianjin, China
| | - Yong-Cheng Hu
- Department of Bone Oncology, Tianjin Hospital, Tianjin, China
| | - Deng-Xing Lun
- Department of Spine Surgery, Weifang People's Hospital, Weifang, China
| | - Jun Miao
- Department of Spine Surgery, Tianjin Hospital, Tianjin, China
| | - Feng Wang
- The Graduate School, Tianjin Medical University, Tianjin, China
| | - Xiong-Gang Yang
- The Graduate School, Tianjin Medical University, Tianjin, China
| | - Xin-Long Ma
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China
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Guder WK, Hardes J, Gosheger G, Nottrott M, Streitbürger A. Ultra-short stem anchorage in the proximal tibial epiphysis after intercalary tumor resections: analysis of reconstruction survival in four patients at a mean follow-up of 56 months. Arch Orthop Trauma Surg 2017; 137:481-488. [PMID: 28213847 DOI: 10.1007/s00402-017-2637-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Tumors localized in the proximal tibial meta-diaphysis often lead to osteoarticular resections. MATERIALS AND METHODS In this study, we retrospectively reviewed four patients who underwent intercalary tumor resection and reconstruction using an ultra-short stem in the proximal tibial epiphysis, a procedure that to our knowledge has not been reported in literature so far. RESULTS At the time of operation, the mean patient age was 26.2 years. Three patients were male and one was female. Patients were diagnosed with osteosarcoma in two cases, Ewing's sarcoma and malignant fibrous histiocytoma of bone in one case each. In all cases, wide tumor resections were achieved (osteotomy 3-3.5 cm below the tibia plateau joint surface, mean resection length of tibial bone 18 cm) at a mean time of operation of 198.8 min. Two superficial wound-healing disorders occurred, leading to one surgical revision in each case. One local tumor recurrence occurred 12 months after operation in a patient who discontinued his adjuvant chemotherapy. This patient died of disease, 31 months after operation. Three patients are alive with no evidence of disease at a mean follow-up of 56 months. Walking is not impaired and light sports activities have been reported in all cases. The mean MSTS score is 28/30. CONCLUSIONS Therefore, we report this reconstruction technique to be considered for special indications where the functional outcome can be improved by preservation of the knee joint in tumors of the proximal meta-diaphyseal tibial region.
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Affiliation(s)
- W K Guder
- Department of Orthopedics and Tumor Orthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany.
| | - J Hardes
- Department of Orthopedics and Tumor Orthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
| | - G Gosheger
- Department of Orthopedics and Tumor Orthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
| | - M Nottrott
- Department of Orthopedics and Tumor Orthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
| | - A Streitbürger
- Department of Orthopedics and Tumor Orthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
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Gibson PD, Ippolito JA, Benevenia J. Radial Shaft Reconstruction With an Intercalary Endoprosthesis Following Resection of Metastatic Tumor. Orthopedics 2017; 40:e242-e247. [PMID: 27610702 DOI: 10.3928/01477447-20160901-03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 08/01/2016] [Indexed: 02/03/2023]
Abstract
Improvements in imaging and treatment of musculoskeletal tumors have increased the variety of options for reconstruction following joint-sparing diaphyseal resection. The purpose of this case series was to show that reconstruction of malignant tumors of the radial shaft with an intercalary prosthesis may be an option for patients with segmental bone loss. Three consecutive patients underwent wide resection of the radial diaphysis followed by reconstruction with a custom intercalary prosthesis. A custom intercalary prosthesis with lap joint design was used in all 3 cases. Mean follow-up was 18 months (range, 9-25 months). All patients were weight bearing as tolerated 1 week postoperatively. At the most recent follow-up, patients' mean elbow flexion and extension arc was 137° (range, 130°-140°). At the forearm, mean supination was 60° (range, 30°-90°) and mean pronation was 70° (range, 60°-90°). At the wrist, mean palmar flexion was 80° (range, 70°-90°) and mean dorsiflexion was 80° (range, 70°-90°). All patients reported minimal to no pain and no significant functional limitations. Mean Musculoskeletal Tumor Society score was 26/30 (87%). Reconstruction with an intercalary prosthesis is a viable option for patients with metastatic disease of the radial shaft. All patients had satisfactory results and early return to function; none required return to the operating room. Possible advantages of reconstruction with an intercalary prosthesis compared with reconstruction with a bone graft or polymethylmethacrylate osteosynthesis include early return to function and minimal weight-bearing restrictions postoperatively. [Orthopedics. 2017; 40(2):e242-e247.].
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Li J, Zhang F, Yang M, Liu S, Wang X, Yang Q, Wu Z, Ji C. Extracorporeally frozen tumour-bearing bone combined with free vascularised fibula for the intercalary reconstruction of femoral defect after resection of bony sarcoma. J Plast Reconstr Aesthet Surg 2016; 69:856-863. [PMID: 27039218 DOI: 10.1016/j.bjps.2016.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 01/02/2016] [Accepted: 02/28/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND With the improved survival for patients with bone sarcomas, there is a trend to reconstruct intercalary femur defects using biologic techniques. This study examined whether the results of a frozen femur autograft with vascularised fibula are comparable to other reconstructive options in terms of the functional outcomes and the complications. MATERIALS AND METHODS Between 2008 and 2012, eight patients with bony sarcoma of the femur were subjected to reconstruction with a recycled frozen autograft combined with a vascularised fibula flap inside. The oncologic and functional results were analysed retrospectively. RESULTS The mean follow-up was 48.7 months (37-71). The oncologic results were continuously disease free in five patients; there was no evidence of disease in one, one patient was alive with disease and another died of the disease. The average length of defect was 13.6 cm (9-21). Bone union was achieved in all cases. The mean time to bone union was 7.9 months (5-19) and to full weight bearing was 7.8 months (6-11). There was no infection or construct fracture in this series. Two complications were observed. One tumour recurrence in soft tissue was treated with reresection. One tibia fracture was successfully managed with cast immobilisation. The average Musculoskeletal Tumor Society functional score was 95% (27-30). The construct was intact in all patients. CONCLUSIONS Vascularised fibular flap combined with frozen autografts is a dependable and durable option for the reconstruction of large bony defects after femoral sarcoma resection. It had the merits of reliable bone union and low complications, which compare well with other biological reconstructions. Evidence Rating Scale for Therapeutic Studies Level IV, therapeutic study.
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Affiliation(s)
- Jing Li
- The Orthopaedic Department, Xi Jing Hospital Affiliated to the Fourth Military Medical University, Xi'an, People's Republic of China.
| | - Fujun Zhang
- The Orthopaedic Department, Xi Jing Hospital Affiliated to the Fourth Military Medical University, Xi'an, People's Republic of China
| | - Ming Yang
- The Orthopaedic Department, Xi Jing Hospital Affiliated to the Fourth Military Medical University, Xi'an, People's Republic of China
| | - Shiping Liu
- The Orthopaedic Department, Yan'an People Hospital Affiliated to the Yan'an University, Yan'an, People's Republic of China
| | - Xin Wang
- The Orthopaedic Department, Yan'an People Hospital Affiliated to the Yan'an University, Yan'an, People's Republic of China
| | - Qianzi Yang
- The Orthopaedic Department, Wuwei Cancer Hospital Affiliated to the Lanzhou University, Wuwei, People's Republic of China
| | - Zhigang Wu
- The Orthopaedic Department, Xi Jing Hospital Affiliated to the Fourth Military Medical University, Xi'an, People's Republic of China
| | - Chuanlei Ji
- The Orthopaedic Department, Xi Jing Hospital Affiliated to the Fourth Military Medical University, Xi'an, People's Republic of China
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Benevenia J, Kirchner R, Patterson F, Beebe K, Wirtz DC, Rivero S, Palma M, Friedrich MJ. Outcomes of a Modular Intercalary Endoprosthesis as Treatment for Segmental Defects of the Femur, Tibia, and Humerus. Clin Orthop Relat Res 2016; 474:539-48. [PMID: 26475032 DOI: 10.1007/s11999-015-4588-z] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 10/02/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Resection of diaphyseal bone tumors for local tumor control and stabilization often results in an intercalary skeletal defect and presents a reconstructive challenge for orthopaedic surgeons. Although many options for reconstruction have been described, relatively few studies report on the functional outcomes and complications of patients treated with modular intercalary endoprostheses. QUESTIONS/PURPOSES The objectives of this study were to examine clinical outcomes after reconstruction with a modular intercalary endoprosthesis with a specific focus on (1) the rate of complication or failure; (2) differences in complication rates by anatomic site; (3) functional results as assessed by the Musculoskeletal Tumor Society System (MSTS); and (4) differences in complication rate between patients treated with cemented versus noncemented fixation. METHODS We conducted a retrospective chart review of patients treated with a modular intercalary endoprosthesis from three musculoskeletal oncology centers from 2008 to 2013. The indication for use of this intercalary endoprosthesis was segmental bone loss from aggressive or malignant tumor with sparing of the joint above and below and deemed unsuitable for biologic reconstruction. No other implant was used for this indication during this period. During this period, 41 patients received a total of 44 intercalary implants, which included 18 (40%) humeri, 5 (11%) tibiae, and 21 (48%) femora. There were 27 (66%) men and 14 (34%) women with a mean age of 63 years (range, 18–91 years). Eight patients (20%) had primary bone tumors and 33 (80%) had metastatic lesions. Thirty-five (85%) patients were being operated on as an initial treatment and six (15%) for revision of a previous reconstruction. Twenty-nine (66%) procedures had cemented stem fixation and 15 (34%) were treated with noncemented fixation. The overall mean followup was 14 months (range, 1–51 months). Patients with primary tumors had a mean followup of 19 months (range, 4–48 months) and patients with metastatic disease had a mean followup of 11 months (range, 1–51 months). Causes of implant failure were categorized according to Henderson et al. [19] into five types as follows: Type I (soft tissue failure), Type II (aseptic loosening), Type III (structural failure), Type IV (infection), and Type V (tumor progression). At 2 years of followup, 38 (93%) of these patients were accounted for with three (7%) lost to followup. MSTS functional assessment was available for 39 of 41 patients (95%). RESULTS At latest followup of these 41 patients, 14 (34%) patients were dead of disease, two patients (5%) dead of other causes, seven (17%) are continuously disease-free, one (2%) shows no evidence of disease, and 17 (41%) are alive with disease. There were 12 (27%) nononcologic complications. Five (11%) of these were Type II failures occurring in noncemented implants between the stem and bone, and six (14%) were Type III failures occurring in cemented implants at the clamp-rod implant interface. One patient developed a deep infection (2%, Type IV failure) and underwent removal of the implant. Additionally, one patient (2%, Type V failure) was treated by amputation after local progression of his metastatic disease. Complications were more common in femoral reconstructions than in tibial or humeral reconstructions. Twelve of 21 patients (57%) with femoral reconstructions had complications versus 0% of tibial or humeral reconstructions (0 of 23; odds ratio [OR], 62; 95% confidence interval [CI], 3–1154; p < 0.0001). The mean overall MSTS score was 77%. Implants with cemented fixation (29) had higher mean MSTS scores when compared with implants with noncemented (15) fixation (84% versus 66%, p = 0.0017). The complication rate was 33% in noncemented cases and 21% in cemented cases (p = 0.39); however, Type II failure at the bone-stem interface was associated with noncemented fixation and Type III failure at the clamp-rod interface was associated with cemented fixation (OR, 143; 95% CI, 2.413–8476; p = 0.0022). CONCLUSIONS The results of this study indicate that this modular intercalary endoprosthesis yields equivalent results to other studies of intercalary endoprostheses in terms of MSTS scores. We found that patients treated with intercalary endoprostheses in the femur experienced more frequent complications than those treated for lesions in either the humerus or tibia and that the femoral complication rate of this endoprosthesis is higher when compared with other studies of intercalary endoprostheses for femoral reconstruction. Further studies are still needed to determine the long-term outcomes of this endoprosthesis in patients with primary tumors where longevity of the implant is of more importance than in the metastatic setting. We recommend cemented fixation for this intercalary modular endoprostheses because this provides improved MSTS scores and allows immediate return to weightbearing, which is of advantage to metastatic patients with limited lifespans. Level of Evidence: Level III, therapeutic study.
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Piccioli A, Rossi B, Sacchetti FM, Spinelli MS, Di Martino A. Fractures in bone tumour prosthesis. Int Orthop 2015; 39:1981-7. [PMID: 26306584 DOI: 10.1007/s00264-015-2956-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 08/03/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of the present narrative review is to report the different aspects related to the fractures around tumour prosthetic implants in terms of technical and medical issues. METHODS A non systematic literature review on the topic was performed. RESULTS Given the increased rate of limb salvage procedures and megaprostheses implanted for bone tumours, the increased number of osteoporotic periprosthetic fractures, and the burden of revision arthroplasty, the number of surgeries using endoprosthetic implants is likely to increase in the near future. Surgeons will face more frequently the complications related to tumour endoprosthetic implant. Endoprosthetic reconstruction has a higher risk of intra-operative and post-operative complications compared to conventional prosthetic replacement. CONCLUSIONS Very rare reports and recommendations are available in literature regarding the treatment of periprosthetic fractures after megaprosthesis, and there is currently no consensus about which should be the standard management for periprosthetic fractures in this population of patients.
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Affiliation(s)
- Andrea Piccioli
- Centro Oncologico di Palazzo Baleani, Azienda Policlinico Umberto I, Roma, Italy.
| | - Barbara Rossi
- Presidio Ospedaliero Gubbio Gualdo Tadino, ASL Umbria 1, Roma, Italy
| | | | - Maria Silvia Spinelli
- Department of Orthopaedic and Traumatology, Catholic University Hospital, Rome, Italy
| | - Alberto Di Martino
- Department of Orthopaedics and Trauma Surgery, University Campus Bio-Medico of Rome, Rome, Italy
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Hilven PH, Bayliss L, Cosker T, Dijkstra PDS, Jutte PC, Lahoda LU, Schaap GR, Bramer JAM, van Drunen GK, Strackee SD, van Vooren J, Gibbons M, Giele H, van de Sande MAJ. The vascularised fibular graft for limb salvage after bone tumour surgery. Bone Joint J 2015; 97-B:853-61. [DOI: 10.1302/0301-620x.97b6.34692] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Vascularised fibular grafts (VFGs ) are a valuable surgical technique in limb salvage after resection of a tumour. The primary objective of this multicentre study was to assess the risk factors for failure and complications for using a VFG after resection of a tumour. The study involved 74 consecutive patients (45 men and 29 women with mean age of 23 years (1 to 64) from four tertiary centres for orthopaedic oncology who underwent reconstruction using a VFG after resection of a tumour between 1996 and 2011. There were 52 primary and 22 secondary reconstructions. The mean follow-up was 77 months (10 to 195). In all, 69 patients (93%) had successful limb salvage; all of these united and 65 (88%) showed hypertrophy of the graft. The mean time to union differed between those involving the upper (28 weeks; 12 to 96) and lower limbs (44 weeks; 12 to 250). Fracture occurred in 11 (15%), and nonunion in 14 (19%) patients. In 35 patients (47%) at least one complication arose, with a greater proportion in lower limb reconstructions, non-bridging osteosynthesis, and in children. These complications resulted in revision surgery in 26 patients (35%). VFG is a successful and durable technique for reconstruction of a defect in bone after resection of a tumour, but is accompanied by a significant risk of complications, that often require revision surgery. Union was not markedly influenced by the need for chemo- or radiotherapy, but should not be expected during chemotherapy. Therefore, restricted weight-bearing within this period is advocated. Cite this article: Bone Joint J 2015;97-B:853–61.
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Affiliation(s)
- P. H. Hilven
- Leiden University Medical Centre, Albinusdreef
2, 2300RC Leiden, The, Netherlands
| | - L. Bayliss
- Nuffield Orthopaedic Centre, Windmill
Road, Headington, Oxford
OX3 7HE, UK
| | - T. Cosker
- Academic Medical Centre, Postbus
22660 1100 DD Amsterdam, The, Netherlands
| | - P. D. S. Dijkstra
- Leiden University Medical Centre, Albinusdreef
2, 2300RC Leiden, The, Netherlands
| | - P. C. Jutte
- University Medical Center, Hanzeplein
1 Postbus 30.001 9700 RB Groningen, The, Netherlands
| | | | - G. R. Schaap
- Academic Medical Centre, Postbus
22660 1100 DD Amsterdam, The, Netherlands
| | - J. A. M. Bramer
- Academic Medical Centre, Postbus
22660 1100 DD Amsterdam, The, Netherlands
| | - G. K. van Drunen
- Leiden University Medical Centre, Albinusdreef
2, 2300RC Leiden, The, Netherlands
| | - S. D. Strackee
- Academic Medical Centre, Postbus
22660 1100 DD Amsterdam, The, Netherlands
| | - J. van Vooren
- Leiden University Medical Centre, Albinusdreef
2, 2300RC Leiden, The, Netherlands
| | - M. Gibbons
- Nuffield Orthopaedic Centre, Windmill
Road, Headington, Oxford
OX3 7HE, UK
| | - H. Giele
- Nuffield Orthopaedic Centre, Windmill
Road, Headington, Oxford
OX3 7HE, UK
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41
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Friedrich M, Schmolders J, Lob G, Randau T, Gravius S, Wirtz D, Pennekamp P. Interkalare Rekonstruktion diaphysärer Knochendefekte mit einem modularen Diapyhsenersatzsystem: Klinische Ergebnisse. Oper Orthop Traumatol 2015; 27:455-62. [DOI: 10.1007/s00064-014-0329-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 08/13/2014] [Accepted: 08/14/2014] [Indexed: 11/26/2022]
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Ogura K, Miyamoto S, Sakuraba M, Fujiwara T, Chuman H, Kawai A. Intercalary reconstruction after wide resection of malignant bone tumors of the lower extremity using a composite graft with a devitalized autograft and a vascularized fibula. Sarcoma 2015; 2015:861575. [PMID: 25784833 DOI: 10.1155/2015/861575] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 01/16/2015] [Accepted: 02/02/2015] [Indexed: 11/30/2022] Open
Abstract
Introduction. Although several intercalary reconstructions after resection of a lower extremity malignant bone tumor are reported, there are no optimal methods which can provide a long-term reconstruction with fewest complications. We present the outcome of reconstruction using a devitalized autograft and a vascularized fibula graft composite. Materials and Methods. We conducted a retrospective review of 11 patients (7 males, 4 females; median age 27 years) undergoing reconstruction using a devitalized autograft (pasteurization (n = 6), deep freezing (n = 5)) and a vascularized fibula graft composite for lower extremity malignant bone tumors (femur (n = 10), tibia (n = 1)). Results. The mean period required for callus formation and bone union was 4.4 months and 9.9 months, respectively. Four postoperative complications occurred in 3 patients: 2 infections (1 pasteurized autograft, 1 frozen autograft) and 1 fracture and 1 implant failure (both in pasteurized autografts). Graft removal was required in 2 patients with infections. The mean MSTS score was 81% at last follow-up. Conclusions. Although some complications were noted in early cases involving a pasteurized autograft, our novel method involving a combination of a frozen autograft with a vascularized fibula graft and rigid fixation with a locking plate may offer better outcomes than previously reported allografts or devitalized autografts.
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43
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Schuh R, Panotopoulos J, Puchner SE, Willegger M, Hobusch GM, Windhager R, Funovics PT. Vascularised or non-vascularised autologous fibular grafting for the reconstruction of a diaphyseal bone defect after resection of a musculoskeletal tumour. Bone Joint J 2014; 96-B:1258-63. [PMID: 25183600 DOI: 10.1302/0301-620x.96b9.33230] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Resection of a primary sarcoma of the diaphysis of a long bone creates a large defect. The biological options for reconstruction include the use of a vascularised and non-vascularised fibular autograft. The purpose of the present study was to compare these methods of reconstruction. Between 1985 and 2007, 53 patients (26 male and 27 female) underwent biological reconstruction of a diaphyseal defect after resection of a primary sarcoma. Their mean age was 20.7 years (3.6 to 62.4). Of these, 26 (49 %) had a vascularised and 27 (51 %) a non-vascularised fibular autograft. Either method could have been used for any patient in the study. The mean follow-up was 52 months (12 to 259). Oncological, surgical and functional outcome were evaluated. Kaplan-Meier analysis was performed for graft survival with major complication as the end point. At final follow-up, eight patients had died of disease. Primary union was achieved in 40 patients (75%); 22 (42%) with a vascularised fibular autograft and 18 (34%) a non-vascularised (p = 0.167). A total of 32 patients (60%) required revision surgery. Kaplan-Meier analysis revealed a mean survival without complication of 36 months (0.06 to 107.3, sd 9) for the vascularised group and 88 months (0.33 to 163.9, sd 16) for the non-vascularised group (p = 0.035). Both groups seem to be reliable biological methods of reconstructing a diaphyseal bone defect. Vascularised autografts require more revisions mainly due to problems with wound healing in distal sites of tumour, such as the foot.
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Affiliation(s)
- R Schuh
- Medical University of Vienna, Department of Orthopaedics, Waehringer Guertel 18 to 20, Vienna, 1090, Austria
| | - J Panotopoulos
- Medical University of Vienna, Department of Orthopaedics, Waehringer Guertel 18 to 20, Vienna, 1090, Austria
| | - S E Puchner
- Medical University of Vienna, Department of Orthopaedics, Waehringer Guertel 18 to 20, Vienna, 1090, Austria
| | - M Willegger
- Medical University of Vienna, Department of Orthopaedics, Waehringer Guertel 18 to 20, Vienna, 1090, Austria
| | - G M Hobusch
- Medical University of Vienna, Department of Orthopaedics, Waehringer Guertel 18 to 20, Vienna, 1090, Austria
| | - R Windhager
- Medical University of Vienna, Department of Orthopaedics, Waehringer Guertel 18 to 20, Vienna, 1090, Austria
| | - P T Funovics
- Medical University of Vienna, Department of Orthopaedics, Waehringer Guertel 18 to 20, Vienna, 1090, Austria
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Streitbürger A, Gosheger G, Dieckmann R, Nottrott M, Ahrens H, Hardes J. Rekonstruktion knöcherner Defekte in der Knochensarkomchirurgie: Tumorendoprothese vs. biologische Rekonstruktion. Unfallchirurg 2014; 117:600-6. [DOI: 10.1007/s00113-013-2476-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hardes J, Henrichs MP, Gosheger G, Gebert C, Höll S, Dieckmann R, Hauschild G, Streitbürger A. Endoprosthetic replacement after extra-articular resection of bone and soft-tissue tumours around the knee. Bone Joint J 2013; 95-B:1425-31. [PMID: 24078544 DOI: 10.1302/0301-620x.95b10.31740] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
We evaluated the clinical results and complications after extra-articular resection of the distal femur and/or proximal tibia and reconstruction with a tumour endoprosthesis (MUTARS) in 59 patients (mean age 33 years (11 to 74)) with malignant bone or soft-tissue tumours. According to a Kaplan-Meier analysis, limb survival was 76% (95% confidence interval (CI) 64.1 to 88.5) after a mean follow-up of 4.7 years (one month to 17 years). Peri-prosthetic infection was the most common indication for subsequent amputation (eight patients). Survival of the prosthesis without revision was 48% (95% CI 34.8 to 62.0) at two years and 25% (95% CI 11.1 to 39.9) at five years post-operatively. Failure of the prosthesis was due to deep infection in 22 patients (37%), aseptic loosening in ten patients (17%), and peri-prosthetic fracture in six patients (10%). Wear of the bearings made a minor revision necessary in 12 patients (20%). The mean Musculoskeletal Tumor Society score was 23 (10 to 29). An extensor lag > 10° was noted in ten patients (17%). These results suggest that limb salvage after extra-articular resection with a tumour prosthesis can achieve good functional results in most patients, although the rates of complications and subsequent amputation are higher than in patients treated with intra-articular resection.
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Affiliation(s)
- J Hardes
- University Clinic of Muenster, Department of Orthopaedics and Tumour Orthopaedics, Albert-Schweitzer-Str. 33, Muenster, Germany
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Racano A, Pazionis T, Farrokhyar F, Deheshi B, Ghert M. High infection rate outcomes in long-bone tumor surgery with endoprosthetic reconstruction in adults: a systematic review. Clin Orthop Relat Res 2013; 471:2017-27. [PMID: 23404421 PMCID: PMC3706642 DOI: 10.1007/s11999-013-2842-9] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 01/31/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Limb salvage surgery (LSS) with endoprosthetic replacement is the most common method of reconstruction following bone tumor resection in the adult population. The risk of a postoperative infection developing is high when compared with conventional arthroplasty and there are no appropriate guidelines for antibiotic prophylaxis. QUESTIONS/PURPOSES We sought to answer the following questions: (1) What is the overall risk of deep infection and the causative organism in lower-extremity long-bone tumor surgery with endoprosthetic reconstruction? (2) What antibiotic regimens are used with endoprosthetic reconstruction? (3) Is there a correlation between infection and either duration of postoperative antibiotics or sample size? METHODS We conducted a systematic review of the literature for clinical studies that reported infection rates in adults with primary bony malignancies of the lower extremity treated with surgery and endoprosthetic reconstruction. The search included articles published in English between 1980 and July 2011. RESULTS The systematic literature review yielded 48 studies reporting on a total of 4838 patients. The overall pooled weighted infection rate for lower-extremity LSS with endoprosthetic reconstruction was approximately 10% (95% CI, 8%-11%), with the most common causative organism reported to be Gram-positive bacteria in the majority of cases. The pooled weighted infection rate was 13% after short-term postoperative antibiotics and 8% after long-term postoperative antibiotics. There was no correlation between sample size and infection rate. CONCLUSIONS Infection rates of 10% are high when compared with rates for conventional arthroplasty. Our results suggest that long-term antibiotic prophylaxis decreases the risk of deep infection. However, the data should be interpreted with caution owing to the retrospective nature of the studies.
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Affiliation(s)
- Antonella Racano
- />Department of Surgery, McMaster University, Juravinski Hospital and Cancer Centre, 711 Concession Street, Hamilton, ON L8V 1C3 Canada
| | - Theresa Pazionis
- />Department of Surgery, McMaster University, Juravinski Hospital and Cancer Centre, 711 Concession Street, Hamilton, ON L8V 1C3 Canada
| | - Forough Farrokhyar
- />Department of Surgery, McMaster University, Juravinski Hospital and Cancer Centre, 711 Concession Street, Hamilton, ON L8V 1C3 Canada
- />Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON Canada
| | - Benjamin Deheshi
- />Department of Surgery, McMaster University, Juravinski Hospital and Cancer Centre, 711 Concession Street, Hamilton, ON L8V 1C3 Canada
| | - Michelle Ghert
- />Department of Surgery, McMaster University, Juravinski Hospital and Cancer Centre, 711 Concession Street, Hamilton, ON L8V 1C3 Canada
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47
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Mottard S, Grimer RJ, Abudu A, Carter SR, Tillman RM, Jeys L, Spooner D. Biological reconstruction after excision, irradiation and reimplantation of diaphyseal tibial tumours using an ipsilateral vascularised fibular graft. ACTA ACUST UNITED AC 2012; 94:1282-7. [DOI: 10.1302/0301-620x.94b9.29164] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The purpose of this study was to assess the outcome of 15 patients (mean age 13.6 years (7 to 25)) with a primary sarcoma of the tibial diaphysis who had undergone excision of the affected segment that was then irradiated (90 Gy) and reimplanted with an ipsilateral vascularised fibular graft within it. The mean follow-up was 57 months (22 to 99). The mean time to full weight-bearing was 23 weeks (9 to 57) and to complete radiological union 42.1 weeks (33 to 55). Of the 15 patients, seven required a further operation, four to obtain skin cover. The mean Musculoskeletal Society Tumor Society functional score at final follow-up was 27 out of 30 once union was complete. The functional results were comparable with those of allograft reconstruction and had a similar rate of complication. We believe this to be a satisfactory method of biological reconstruction of the tibial diaphysis in selected patients.
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Affiliation(s)
- S. Mottard
- Maisonneuve-Rosemont Hospital, Montreal
H1T 4B3, Canada
| | - R. J. Grimer
- Royal Orthopaedic Hospital NHS Foundation
Trust, Bristol Road South, Northfield, Birmingham
B31 2AP, UK
| | - A. Abudu
- Royal Orthopaedic Hospital NHS Foundation
Trust, Bristol Road South, Northfield, Birmingham
B31 2AP, UK
| | - S. R. Carter
- Royal Orthopaedic Hospital NHS Foundation
Trust, Bristol Road South, Northfield, Birmingham
B31 2AP, UK
| | - R. M. Tillman
- Royal Orthopaedic Hospital NHS Foundation
Trust, Bristol Road South, Northfield, Birmingham
B31 2AP, UK
| | - L. Jeys
- Royal Orthopaedic Hospital NHS Foundation
Trust, Bristol Road South, Northfield, Birmingham
B31 2AP, UK
| | - D. Spooner
- University Hospital Birmingham, Queen
Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham
B15 2WB, UK
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48
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Puri A, Gulia A, Jambhekar N, Laskar S. The outcome of the treatment of diaphyseal primary bone sarcoma by resection, irradiation and re-implantation of the host bone. ACTA ACUST UNITED AC 2012; 94:982-8. [DOI: 10.1302/0301-620x.94b7.28916] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We analysed the outcome of patients with primary non-metastatic diaphyseal sarcomas who had en bloc resection with preservation of the adjoining joints and reconstruction with re-implantation of sterilised tumour bone after extracorporeal radiation (50 Gy). Between March 2005 and September 2009, 32 patients (16 Ewing’s sarcoma and 16 osteogenic sarcoma) with a mean age of 15 years (2 to 35) underwent this procedure. The femur was the most common site in 17 patients, followed by the tibia in 11, humerus in three and ulna in one. The mean resected length of bone was 19 cm (10 to 26). A total of 31 patients were available at a mean follow-up of 34 months (12 to 74). The mean time to union for all osteotomy sites was 7.3 months (3 to 28): metaphyseal osteotomy sites united quicker than diaphyseal osteotomy sites (5.8 months (3 to 10) versus 9.5 months (4 to 28)). There were three local recurrences, all in soft-tissue away from irradiated graft. At the time of final follow-up, 19 patients were free of disease, one was alive with disease and 11 had died of disease. The mean Musculoskeletal Tumor Society Score for 29 patients evaluated at the last follow-up was 26 (9 to 30). Extracorporeal irradiation is an oncologically safe and inexpensive technique for limb salvage in diaphyseal sarcomas and has good functional results.
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Affiliation(s)
- A. Puri
- Tata Memorial Hospital, E
Borges Road, Parel, Mumbai
400 012, India
| | - A. Gulia
- Tata Memorial Hospital, E
Borges Road, Parel, Mumbai
400 012, India
| | - N. Jambhekar
- Tata Memorial Hospital, E
Borges Road, Parel, Mumbai
400 012, India
| | - S. Laskar
- Tata Memorial Hospital, E
Borges Road, Parel, Mumbai
400 012, India
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49
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Frisoni T, Cevolani L, Giorgini A, Dozza B, Donati DM. Factors affecting outcome of massive intercalary bone allografts in the treatment of tumours of the femur. ACTA ACUST UNITED AC 2012; 94:836-41. [DOI: 10.1302/0301-620x.94b6.28680] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We retrospectively reviewed 101 consecutive patients with 114 femoral tumours treated by massive bone allograft at our institution between 1986 and 2005. There were 49 females and 52 males with a mean age of 20 years (4 to 74). At a median follow-up of 9.3 years (2 to 19.8), 36 reconstructions (31.5%) had failed. The allograft itself failed in 27 reconstructions (24%). Mechanical complications such as delayed union, fracture and failure of fixation were studied. The most adverse factor on the outcome was the use of intramedullary nails, followed by post-operative chemotherapy, resection length > 17 cm and age > 18 years at the time of intervention. The simultaneous use of a vascularised fibular graft to protect the allograft from mechanical complications improved the outcome, but the use of intramedullary cementing was not as successful. In order to improve the strength of the reconstruction and to advance the biology of host–graft integration, we suggest avoiding the use of intramedullary nails and titanium plates, but instead using stainless steel plates, as these gave better results. The use of a supplementary vascularised fibular graft should be strongly considered in adult patients with resection > 17 cm and in those who require post-operative chemotherapy.
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Affiliation(s)
- T. Frisoni
- Istituto Ortopedico Rizzoli, via
Pupilli 1, Bologna 40136, Italy
| | - L. Cevolani
- Istituto Ortopedico Rizzoli, via
Pupilli 1, Bologna 40136, Italy
| | - A. Giorgini
- Istituto Ortopedico Rizzoli, via
Pupilli 1, Bologna 40136, Italy
| | - B. Dozza
- Istituto Ortopedico Rizzoli, Laboratorio
di Patologia Ortopedica e Rigenerazione Tissutale Ossea, via
Pupilli 1, Bologna 40136, Italy
| | - D. M. Donati
- Istituto Ortopedico Rizzoli, via
Pupilli 1, Bologna 40136, Italy
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50
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Abstract
Reconstruction after intercalary resection of the tibia is demanding due to subcutaneous location, poor vascularity of the tibia, and high infection rate. The purpose of this study was to evaluate the survivorship, complications, and functional outcome of intercalary tibial allograft reconstructions following tumor resections. Intercalary tibia segmental allografts were implanted in 26 consecutive patients after segmental resections. Patients were followed for an average of 6 years. Allograft survival was determined with the Kaplan-Meier method. Patient function was evaluated with the Musculoskeletal Tumor Society (MSTS) scoring system. Survivorship was 84% (95% confidence interval [CI], 98%-70%) at 5 years and 79% (95% CI, 63%-95%) at 10 years. Allografts were removed in 5 patients due to 3 infections and 2 local recurrences. Two patients showed diaphyseal nonunion, and 3 patients underwent an incomplete fracture; no allografts were removed in these patients. Average MSTS functional score was 29 points (range, 27-30 points). Despite the incidence of complications, this analysis showed an acceptable survivor-ship with excellent functional scores. The use of intercalary allograft has a place in the reconstruction of a segmental defect created by the resection of a tumor in the diaphyseal or metaphyseal portion of the tibia.
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Affiliation(s)
- Germán L Farfalli
- Carlos E. Ottolenghi Institute of Orthopedics, Italian Hospital of Buenos Aires, Potosí 4247 (1199), Buenos Aires, Argentina. german.
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