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Xu H, Li Y, Yu F, Liu W, Hao L, Zhang Q, Niu X. An innovative staged prosthetic lengthening reconstruction strategy for osteosarcoma-related leg discrepancy. Sci Rep 2024; 14:717. [PMID: 38184715 PMCID: PMC10771419 DOI: 10.1038/s41598-023-50422-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 12/19/2023] [Indexed: 01/08/2024] Open
Abstract
Correction of leg length discrepancy (LLD) in skeletally mature patients with osteosarcoma was rarely reported and quite challenging. This study aimed to propose a treatment strategy of staged lengthening and reconstruction with a standard static prosthesis to address LLD and restore limb function. It also evaluated the effectiveness of the strategy in terms of leg lengthening, functional outcomes, and complications. The strategy for lengthening included three stages. In stage 1, the previous prosthesis was removed and an external fixator with a temporary rod-cement spacer was placed. In this stage, the external fixator was used to lengthen the limb to the appropriate length. In stage 2, the external fixator was removed and the old rod-cement spacer was replaced with a new one. In stage 3, the rod-cement spacer was removed and the standard static prosthesis was planted. Nine skeletally mature distal femoral osteosarcoma patients with unacceptable LLD were treated in our institution from 2019 to 2021. We performed a chart review on nine patients for the clinical and radiographic assessment of functional outcomes, LLD, and complications. The mean (range) leg lengthening was 7.3 cm (3.6-15.6). The mean (range) LLD of the lower limbs decreased from 7.6 cm (4.1-14.2) before the lengthening to 0.3 cm (- 0.3 to 2.1) at the final follow-up with statistical significance (P = 0.000). The mean (range) Musculoskeletal Tumor Society score improved from 30.3% (16.7%-53.3%) before the lengthening to 96.3% (86.7%-100%) at the final follow-up with statistical significance (P = 0.000). Three patients (33.3%) had a minor complication; none needed additional surgical intervention. In the short term, the current staged lengthening and reconstruction with standard static prosthesis provided satisfactory functional outcomes and LLD correction with few complications. The long-term effects of this method need further exploration.
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Affiliation(s)
- Hairong Xu
- JST Sarcoma & Bone Tumor Center, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Yuan Li
- JST Sarcoma & Bone Tumor Center, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Feng Yu
- JST Sarcoma & Bone Tumor Center, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Weifeng Liu
- JST Sarcoma & Bone Tumor Center, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Lin Hao
- JST Sarcoma & Bone Tumor Center, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Qing Zhang
- JST Sarcoma & Bone Tumor Center, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Xiaohui Niu
- JST Sarcoma & Bone Tumor Center, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China.
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Li Y, Ji T, Wang Q, Guo W. 99mTc-MDP bone scintigraphy-based growth evaluation and prediction of epiphysis around the knee: a study of paediatric limb salvage for malignant bone tumours. Clin Radiol 2023; 78:608-615. [PMID: 37308349 DOI: 10.1016/j.crad.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 02/13/2023] [Accepted: 05/02/2023] [Indexed: 06/14/2023]
Abstract
AIM To investigate the feasibility of bone scintigraphy in the assessment and prediction of bone growth potential after limb-salvage surgery in children with bone tumours. MATERIALS AND METHODS Fifty-five skeletally immature patients with primary bone malignancies in distal femur was enrolled. Thirty-two patients received epiphysis minimally invasive endoprosthesis (EMIE) reconstruction, seven received hemiarthroplasty, and 16 received adult-type rotation-hinged endoprosthesis (ATRHE) reconstruction. All enrolled patients underwent radiographic examination at regular intervals and followed-up for >12 months. The actual limb length discrepancy (LLDa) of the tibia was measured on the radiography image. The expected LLD of tibia (LLDp) was calculated according to multiplier method. The uptake ratio of the ipsilateral epiphysis to the contralateral epiphysis (Ri/c) was calculated at bone scintigraphy. The Ri/c value was accommodated in the formula of multiplier method for a modification. The difference and correlation between the modified expected LLD (LLDm), LLDp and LLDa were analysed. RESULTS The growth potential of ipsilateral epiphysis was reserved in all patients who underwent hemiarthroplasty and one fourth of EMIE reconstruction. The Ri/c values in the hemiarthroplasty endoprosthesis group were significantly higher than the EMIE and ATRHE groups. There was no significant difference in Ri/c values between the EMIE and ATRHE group. Data from the 26 patients who reached bone maturation showed that there was a significant difference between LLDp and LLDa. LLDm showed a higher correlation with LLDa than LLDp. CONCLUSION Bone scintigraphy is helpful to evaluate the growth potential of epiphysis after surgery. The multiplier method modified by Ri/c value improves prediction accuracy of bone growth.
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Affiliation(s)
- Y Li
- Department of Nuclear Medicine, Peking University People's Hospital, China
| | - T Ji
- Musculoskeletal Tumor Center, Peking University People's Hospital, China.
| | - Q Wang
- Department of Nuclear Medicine, Peking University People's Hospital, China.
| | - W Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, China
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Zhao Z, Yang Y, Yan T, Tang X, Yang R, Guo W. Outcomes of Fixed-Hinged Knee Prosthesis for Distal Femoral Osteosarcoma in Skeletally Immature Patients: First Results. J Knee Surg 2023; 36:68-78. [PMID: 34187071 DOI: 10.1055/s-0041-1729623] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The best surgical choice for distal femur osteosarcoma in skeletally immature patients remains controversial. A fixed hinged knee prosthesis has been designed to preserve the growth plates in the adjacent tibia, expecting tibial growth to be continued. This study aims to report the (1) clinical outcomes after prosthetic replacement, (2) postoperative complications, and (3) length of discrepancy of the operative tibia with the unaffected tibia. Thirty-four skeletally immature patients (averaged 9 years at surgery; range, 5-12 years) with distal femoral osteosarcoma underwent placement of this hinged knee prosthesis between January 2015 and August 2018. Postoperative function and complications were assessed. Length discrepancy was measured using a series of full-length standing anteroposterior radiographs of the bilateral lower extremity. The average follow-up duration was 34 months (2.8 years). In the last follow-up, four patients expired because of pulmonary metastasis. Two patients presented with local recurrence of the soft tissue. Postoperatively, the flexion range of the knee joint range was between 100 and 130 degrees, with an average of 115.2 degrees. The mean functional score of living patients evaluated using the Musculoskeletal Tumor Society scoring system was 89.2% (range, 76.7-100%). Types 1 (three patients), 2 (one patient), 3 (two patients), and 5 (two patients) complications exist. Among them, three patients received revision surgery. The proximal tibial physis still grew after surgery, with an average of 74.3% (range, 30-100%) growth potential compared with the unaffected proximal tibial physis. Moreover, 27 children exhibited tibial length discrepancy compared with the contralateral tibia, and the mean discrepancy in tibial length was 1.1 cm (range, 0.2-3.1 cm). This hinged knee prosthesis can keep the growth potential in the adjacent tibia, provides satisfying functional outcomes, and has a lower postoperative complication rate. Thus, it could serve as an alternative intervention for distal femoral osteosarcoma in skeletally immature patients.
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Affiliation(s)
- Zhiqing Zhao
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, P.R. China
| | - Yi Yang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, P.R. China
| | - Taiqiang Yan
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, P.R. China
| | - Xiaodong Tang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, P.R. China
| | - Rongli Yang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, P.R. China
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, P.R. China
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Li Z, Lu M, Zhang Y, You Q, Wang Y, Li L, Ye Q, Wang Y, Luo Y, Min L, Zhou Y, Tu C. Three-dimensional printed customized uncemented unipolar prosthesis combined with ligament reconstruction for tumorous defect of the distal femur in children. BMC Musculoskelet Disord 2022; 23:1100. [PMID: 36527043 PMCID: PMC9756496 DOI: 10.1186/s12891-022-06053-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Hemiarthroplasty following tumor resection of the distal femur in children provides a chance to preserve the proximal tibial physis for limb elongation. Based on three-dimensional (3D) printing technology, the uncemented unipolar prosthesis with joint stability reinforced structures (JSRSs) was custom-designed for our cases. This study aimed to describe the design and assess the short-term outcomes of this refined prosthetic hemiarthroplasty. METHODS Seven patients (four females and three males) received 3D-printed customized uncemented unipolar prosthesis for hemiarthroplasty after removal of the distal femur, from September 2019 to October 2020 at our Orthopedics department. The limb function, growth of the preserved proximal tibial physis, joint stability, and limb length discrepancy (LLD) were assessed. Complications were recorded. RESULTS Six patients survived with no evidence of metastasis or local recurrence at the last follow-up, and one patient died of lung metastasis at 19 months postoperatively. Follow-up ranged from 19 to 32 months, with an average of 26 months. Elongation of the tibia was observed in all cases. At the last follow-up, four patients exhibited equal growth length compared with the healthy contralateral tibia. LLD ranged from 0.8 to 1.6 cm with a mean of 1.3 cm. The average knee range of motion was 95.3° of flexion and 4.5° of extension. All patients achieved satisfactory postoperative limb function with a mean MSTS score of 25.8. The results of the drawer, Lachman, and pivot shift tests were negative in all patients. During follow-up, painless joint space narrowing was observed in two patients. The screw for ligament fixation loosened in one of the seven patients at 17 months postoperatively. No subluxation of the joint, angular deformity, or breakage of the implant was detected in the remaining patients. CONCLUSIONS 3D-printed customized uncemented unipolar prosthesis with JSRS would be a good choice for reconstructing tumorous defect in the distal femur in children.
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Affiliation(s)
- Zhuangzhuang Li
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 People’s Republic of China ,grid.412901.f0000 0004 1770 1022Model Worker and Craftsman Talent Innovation Workshop of Sichuan province , West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Minxun Lu
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 People’s Republic of China ,grid.412901.f0000 0004 1770 1022Model Worker and Craftsman Talent Innovation Workshop of Sichuan province , West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Yuqi Zhang
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 People’s Republic of China ,grid.412901.f0000 0004 1770 1022Model Worker and Craftsman Talent Innovation Workshop of Sichuan province , West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Qi You
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 People’s Republic of China ,grid.412901.f0000 0004 1770 1022Model Worker and Craftsman Talent Innovation Workshop of Sichuan province , West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Yitian Wang
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 People’s Republic of China ,grid.412901.f0000 0004 1770 1022Model Worker and Craftsman Talent Innovation Workshop of Sichuan province , West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Longqing Li
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 People’s Republic of China ,grid.412901.f0000 0004 1770 1022Model Worker and Craftsman Talent Innovation Workshop of Sichuan province , West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Qiang Ye
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 People’s Republic of China ,grid.412901.f0000 0004 1770 1022Model Worker and Craftsman Talent Innovation Workshop of Sichuan province , West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Yang Wang
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 People’s Republic of China ,grid.412901.f0000 0004 1770 1022Model Worker and Craftsman Talent Innovation Workshop of Sichuan province , West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Yi Luo
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 People’s Republic of China ,grid.412901.f0000 0004 1770 1022Model Worker and Craftsman Talent Innovation Workshop of Sichuan province , West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Li Min
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 People’s Republic of China ,grid.412901.f0000 0004 1770 1022Model Worker and Craftsman Talent Innovation Workshop of Sichuan province , West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Yong Zhou
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 People’s Republic of China ,grid.412901.f0000 0004 1770 1022Model Worker and Craftsman Talent Innovation Workshop of Sichuan province , West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Chongqi Tu
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 People’s Republic of China ,grid.412901.f0000 0004 1770 1022Model 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 D, Ji T, Guo W, Qu H, Liang H, Yang Y, Tang X, Yang R, Wang J. Outcomes of Semiknee Replacement in Skeletally Immature Bone Sarcoma Patients. J Knee Surg 2022. [PMID: 35817056 DOI: 10.1055/s-0042-1748823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION A semiknee mega endoprosthesis (SKMEP) was used to replace the resected distal femur or proximal tibia in skeletally immature bone sarcoma patients. This study investigated the surgical technique, endoprosthesis survival rate, functional outcome, complications, and approaches to resolve limb-length discrepancy (LLD) following this procedure. PATIENTS AND METHODS In total, 15 girls and 16 boys with a mean age of 9.1 years (range, 4-12) and 8.9 years (range, 5-13), respectively, were included in this study. The mean length of the resected distal femur (15 cases) and proximal tibia (16) was 145.0 and 122.8 mm, respectively. Altogether, 19 custom-made SKMEPs and 12 modular units were used to reconstruct the bone and joint defects. RESULTS The average follow-up was 82.8 months (range, 4-225 months). Five patients died of disease. Seven SKMEPs were revised to total knee endoprosthesis after a mean of 40.3 months. Nineteen patients retained the original SKMEP, and the mean LLD was 4.3 cm (range, 0-10 cm). One case each of Henderson type 1B, type 2A, type 2B, and type 5B failures was observed. Knee subluxation occurred in two cases. Although a slight laxity of the knee was identified on physical examination, the average Musculoskeletal Tumor Society 93(MSTS93) functional score was 84.5% (range, 57-97%). The estimated implant survival was 70.5% at 5 years. CONCLUSION This was the largest retrospective study reporting the application of SKMEP in bone sarcoma patients. For selected skeletally immature bone sarcoma patients, SKMEP is an option with satisfactory functional outcomes and survival rates. However, heightening pads or shoes to compensate the LLD were indispensable before subsequent LLD was adjusted by further operation(s).
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Affiliation(s)
- Dasen Li
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Tao Ji
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Huayi Qu
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Haijie Liang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Yi Yang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Xiaodong Tang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Rongli Yang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Jichuan Wang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China
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Hindiskere S, Rajan S, Pal U, Dixit PP, Varma VR, Chinder PS. Hemiarthroplasty of Pedicle-Frozen Proximal Tibia for Primary Malignant Bone Tumours. Indian J Orthop 2022; 56:1285-1290. [PMID: 35813537 PMCID: PMC9232691 DOI: 10.1007/s43465-022-00658-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/09/2022] [Indexed: 02/04/2023]
Abstract
UNLABELLED The proximal tibia is one of the most common locations for primary malignant bone tumours and is usually seen in a population that has not attained skeletal maturity. Most of the surgical techniques for resection and reconstruction of the proximal tibia in children involves sacrificing the distal femoral epiphysis, which leads to a significant limb length discrepancy. Hemiarthroplasty is a relatively lesser known technique for knee joint reconstruction that preserves one of the epiphyses around the knee joint. Pedicle freezing is a sterilization technique used to treat malignant bone tumours, without performing an osteotomy of the diaphysis, thereby preventing non-union which is the most common complication of biological reconstruction techniques. We describe the surgical technique of hemiarthroplasty of the pedicle-frozen proximal tibia for malignant bone tumours of the proximal tibia. This is a novel, safe and effective reconstructive method in children, resulting in reduced limb length discrepancy and excellent functional outcomes. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s43465-022-00658-9.
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Affiliation(s)
- Suraj Hindiskere
- grid.492832.60000 0004 1759 6672Department of Musculoskeletal Oncology, HCG Hospital, Room no. 206, Tower 4, 2nd Floor, No.8, P.Kalinga Rao Road, Sampangirama Nagar, Bangalore, 560029 India
| | - Sreeraj Rajan
- grid.492832.60000 0004 1759 6672Department of Musculoskeletal Oncology, HCG Hospital, Room no. 206, Tower 4, 2nd Floor, No.8, P.Kalinga Rao Road, Sampangirama Nagar, Bangalore, 560029 India
| | - Utkarsh Pal
- grid.492832.60000 0004 1759 6672Department of Musculoskeletal Oncology, HCG Hospital, Room no. 206, Tower 4, 2nd Floor, No.8, P.Kalinga Rao Road, Sampangirama Nagar, Bangalore, 560029 India
| | - Pramatha P. Dixit
- Department of Musculoskeletal Oncology, The Yellow Ribbon, Bangalore, India
| | - Vaishnavi R. Varma
- Department of Musculoskeletal Oncology, The Yellow Ribbon, Bangalore, India
| | - Pramod S. Chinder
- grid.492832.60000 0004 1759 6672Department of Musculoskeletal Oncology, HCG Hospital, Room no. 206, Tower 4, 2nd Floor, No.8, P.Kalinga Rao Road, Sampangirama Nagar, Bangalore, 560029 India
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Imanishi J, Tanabe M, Kurihara T, Torigoe T, Kikkawa J, Ohta A, Watanabe A, Tanaka R, Saita K, Kadono Y, Yazawa Y. Temporal hemiarthroplasty for distal femoral osteosarcoma in early childhood: a case report. World J Surg Oncol 2020; 18:280. [PMID: 33115497 PMCID: PMC7594408 DOI: 10.1186/s12957-020-02047-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 10/13/2020] [Indexed: 11/18/2022] Open
Abstract
Background Prosthetic reconstruction for distal femoral osteosarcoma is challenging for younger children. We herein report a successful case of limb-sparing surgery for a younger patient with distal femoral osteosarcoma requiring osteo-articular resection. Case presentation A 5-year-old girl with high-grade conventional osteosarcoma in the left distal femur underwent a series of surgeries. After three cycles of neoadjuvant chemotherapy, limb-salvage surgery was planned because femoral rotationplasty had been refused. At 6 years and 2 months old, distal femoral resection and temporary spacer insertion using a 7-mm-diameter intramedullary nail and molded polymethylmethacrylate was performed. At 7 years and 8 months old, secondary surgery was performed because the first spacer had been dislocated and the residual femur became atrophic. The distal end of the residual femur was removed by 1 cm, but the periosteum and induced membrane around polymethylmethacrylate was preserved. In order to stabilize the spacer against the tibia, a custom-made ceramic spacer with a smooth straight 8-mm-diameter stem was utilized. The bone-spacer junction was fixed with polymethylmethacrylate and then covered with the preserved periosteum and induced membrane. After surgery, the bone atrophy improved. At 9 years and 7 months old, the second spacer was removed because it had loosened, and the knee joint was reconstructed using a custom-made growing femoral prosthesis with a curved porous 8.5-mm-diameter stem. Cancellous bone tips from the proximal tibia were grafted around the bone-prosthesis junction underneath the induced membrane. At 10 years and 5 months old, the patient was able to walk unsupported and a radiograph showed further thickening of the cortex of the residual femur without any stress shielding. Although having 5 cm of limb length discrepancy, the patient and her mother were satisfied with the function. The MSTS score was 24 out of 30 points. Repeated limb length extensions are planned. Conclusions This case report provides an example of limb-salvage surgery after distal femoral resection in a small child. The use of a temporary spacer utilizing partial cementation and preservation of the periosteum and induced membrane appears to afford a viable limb-salvage option after distal femoral resection for younger children. Supplementary Information Supplementary information accompanies this paper at 10.1186/s12957-020-02047-8.
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Affiliation(s)
- Jungo Imanishi
- Department of Orthopaedic Oncology and Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 3501298, Japan. .,Department of Orthopaedic Surgery, Saitama Medical University Hospital, 38 Moro-hongo, Moroyama, Saitama, 3500495, Japan. .,Department of Orthopaedic Surgery, School of Medicine, Teikyo University, Tokyo, 1738605, Japan.
| | - Masayuki Tanabe
- Department of Orthopaedic Oncology and Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 3501298, Japan.,Department of Orthopaedic Surgery, Saitama Medical University Saitama Medical Center, 1981 Kamoda, Kawagoe, Saitama, 3508550, Japan
| | - Taisei Kurihara
- Department of Orthopaedic Oncology and Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 3501298, Japan
| | - Tomoaki Torigoe
- Department of Orthopaedic Oncology and Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 3501298, Japan
| | - Jun Kikkawa
- Department of Orthopaedic Surgery, Saitama Medical University Hospital, 38 Moro-hongo, Moroyama, Saitama, 3500495, Japan.,Department of Critical Care and Emergency, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 3501298, Japan
| | - Atsuhiko Ohta
- Department of Pediatric Hematology and Oncology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 3501298, Japan
| | - Atsuko Watanabe
- Department of Pediatric Hematology and Oncology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 3501298, Japan
| | - Ryuhei Tanaka
- Department of Pediatric Hematology and Oncology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 3501298, Japan
| | - Kazuo Saita
- Department of Orthopaedic Surgery, Saitama Medical University Saitama Medical Center, 1981 Kamoda, Kawagoe, Saitama, 3508550, Japan
| | - Yuho Kadono
- Department of Orthopaedic Surgery, Saitama Medical University Hospital, 38 Moro-hongo, Moroyama, Saitama, 3500495, Japan
| | - Yasuo Yazawa
- Department of Orthopaedic Oncology and Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 3501298, Japan
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Prabowo Y, Primaputra MRA, Kodrat E. Reconstruction of osteosarcoma of the proximal tibia using bone on polyethylene hemiarthroplasty knee joint system: A case report. Int J Surg Case Rep 2020; 72:188-196. [PMID: 32544827 PMCID: PMC7298547 DOI: 10.1016/j.ijscr.2020.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 11/28/2022] Open
Abstract
Limb-sparing surgery remains a challenging procedure in skeletally immature patients. This bone on polyethylene technique would be functional due to high adaptability in paediatric patients in order to decrease the number of surgeries until the final goal of limb equalization. Such techinique enables good and reliable functional outcome while maintaining the knee joint for daily activity.
Introduction Current treatment in treating patient with osteosarcoma is combination of chemotherapy and surgery, either limb-sparing or limb-ablation surgery. One challenge in limb-sparing technique in children is how to deal with the remaining growth of the bone. We created a limb-sparing reconstruction technique that can be fitted in many types of hospital and have a good functional outcome. Case presentation We reported a case of 13-years-old female with left knee pain since 8 months prior hospital admission with previous treatment to a bone setter and open biopsy at previous hospital. Histopathological findings demonstrated osteosarcoma. The patient had a neoadjuvant chemotherapy and followed with limb-sparing surgery. We performed wide excision of proximal tibia and reconstruction using a bone on polyethylene hemiarthroplasty system of the knee joint. Patient then continued on adjuvant chemotherapy. Later on, local recurrence occurred and we performed excision again. Within one year, the patient could walk full weight bearing, perform daily activities with no limitation and no pain, and she had MSTS score of 21. Discussion Limb-sparing surgery remains a challenging procedure in skeletally immature patients. This bone on polyethylene technique would be functional due to high adaptability in paediatric patients in order to decrease the number of surgeries until the final goal of limb equalization. Conclusion Bone on polyethylene hemiarthroplasty system enables good and reliable functional outcome while maintaining the knee joint for daily activity. It can be chosen as one of viable options in treating osteosarcoma around the knee joint in children.
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Affiliation(s)
- Yogi Prabowo
- Department of Orthopaedic & Traumatology, Cipto Mangunkusumo National Central Hospital and Faculty of Medicine, Universitas Indonesia, Jalan Diponegoro No. 71, Central Jakarta, Jakarta 10430, Indonesia
| | - Muhammad Rizqi Adhi Primaputra
- Department of Orthopaedic & Traumatology, Cipto Mangunkusumo National Central Hospital and Faculty of Medicine, Universitas Indonesia, Jalan Diponegoro No. 71, Central Jakarta, Jakarta 10430, Indonesia.
| | - Evelina Kodrat
- Department of Anatomical Pathology, Cipto Mangunkusumo National Central Hospital and Faculty of Medicine, Universitas Indonesia, Jalan Diponegoro No. 71, Central Jakarta, Jakarta 10430, Indonesia
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Ji T, Yang Y, Li DS, Tang XD, Guo W. Limb Salvage Using Non-hinged Endoprosthesis and Staged Correction of Leg-length Discrepancy for Children with Distal Femoral Malignant Tumors. Orthop Surg 2019; 11:819-825. [PMID: 31489784 PMCID: PMC6819186 DOI: 10.1111/os.12525] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 07/05/2019] [Accepted: 07/21/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Limb salvage in pediatric patients remains a challenge. We describe a staged strategy. The procedure includes: (i) tumor removal and non-hinged static endoprosthesis reconstruction; (ii) leg length discrepancy (LLD) correction by shoe lift or distraction osteogenesis; and (iii) maturity reconstruction by regular endoprosthesis. The aim of the study was to investigate the results of non-hinged static megaprosthesis reconstruction and staged LLD correction in the treatment of malignant tumors in the distal femur in children. METHODS Non-hinged megaprostheses were implanted in 12 pediatric patients with osteosarcoma in the distal femur. The prosthesis consists of a femoral component with constrained condylar knee (CCK) design, and a tibial component with a small-diameter press-fit stem and derotation fins. A posterior stabilizing polyethylene component is fixed on the tibial component. The cases were prospectively followed up with focus on the growth rate of adjacent uninvolved bone in the salvaged limb, joint stability, knee stability, function outcome, length discrepancy, and surgery-related complications. RESULTS There were five girls and seven boys included in the study, with an average age at the time of primary surgery of 10.0 years (range, 8-12 years). All the tumors were located in the distal femur. The average follow up was 76.3 months (range, 24-139 months). The Ligament Augmentation and Reconstruction System (LARS) ligament was used in two patients to enhance the soft tissue reattachment and reconstruct medial collateral ligament (MCL). Ten patients were alive at the final follow-up and two had died of lung metastases. Expected LLD was 6.7 cm (range, 3.0-13.2 cm) at initial surgery. At the final follow-up, nine patients reached skeletal maturity and the actual LLD at the femur was 5.3 cm (range, 3.0-10.1 cm), excluding 1 cm correction at initial surgery by endoprosthesis. The proximal tibia physis showed an average of 86.7% (range, 56.5%-100%) growth of the contralateral side. The mean reduction in tibial length was 1.2 cm (range, 0.5-4.7 cm). Six patients received distraction osteogenesis at a mean length of 5.4 cm (range, 3.0-9.1 cm). Range of knee movement was between 85° and 125°, with an average of 102.5°. The Musculoskeletal Tumor Society 93 score of patients alive was 80.6 (range, 60-90). CONCLUSION Non-hinged static megaprosthesis followed by LLD correction with shoe lift or staged distraction osteogenesis appears to be an alternative option to treat children with malignant bone tumors around the knee.
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Affiliation(s)
- Tao Ji
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing, China
| | - Yi Yang
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing, China
| | - Da-Sen Li
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing, China
| | - Xiao-Dong Tang
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing, China
| | - Wei Guo
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing, China
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10
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Morris CD, Wustrack RL, Levin AS. Limb-Salvage Options in Growing Children with Malignant Bone Tumors of the Lower Extremity. JBJS Rev 2017; 5:e7. [DOI: 10.2106/jbjs.rvw.16.00026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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11
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Kang S, Lee JS, Park J, Park SS. Staged lengthening and reconstruction for children with a leg-length discrepancy after excision of an osteosarcoma around the knee. Bone Joint J 2017; 99-B:401-408. [PMID: 28249982 DOI: 10.1302/0301-620x.99b3.38018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 11/25/2016] [Indexed: 11/05/2022]
Abstract
AIMS Children treated for osteosarcoma around the knee often have a substantial leg-length discrepancy at skeletal maturity. The aim of this study was to investigate the results of staged skeletal reconstruction after a leg lengthening procedure using an external fixator in these patients. PATIENTS AND METHODS We reviewed 11 patients who underwent staged reconstruction with either an arthroplasty (n = 6) or an arthrodesis (n = 5). A control group of 11 patients who had undergone wide excision and concurrent reconstruction with an arthroplasty were matched for gender, location, and size of tumour. We investigated the change in leg-length discrepancy, function as assessed by the Musculoskeletal Tumor Society Scale (MSTS) score and complications. RESULTS A mean 5.2 cm (1.7 to 8.9) of lengthening was achieved. The mean MSTS scores significantly improved after staged reconstruction (p = 0.003) but were still worse than those of the control group (p = 0.049). However, the MSTS scores of the arthroplasty subgroup were comparable with those of the controls, although the extensor lag was greater and the range of movement was less. The patient group experienced more complications, but all of these resolved. CONCLUSION Approximately 5 cm of lengthening and significant functional improvement can be achieved by staged reconstruction and lengthening, without major complications. Although it has limitations, this method of treatment seems to be a satisfactory surgical option for growing children with a significant leg-length discrepancy after excision of an osteosarcoma around the knee. Cite this article: Bone Joint J 2017;99-B:401-8.
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Affiliation(s)
- S Kang
- University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul 05505, South, Korea
| | - J S Lee
- University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul 05505, South, Korea
| | - J Park
- University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul 05505, South, Korea
| | - S-S Park
- University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul 05505, South, Korea
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