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Limam K, Lucena T, Courtot L, Marot V, Cavaignac E. Distal femoral megaprosthesis fracture treated by RescueSleeve MEGASYSTEM-C. Orthop Traumatol Surg Res 2024; 110:103822. [PMID: 38266671 DOI: 10.1016/j.otsr.2024.103822] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 12/04/2023] [Accepted: 12/19/2023] [Indexed: 01/26/2024]
Abstract
Escalating revision surgery after megaprosthesis knee replacement sometimes raises the question of "limb salvage". Here we present a salvage technique for megaprosthesis fracture at the junction between the stem and the metaphyseal component. In this young active patient, the short residual proximal femur was not loose and was difficult to extract without prosthetic escalation. The technique described here conserved the well-fixed primary stem and used a custom-made RescueSleeve MEGASYSTEM-C connection sleeve (Link, Hamburg, Germany) plus spacer and a standard epiphyseal implant. This semi-conservative procedure avoided femorotomy or larger morbid segmental femoral resection. It conserved maximal bone stock and achieved rapid functional recovery. To our knowledge, this is the first reported case of this technique using a custom-made connecting part to manage megaprosthesis fracture. LEVEL OF EVIDENCE: IV.
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Affiliation(s)
- Kenza Limam
- Clinique universitaire du sport, CHU Purpan, hôpital Pierre-Paul-Riquet, place du Dr Baylac, 31059 Toulouse, France
| | - Thibaut Lucena
- Clinique universitaire du sport, CHU Purpan, hôpital Pierre-Paul-Riquet, place du Dr Baylac, 31059 Toulouse, France
| | - Louis Courtot
- Clinique universitaire du sport, CHU Purpan, hôpital Pierre-Paul-Riquet, place du Dr Baylac, 31059 Toulouse, France
| | - Vincent Marot
- Hospital Nostra Senyora de Meritxell, 17, Baixos, AD700 Escaldes-Engordany, Andorra
| | - Etienne Cavaignac
- Clinique universitaire du sport, CHU Purpan, hôpital Pierre-Paul-Riquet, place du Dr Baylac, 31059 Toulouse, France.
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Hovav O, Kolonko S, Zahir SF, Velli G, Chouhan P, Wagels M. Limb salvage surgery reconstructive techniques following long-bone lower limb oncological resection: a systematic review and meta-analysis. ANZ J Surg 2023; 93:2609-2620. [PMID: 36821561 DOI: 10.1111/ans.18335] [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: 12/18/2022] [Revised: 01/31/2023] [Accepted: 02/05/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Limb salvage surgery (LSS) is now considered the gold standard surgical treatment for lower limb bone sarcomas. However, there is a paucity of literature comparing the various LSS reconstructive options. The aim of this systematic review and meta-analysis was to compare functional outcomes and complications of LSS reconstructive techniques. METHODS The primary aim of the meta-analysis was to determine functional outcomes from the pooled data utilizing the Musculoskeletal Tumour Society score (MSTS). Comparisons could then made for this outcome between biological and prosthetic, vascularised and non-vascularised, and prosthetic and composite reconstructions. The secondary aim was to compare complication outcomes of each reconstruction. Standardized mean difference (Cohen's d) and odds ratios were estimated using a random effects model. RESULTS Fourteen studies with a total of 785 patients were included. We found structural failure was 75% less likely to occur in prosthetic reconstruction compared to biological (OR = 0.24; 95% CI: 0.07-0.79; P = 0.02). We did not find any evidence of difference in function (MSTS score) between vascularised verses non-vascularised reconstructions (Cohen's d = -1.14; 95% CI = -3.06 to 0.78; I2 = 87%). Other analyses comparing complications found no difference between the reconstructive groups. CONCLUSION The study found no correlation between functional outcomes and the type of LSS reconstruction. Structural failure was more likely to occur in biological when compared with prosthetic reconstruction. There was no correlation between the incidence of other complications and the type of LSS technique. This suggests a role for improved approaches to reconstruction methods including bioprinting and bioresorbable devices.
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Affiliation(s)
- Oliver Hovav
- Department of Plastic and Reconstructive Surgery, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- The Australian Centre for Complex Integrated Surgical Solutions, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- QCIF Facility for Advanced Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
| | - Sarah Kolonko
- Department of Plastic and Reconstructive Surgery, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Syeda Farah Zahir
- Princess Alexandra Hospital Library and Knowledge Centre, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Gina Velli
- Department Plastic and Reconstructive Surgery, Sunshine Coast, Sunshine Coast University Hospital, Queensland, Australia
| | - Prem Chouhan
- School of Medicine, Griffith University, Southport, Queensland, Australia
- Department of Plastic Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Michael Wagels
- Department of Plastic and Reconstructive Surgery, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- The Australian Centre for Complex Integrated Surgical Solutions, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- QCIF Facility for Advanced Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
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Li Z, Lu M, Zhang Y, Gong T, Min L, Zhou Y, Luo Y, Tu C. 3D-printed custom-made short stem with porous structure for fixation of massive endoprosthesis in joint-preserving reconstruction after tumor resection. J Orthop Surg Res 2023; 18:468. [PMID: 37386639 DOI: 10.1186/s13018-023-03954-8] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/23/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Large malignant bone tumors and revision limb salvage procedures often result in massive bone loss, leaving a short residual bone segment that cannot accommodate a standard stem for endoprosthesis fixation. Three-dimensional-printed (3DP) short stem with porous structure seems to be an alternative for short-segment fixation. This retrospective study aims to evaluate surgical outcomes, radiographical results, limb functions, and complications of using 3DP porous short stems in massive endoprosthesis replacement. METHODS Between July 2018 to February 2021, 12 patients with massive bone loss undergoing reconstruction with custom-made, short-stemmed massive endoprostheses were identified. Endoprosthesis replacement involved the proximal femur (n = 4), distal femur (n = 1), proximal humerus (n = 4), distal humerus (n = 1), and proximal radius (n = 2). RESULTS The mean percentage of resected bone was 72.4% of the whole length of the bone, ranging from 58.4 to 88.5%. The mean length of 3DP porous short stems was 6.3 cm. The median follow-up was 38 months (range, 22-58 months). The mean MSTS score was 89%, ranging from 77% to 93%. Radiographical assessment results showed bone in-growth to the porous structure in 11 patients, and the implants were well osseointegrated. Breakage of the 3DP porous short stem occurred in one patient intraoperatively. The patient developed aseptic loosening (Type 2) four-month after surgery and underwent revision with a plate applied to assist fixation. The implant survivorship was 91.7% at 2 years. No other complications were detected, such as soft-tissue failures, structural failures, infection, or tumor progression. CONCLUSIONS 3DP custom-made short stem with porous structure is a viable method for fixation of the massive endoprosthesis in the short segment after tumor resection, with satisfactory limb function, great endoprosthetic stability, and low complication rates.
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Affiliation(s)
- Zhuangzhuang Li
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Minxun Lu
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yuqi Zhang
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Taojun Gong
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Li Min
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yong Zhou
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yi Luo
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China.
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
| | - Chongqi Tu
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China.
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
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Li Z, Yu X, Xu M, Zheng K, Hou Z, Miao Z, Sun Y. Aseptic loosening of tumor prostheses in distal femur after revision surgery: a retrospective study. World J Surg Oncol 2023; 21:164. [PMID: 37254167 DOI: 10.1186/s12957-023-03047-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/26/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Tumor prostheses of the distal femur after revision surgery is associated with high rates of aseptic loosening, which has introduced great challenges to the survival of patients, but only a few studies have evaluated their X-ray imaging. The purpose of this study was to analyze the risk factors for recurrence of aseptic loosening and make recommendations to reduce the incidence of aseptic loosening after revision surgery of tumor prostheses in the distal femur. METHOD A retrospective analysis was performed on 23 patients who had revision surgery for distal femur prostheses due to aseptic loosening between June 2002 and June 2021. They were divided into two groups based on the condition of the prostheses after revision surgery: loosening group (9 patients) and control group (14 patients). Following the initial replacement, the length and diameter of the prosthetic intramedullary stem were measured through the standard full-length anteroposterior X-ray imaging of both lower limbs. The osteotomy length, femoral length and diameter, femoral intramedullary stem diameter, hip-knee-ankle angle (HKAA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and so on were measured as well. Following that, statistical analysis was performed. RESULTS Patients in the loosening group had statistically significant differences in the ratio of prostheses length to femur length (71.89 ± 6.62) and the ratio of intramedullary stem diameter to femoral diameter (25.50 ± 6.90) (P < 0.05), when compared to the control group. The HKAA (175.58 ± 2.78), mLDFA (94.42 ± 2.57), and the deviation angle between the lower limb alignment and the tibial prostheses force line (2.23 ± 1.09) in the loosening group were significantly different from those in the control group (P < 0.05) on postoperative radiographs of the entire length of the lower limbs. The lowest score in intramedullary manubrium I indicated less osteolysis, while the highest score in intramedullary manubrium III indicated the most serious osteolysis, and the difference was statistically significant (P < 0.05). CONCLUSIONS Our study suggests that the use of longer and thicker intramedullary stems can effectively decrease the occurrence of aseptic loosening. Additionally, it is important to avoid using the original prostheses and reconstruct the standard line of lower limb force to further reduce the incidence of aseptic loosening. It is crucial to closely monitor the distal segment of the intramedullary stem for osteolysis after surgery.
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Affiliation(s)
- Ziming Li
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
| | - Xiuchun Yu
- Department of Orthopaedics, The 960Th Hospital of the PLA, Jinan, China.
| | - Ming Xu
- Department of Orthopaedics, The 960Th Hospital of the PLA, Jinan, China
| | - Kai Zheng
- Department of Orthopaedics, The 960Th Hospital of the PLA, Jinan, China
| | - Ziwei Hou
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
| | - Zukang Miao
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
| | - Yanshun Sun
- School of Public Health, Weifang Medical College, Weifang, Shandong Province, China
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Krajbich JI. CORR Insights®: What Are Risk Factors for and Outcomes of Late Amputation After Treatment for Lower Extremity Sarcoma: A Childhood Cancer Survivor Study Report. Clin Orthop Relat Res 2023; 481:539-541. [PMID: 35969511 PMCID: PMC9928681 DOI: 10.1097/corr.0000000000002316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/20/2022] [Indexed: 01/31/2023]
Affiliation(s)
- J Ivan Krajbich
- Staff Orthopaedic Surgeon, Shriners Hospital for Children, Portland, OR, USA
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Tsukamoto S, Mavrogenis AF, Masunaga T, Kido A, Honoki K, Tanaka Y, Fujii H, Tanaka Y, Errani C. Megaprosthetic reconstruction of the distal femur with a short residual proximal femur following bone tumor resection: a systematic review. J Orthop Surg Res 2023; 18:68. [PMID: 36707881 PMCID: PMC9881341 DOI: 10.1186/s13018-023-03553-7] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 01/19/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND To investigate the risk of postoperative function and complications associated with reconstruction methods in patients with short residual proximal femurs (< 12 cm) after resection of distal femoral bone tumors, we performed a systematic review of studies reporting postoperative function and complications in these patients. METHODS Of the 236 studies identified by systematic searches using the Medline, Embase, and Cochrane Central Register of Controlled Trials databases, eight were included (none were randomized controlled trials). In these studies, 106 (68.4%), 12 (7.7%), and 37 (23.9%) patients underwent reconstruction with custom-made megaprostheses with extracortical plates or cross-pins, allograft prosthetic composite (APC), and Compress® compliant pre-stress (CPS) implants, respectively. RESULTS Aseptic loosening occurred slightly more frequently in the APC group than in the other reconstruction methods (APC group, 21%; custom-made megaprosthesis group, 0-17%; CPS implant group, 14%). No differences were noted in the frequencies of implant breakage, fractures, or infections between the three reconstruction methods. Mechanical survival, where endpoint was set as implant removal for any reason, was 80% at seven years in the APC group, 70-77% at 10 years in the custom-made megaprosthesis group, and 68% at nine years in the CPS implant group. Therefore, there appeared to be no difference among the three reconstruction methods with respect to mechanical survival. CONCLUSIONS During megaprosthetic reconstruction of the distal femur with a short residual proximal femur after bone tumor resection, similar results were obtained using custom-made megaprostheses, APCs, and CPS implants.
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Affiliation(s)
- Shinji Tsukamoto
- grid.410814.80000 0004 0372 782XDepartment of Orthopaedic Surgery, Nara Medical University, 840, Shijo-Cho, Kashihara-City, Nara 634-8521 Japan
| | - Andreas F. Mavrogenis
- grid.5216.00000 0001 2155 0800First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 41 Ventouri Street, 15562 Holargos, Athens, Greece
| | - Tomoya Masunaga
- grid.410814.80000 0004 0372 782XDepartment of Orthopaedic Surgery, Nara Medical University, 840, Shijo-Cho, Kashihara-City, Nara 634-8521 Japan
| | - Akira Kido
- grid.410814.80000 0004 0372 782XDepartment of Rehabilitation Medicine, Nara Medical University, 840, Shijo-Cho, Kashihara-City, Nara 634-8521 Japan
| | - Kanya Honoki
- grid.410814.80000 0004 0372 782XDepartment of Orthopaedic Surgery, Nara Medical University, 840, Shijo-Cho, Kashihara-City, Nara 634-8521 Japan
| | - Yuu Tanaka
- Department of Rehabilitation Medicine, Wakayama Professional University of Rehabilitation, 3-1, Minamoto-Cho, Wakayama-City, Wakayama 640-8222 Japan
| | - Hiromasa Fujii
- grid.410814.80000 0004 0372 782XDepartment of Orthopaedic Surgery, Nara Medical University, 840, Shijo-Cho, Kashihara-City, Nara 634-8521 Japan
| | - Yasuhito Tanaka
- grid.410814.80000 0004 0372 782XDepartment of Orthopaedic Surgery, Nara Medical University, 840, Shijo-Cho, Kashihara-City, Nara 634-8521 Japan
| | - Costantino Errani
- grid.419038.70000 0001 2154 6641Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
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Gazendam A, Ghert M. What’s New in Musculoskeletal Tumor Surgery. J Bone Joint Surg Am 2022; 104:2131-2144. [PMID: 37010478 DOI: 10.2106/jbjs.22.00811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | - Michelle Ghert
- McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
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Hou ZW, Xu M, Zheng K, Yu XC. Classification and reconstruction of femoral bone defect in the revision of aseptic loosening of distal femoral endoprostheses: a 10-year multicenter retrospective analysis. BMC Musculoskelet Disord 2022; 23:935. [PMID: 36303200 PMCID: PMC9608886 DOI: 10.1186/s12891-022-05885-7] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 10/14/2022] [Indexed: 12/02/2022] Open
Abstract
Objective This study proposes a system for classifying the aseptic loosening of distal femoral endoprostheses and discusses reconstruction methods for revision surgery, based on different classification types. Methods We retrospectively analyzed the data of patients who received revision surgery for aseptic loosening in distal femoral tumor endoprosthesis from January 2008 to December 2020 at 3 bone tumor treatment centers in China. Based on the patient imaging data, we proposed a classification system for the aseptic loosening of distal femoral endoprostheses and discussed its revision surgery strategy for various bone defects. Results A total of 31 patients were included in this study, including 21 males and 10 females aged 15–75 y (average: 44.3 y). First-revision surgery was performed on 24 patients, whereas second-revision surgery was conducted on 7 patients. The 31 patients were classified into different types based on the degree of aseptic loosening: Type I, 12 patients (38.7%); Type IIa, 7 patients (22.5%); Type IIb, 7 patients (22.5%); Type III, 4 patient (12.9%); and Type IV, 1 patient (3.2%). For type I, 11 patients underwent revisions with standard longer-stem prostheses (one with the original prosthesis), and one patient had the original prosthesis plus cortical allograft strut. For type II (a and b), 10 patients underwent revisions with original prosthesis or longer-stem prosthesis and 4 patients combined with cortical allograft strut. For type III, one patient underwent revision with a longer-stem prosthesis and the other 3 patients with a custom short-stem prosthesis. For type IV, only one patient underwent revision with a custom short-stem prosthesis. Conclusions Aseptic loosening of the distal femoral prosthesis can be divided into 4 types: type I, type II (a, b), type III and type IV. The reconstruction methods of our centers for different types of bone defects can offer some reference value in the revision of aseptic loosening.
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Affiliation(s)
- Zi-Wei Hou
- grid.464402.00000 0000 9459 9325First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Ming Xu
- Department of Orthopedics, The 960Th Hospital of the People’s Liberation Army, Jinan, China
| | - Kai Zheng
- Department of Orthopedics, The 960Th Hospital of the People’s Liberation Army, Jinan, China
| | - Xiu-Chun Yu
- Department of Orthopedics, The 960Th Hospital of the People’s Liberation Army, Jinan, China
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You Q, Lu M, Min L, Zhang Y, Luo Y, Zhou Y, Tu C. Hip-preserving reconstruction using a customized cemented femoral endoprosthesis with a curved stem in patients with short proximal femur segments: Mid-term follow-up outcomes. Front Surg 2022; 9:991168. [DOI: 10.3389/fsurg.2022.991168] [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: 07/11/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundShort metaphyseal segments that remain following extensive distal femoral tumor resection can be challenging to manage, as the residual short segments may not be sufficient to accept an intramedullary cemented stem of standard length. The present study was developed to detail preliminary findings and experiences associated with an intra-neck curved stem (INCS) reconstructive approach, with a particular focus on mechanical stability.MethodFrom March 2013 to August 2016, 11 total patients underwent reconstructive procedures using a customized cemented femoral endoprosthesis (CCFE) with an INCS. Measurements of femoral neck-shaft angle values were made before and after this procedure. Radiological outcomes associated with this treatment strategy over an average 63-month follow-up period were additionally assessed. Functionality was assessed based upon Musculoskeletal Tumor Society (MSTS) scores, while a visual analog scale (VAS) was used to rate pre- and postoperative pain, and any complications were noted.ResultsRelative to the preoperative design, no significant differences in femoral neck–shaft angle were observed after this reconstructive procedure (p = 0.410). Postoperatively, the tip of the stem was primarily positioned within the middle third of the femoral head in both lateral and posterior-anterior radiographic, supporting the accuracy of INCS positioning. The average MSTS score for these patients was 25 (range: 21–28), and VAS scores were significantly reduced after surgery (p < 0.0001). One patient exhibited local disease recurrence and ultimately succumbed to lung metastases, while two patients exhibited aseptic loosening. None of the treated patients exhibited complications such as infections, periprosthetic fractures, or prosthetic fractures as of most recent follow-up.ConclusionCCFE with an INCS represents a viable approach to massive femoral diaphyseal defect with short proximal femur repair, as patients can achieve good functional outcomes and early weight-bearing with proper individualized rehabilitative interventions, all while exhibiting low rates of procedure-related complications.
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You Q, Lu M, Min L, Luo Y, Zhang Y, Wang Y, Zheng C, Zhou Y, Tu C. A comparison of cemented and cementless intra-neck curved stem use during hip-preserving reconstruction following massive femoral malignant tumor removal. Front Oncol 2022; 12:933057. [PMID: 36132148 PMCID: PMC9483172 DOI: 10.3389/fonc.2022.933057] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPatients who undergo massive femoral malignant tumor (MFMT) resection often exhibit shortened femoral metaphyseal juxta-articular segments. The use of a customized femoral endoprosthesis (CFE) with an intra-neck curved stem (INCS) has emerged as a viable reconstructive surgical strategy for these individuals. Relative to a cemented INCS, it remains unclear as to whether cementless INCS use is associated with improvements in functionality or reconstructive longevity. As such, the present study was conducted to compare functional outcomes, endoprosthetic survival, and endoprosthesis-related complication rates in patients undergoing cemented and cementless INCS implantation.MethodsA total of 24 patients undergoing lower limb salvage and reconstructive surgical procedures utilizing cemented or cementless INCS endoprostheses were retrospectively included. Patient-functional outcomes, endoprosthetic survival, and complication rates were compared as a function of age; diagnosis; the length of femoral resection; residual proximal femur length; Musculoskeletal Tumor Society (MSTS) scores; visual analog scale (VAS) scores; and the rates of implant breakage, periprosthetic infections, periprosthetic fractures, and aseptic loosening.ResultsThe mean follow-up was 56 months. Significant differences in the length of femoral resection (p<0.001) and residual proximal femur length were observed (p<0.001) between the cemented and cementless INCS groups. There were no differences in overall patient survival and aseptic loosening-associated endoprosthesis survival in the cemented and cementless groups. None of the included patients experienced periprosthetic fractures, infections, or implant breakage. Average respective MSTS and VAS scores did not differ between groups.ConclusionFor patients undergoing treatment for MFMTs, the use of a CFE with an INCS has emerged as a viable approach to hip-preserving reconstructive surgery. With appropriately designed individualized rehabilitative programs, good functional outcomes can be achieved for these endoprostheses, which are associated with low complication rates. Moreover, the selection between cemented or cementless INCS in the clinic should be made based on patient-specific factors, with cementless INCS implementation being preferable in younger patients with good-quality bone, the potential for long-term survival, and the osteotomy site near the lesser trochanter, whereas cemented INCS use should be favored for individuals who are older, have a shorter life expectancy, or have poor bone quality.
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Affiliation(s)
- Qi You
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Model worker and Craftsman Talent Innovation Research Studio, Chengdu, China
| | - Minxun Lu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Model worker and Craftsman Talent Innovation Research Studio, Chengdu, China
| | - Li Min
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Model worker and Craftsman Talent Innovation Research Studio, Chengdu, China
| | - Yi Luo
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Model worker and Craftsman Talent Innovation Research Studio, Chengdu, China
| | - Yuqi Zhang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Model worker and Craftsman Talent Innovation Research Studio, Chengdu, China
| | - Yitian Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Model worker and Craftsman Talent Innovation Research Studio, Chengdu, China
| | - Chuanxi Zheng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Model worker and Craftsman Talent Innovation Research Studio, Chengdu, China
| | - Yong Zhou
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Model worker and Craftsman Talent Innovation Research Studio, Chengdu, China
- *Correspondence: Chongqi Tu, ; Yong Zhou,
| | - Chongqi Tu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Model worker and Craftsman Talent Innovation Research Studio, Chengdu, China
- *Correspondence: Chongqi Tu, ; Yong Zhou,
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Baleani M, Erani P, Blaise M, Fognani R, Palmas M, Manfrini M. Intercalary reconstruction of long bones by massive allograft: Comparison of construct stability ensured by three different host-graft junctions and two types of fixations in a synthetic femur model. Front Pediatr 2022; 10:868299. [PMID: 35989989 PMCID: PMC9382195 DOI: 10.3389/fped.2022.868299] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 07/04/2022] [Indexed: 11/24/2022] Open
Abstract
An intercalary segmental allograft is an option for limb salvage in bone tumours. Stable and congruent intercalary reconstructions are a prerequisite for achieving host-graft union. However, a too rigid fixation could increase the risk of late complications correlated with negative bone remodelling. This study compared the reconstruction stiffness achieved by three different host-graft junctions, namely, end-to-end, modified step-cut, and taper. A low-stiffness bone plate was used as the fixation method, except for the taper junction where a low-stiffness intramedullary nail was also used to investigate the effects of different types of fixation on construct stiffness. Composite femora were tested under four loading conditions to determine coronal and sagittal bending stiffness, as well as torsional stiffness in opposite directions. Stiffness values were expressed as a percentage of intact host bone stiffness (%IBS). While a reduction of coronal bending stiffness was found with taper junctions (76%IBS) compared with the high values ensured by end-to-end (96%IBS) and modified step-cut junctions (92%IBS), taper junctions significantly increased stiffness under sagittal bending and torsion in intra- and extra-direction: end-to-end 29%IBS, 7%IBS, 7%IBS, modified step-cut 38%IBS, 20%IBS, 21%IBS, and taper junction 52%IBS, 55%IBS, 56%IBS, respectively. Construct stiffness with taper junctions was decreased by 11-41%IBS by replacing the bone plate with an intramedullary nail. Taper junctions can be an alternative to achieve intercalary reconstructions with more homogeneous and, in three out of four loading conditions, significantly higher construct stability without increasing bone plate stiffness. The risk of instability under high torsional loads increases when taper junctions are associated with a low-stiffness intramedullary nail.
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Affiliation(s)
- Massimiliano Baleani
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Erani
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Manon Blaise
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Roberta Fognani
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Palmas
- Clinica Ortopedica e Traumatologica III a Prevalente Indirizzo Oncologico, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Manfrini
- Clinica Ortopedica e Traumatologica III a Prevalente Indirizzo Oncologico, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Schileo E, Feltri P, Taddei F, di Settimi M, Di Martino A, Filardo G. A taper-fit junction to improve long bone reconstruction: A parametric In Silico model. J Mech Behav Biomed Mater 2021; 124:104790. [PMID: 34530302 DOI: 10.1016/j.jmbbm.2021.104790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/26/2021] [Accepted: 08/21/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Critical size long bone defects represent a clinical challenge in orthopaedic surgery. Various grafting techniques have been developed through the years, but they all present several downsides. A key requirement of all grafting techniques is the achievement of a continuous interface between host bone and graft to enhance both biological processes and mechanical stability. This study used a parametric in silico model to quantify the biomechanical effect of the inaccuracies inherent to current osteotomy techniques, and to test a new concept of accurate taper-fit junction that may improve the biomechanical parameters of the reconstruction under load. METHODS A population-based in-silico 3D model of the reconstruction of a long bone defect was built to represent a defect of the femoral mid-diaphysis. To fix the reconstruction a titanium plate was placed on the lateral aspect of the reconstruction. The model was modified to (i) quantify the biomechanical consequences of actual inaccuracies in the realization of a flat host-graft interface, (ii) compare the contact behaviour and bone strains among different taper angles of the new design and the current host-graft flat interface, (iii) evaluate the robustness of the taper-fit design to inter-subject variability in bone geometry and defect length. RESULTS The influence of 2° single-plane misalignments of the host-graft interface is highly dependent on the misalignment orientation with respect to the metal plate. For some misalignment orientations, tangential micromotions of contact interfaces exceeded alert thresholds. When the angle of the taper-fit host-graft junction is changed from 10° to 30° and the results obtained are compared with the planar case, the overall stiffness is almost preserved, the bone strains are almost unchanged with safety factors higher than five, and full contact closure around the host-graft junction is achieved at 20°. Similarly, contact pressures decrease almost linearly with a 20% decrease at 30°. The host-graft micro motions are almost unchanged in both value and distribution up to 20° and never exceed the warning threshold of 50 μm. CONCLUSIONS The present in silico study developed quantitative biomechanical evidence that an osteotomy performed with attention to the perpendicularity of the cut planes is needed to reduce the risk of mismatch and possible complications of long bone reconstructions, and that a new concept of a taper-fit junction may improve the biomechanical environment of the interface between the graft and the host bone. The optimal taper-fit configuration is suggested to be around a 20° taper angle. These results will serve as an input to conduct exvivo experiments to further corroborate the proposed taper-fit junction concept and to refine its surgical implementation.
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Affiliation(s)
- Enrico Schileo
- Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, IT, Italy
| | - Pietro Feltri
- Orthopaedic and Traumatology Unit, Ospedale Regionale di Lugano, EOC, 6900 Lugano, CH Switzerland.
| | - Fulvia Taddei
- Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, IT, Italy
| | | | - Alessandro Di Martino
- Second Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, IT, Italy
| | - Giuseppe Filardo
- Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, IT, Italy
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Potter BK. CORR Insights®: What Is the Survival of the Telescope Allograft Technique to Augment a Short Proximal Femur Segment in Children After Resection and Distal Femur Endoprosthesis Reconstruction for a Bone Sarcoma? Clin Orthop Relat Res 2021; 479:1791-1792. [PMID: 33944812 PMCID: PMC8277255 DOI: 10.1097/corr.0000000000001789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/31/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Benjamin K Potter
- Orthopaedic Surgery, Uniformed Services University-Walter Reed Department of Surgery, Bethesda, MD, USA
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