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Rennie C, Rodriguez M, Futch KN, Krasney LC. Complications Following Osseointegrated Transfemoral and Transtibial Implants: A Systematic Review. Cureus 2024; 16:e57045. [PMID: 38681289 PMCID: PMC11046368 DOI: 10.7759/cureus.57045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 03/27/2024] [Indexed: 05/01/2024] Open
Abstract
Lower limb amputation is a common orthopedic surgery in the United States and can be performed either above or below the knee. Prosthetics are typically externally fitted to the patient's residual stump; however, osseointegrated implants offer a potential alternative to this process. Transcutaneous limb osseointegration involves the intramedullary anchoring of an implant that can later attach to a prosthetic via a stoma in the residual limb. There are proposed benefits to this, including decreased skin and soft tissue complications as well as an increased sense of stability. As this is a relatively new procedure, the complications and efficacy are not well supported by the literature at this time. The primary aim of this analysis was to synthesize the currently available data on transfemoral and transtibial osseointegration in order to improve our understanding of the potential complications of the procedure. A literature search was performed in the following databases: Biomedical Reference Collection, CINAHL, Cochrane Library, and PubMed/MEDLINE. Articles were screened by three independent reviewers for studies written or available in English, study design, and study outcomes, including complications. No filter was applied for publication date, publication national origin, or sample size. A total of 20 articles were selected for the final qualitative analysis. This review demonstrates an overall low or non-inferior rate of both minor and severe complications in transtibial and transfemoral osseointegration. This procedure should be considered as an option during preoperative planning in the context of above-the-knee and below-the-knee amputations. However, continued studies with larger sample sizes and extended postoperative follow-up are necessary for a greater strength of recommendation.
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Affiliation(s)
- Christopher Rennie
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Melissa Rodriguez
- Medicine, Lincoln Memorial University-DeBusk College of Osteopathic Medicine, Harrogate, USA
| | - Katerina N Futch
- Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Leighann C Krasney
- Orthopaedic Surgery, California Pacific Orthopaedics, San Francisco, USA
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Tanaka KS, Andaya VR, Thorpe SW, Gundle KR, Hayden JB, Duong Y, Avedian RS, Mohler DG, Morse LJ, Zimel MN, O'Donnell RJ, Fang A, Randall RL, Tran TH, New C, Wustrack RL. Survival and failure modes of the Compress® spindle and expandable distal femur endoprosthesis among pediatric patients: A multi‐institutional study. J Surg Oncol 2022; 127:148-158. [PMID: 36112398 PMCID: PMC10087226 DOI: 10.1002/jso.27094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/05/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Expandable endoprostheses can be used to equalize limb length for pediatric patients requiring reconstruction following large bony oncologic resections. Outcomes of the Compress® Compliant Pre-Stress (CPS) spindle paired with an Orthopedic Salvage System expandable distal femur endoprosthesis have not been reported. METHODS We conducted a multi-institutional retrospective study of pediatric patients with distal femoral bone sarcomas reconstructed with the above endoprostheses. Statistical analysis utilized Kaplan-Meier survival technique and competing risk analysis. RESULTS Thirty-six patients were included from five institutions. Spindle survivorship was 86.3% (95% confidence interval [CI], 67.7-93.5) at 10 years. Two patients had a failure of osseointegration (5.7%), both within 12 months. Twenty-two (59%) patients had 70 lengthening procedures, with mean expansions of 3.2 cm (range: 1-9) over 3.4 surgeries. The expandable mechanism failed in eight patients with a cumulative incidence of 16.1% (95% CI, 5.6-31.5) at 5 years. Twenty-nine patients sustained International Society of Limb Salvage failures requiring 63 unplanned surgeries. Periprosthetic joint infection occurred in six patients (16.7%). Limb preservation rate was 91% at 10 years. CONCLUSIONS There is a high rate of osseointegration of the Compress® spindle among pediatric patients when coupled with an expandable implant. However, there is a high rate of expansion mechanism failure and prosthetic joint infections requiring revision surgery. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Kara S. Tanaka
- Department of Orthopaedic Surgery University of California, San Francisco San Francisco California USA
| | - Veronica R. Andaya
- Department of Orthopaedic Surgery University of California, San Francisco San Francisco California USA
| | - Steven W. Thorpe
- Department of Orthopaedic Surgery University of California, Davis Sacramento California USA
| | - Kenneth R. Gundle
- Department of Orthopaedic Surgery Oregon Health and Science University Portland Oregon USA
| | - James B. Hayden
- Department of Orthopaedic Surgery Oregon Health and Science University Portland Oregon USA
| | - Yee‐Cheen Duong
- Department of Orthopaedic Surgery Oregon Health and Science University Portland Oregon USA
| | - Raffi S. Avedian
- Department of Orthopaedic Surgery Stanford University Medical Center Palo Alto California USA
| | - David G. Mohler
- Department of Orthopaedic Surgery Stanford University Medical Center Palo Alto California USA
| | - Lee J. Morse
- Department of Orthopaedic Surgery Kaiser Oakland and South San Francisco South San Francisco California USA
| | - Melissa N. Zimel
- Department of Orthopaedic Surgery University of California, San Francisco San Francisco California USA
| | - Richard J. O'Donnell
- Department of Orthopaedic Surgery University of California, San Francisco San Francisco California USA
| | - Andrew Fang
- Department of Orthopaedic Surgery Kaiser Oakland and South San Francisco South San Francisco California USA
| | - Robert Lor Randall
- Department of Orthopaedic Surgery University of California, Davis Sacramento California USA
| | - Tina H. Tran
- Department of Orthopaedic Surgery Oregon Health and Science University Portland Oregon USA
| | - Christin New
- Department of Orthopaedic Surgery Stanford University Medical Center Palo Alto California USA
| | - Rosanna L. Wustrack
- Department of Orthopaedic Surgery University of California, San Francisco San Francisco California USA
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Hu X, Lu M, He X, Li L, Lin J, Zhou Y, Luo Y, Min L, Tu C. Hip reconstruction using a customized intercalary prosthesis with the rhino horn-designed uncemented stem for ultrashort proximal femur segments following tumor resection: a combined biomechanical and clinical study. BMC Musculoskelet Disord 2022; 23:852. [PMID: 36076197 PMCID: PMC9454185 DOI: 10.1186/s12891-022-05805-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/05/2022] [Indexed: 11/17/2022] Open
Abstract
Background Hip-preserved reconstruction for patients with ultrashort proximal femur segments following extensive femoral diaphyseal tumor resection is a formidable undertaking. A customized intercalary prosthesis with a rhino horn-designed uncemented stem was developed for the reconstruction of these extensive skeletal defects. Methods This study was designed to analyze and compare the differences in the biomechanical behavior between the normal femur and the femur with diaphyseal defects reconstructed by an intercalary prosthesis with different stems. The biomechanical behavior under physiological loading conditions is analyzed using the healthy femur as the reference. Five three-dimensional finite element models (healthy, customized intercalary prosthesis with four different stems implemented, respectively) were developed, together with a clinical follow-up of 12 patients who underwent intercalary femoral replacement. Results The biomechanical results showed that normal-like stress and displacement distribution patterns were observed in the remaining proximal femur segments after reconstructions with the rhino horn-designed uncemented stems, compared with the straight stem. Stem A showed better biomechanical performance, whereas the fixation system with Stem B was relatively unstable. The clinical results were consistent with the FEA results. After a mean follow-up period of 32.33 ± 9.12 months, osteointegration and satisfactory clinical outcomes were observed in all patients. Aseptic loosening (asymptomatic) occurred in one patient reconstructed by Stem B; there were no other postoperative complications in the remaining 11 patients. Conclusion The rhino horn-designed uncemented stem is outstanding in precise shape matching and osseointegration. This novel prosthesis design may be beneficial in decreasing the risk of mechanical failure and aseptic loosening, especially when Stem A is used. Therefore, the customized intercalary prosthesis with this rhino horn-designed uncemented stem might be a reasonable alternative for the reconstruction of SSPF following extensive tumor resection.
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Affiliation(s)
- Xin Hu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.,Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Minxun Lu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.,Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xuanhong He
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.,Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Longqing Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.,Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jingqi Lin
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.,Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yong Zhou
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.,Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yi Luo
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.,Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Li Min
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China. .,Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Chongqi Tu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China. .,Department of Model Worker and Innovative Craftsman, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.
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Groundland J, Brown JM, Monument M, Bernthal N, Jones KB, Randall RL. What Are the Long-term Surgical Outcomes of Compressive Endoprosthetic Osseointegration of the Femur with a Minimum 10-year Follow-up Period? Clin Orthop Relat Res 2022; 480:539-548. [PMID: 34559734 PMCID: PMC8846358 DOI: 10.1097/corr.0000000000001979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 08/26/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Endoprosthetic reconstruction after oncologic resection of bone tumors requires stable fixation between the prosthesis and residual host bone. Compressive osseointegration has been developed as an alternative to traditional stemmed implants to address the challenges and complications of achieving this fixation. Sufficient time has now passed from the advent of compressive implants to allow for an assessment of the intermediate-term and long-term results of this form of fixation. QUESTIONS/PURPOSES At a minimum follow-up of 10 years after implantation of a compressive osseointegration device for oncologic reconstruction: (1) What is the risk of periprosthetic fracture, aseptic loosening, or implant breakage resulting in revision surgery for endoprosthesis removal? (2) What is the long-term cortical response at the host-endoprosthesis interface as visualized on plain radiographs? METHODS A single-center, retrospective study was performed between 2002 and 2010, in which 110 patients with primary bone sarcoma of the proximal or distal femur were considered for oncologic resection and reconstruction. Patients were considered for a compressive osseointegration endoprosthesis if they were 50 years of age or younger, had not previously received femoral radiation, had no metabolic disease impairing bone healing, were not diagnosed with metastatic disease, and had life expectancy greater than six months. Of the 110 patients, 25 were treated with a compressive osseointegration implant of the proximal or distal femur, and 85 patients were treated with conventional stemmed implants or amputation because of older age, advanced disease, metabolic comorbidities, inability to tolerate a nonweightbearing postoperative period, or in the case of rotationplasty, patient preference. All patients who received this device during the period of study were considered eligible for inclusion in this review. The median (range) age was 18 years (7 to 50), and 13 of 25 patients were men. Five patients died of disease before the minimum follow-up duration of 10 years; two underwent amputation due to local recurrence and three died with the implant in situ, leaving 20 patients for complete analysis. Median follow-up was 144 months, and all 20 surviving patients had a minimum follow-up of 10 years (121 to 230 months). The primary endpoint was reoperation and implant removal for periprosthetic fracture, aseptic loosening, or mechanical breakage of any component of the compressive device in the endoprosthesis. In final analysis, death was considered a competing event to revision surgery, and cumulative incidence was reported after competing-event analysis. A secondary aim was radiographic evaluation of the host-implant interface to assess the long-term cortical response to compressive osseointegration. RESULTS Spindle fracture or loosening was noted in three patients, and the remaining 17 patients maintained the compression device until the final follow-up. The risk of reoperation for aseptic loosening, periprosthetic fracture, or mechanical breakage of the implant using a competing risks estimator was 12% at 10 years (95% CI 0% to 26%). These complications occurred within 29 months of the index surgery; no patients had implant loosening or mechanical breakdown after this initial period. On radiographic assessment, 14 patients demonstrated cortical hypertrophy of the bone-implant interface, six patients had maintenance of the native cortical contour, and no patients had cortical atrophy or narrowing at the implant interface.Conclusion Long-term follow-up in patients with compressive osseointegrative endoprosthetic devices demonstrated no late revisions because of periprosthetic fracture, aseptic loosening, or implant breakage in this cohort with a minimum 10-year follow-up. There was no evidence of late-onset cortical atrophy or stress shielding at the host-implant interface. This study supports the long-term stability of the interface between host bone and the endoprosthesis in compressive osseointegration devices. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- John Groundland
- Department of Orthopedics, Sarcoma Service, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Jeffrey M. Brown
- University of Miami Miller School of Medicine, Orthopedics, Miami, FL, USA
| | - Michael Monument
- Arnie Charbonneau Cancer Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nicholas Bernthal
- Department of Orthopaedic Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Santa Monica, CA, USA
| | - Kevin B. Jones
- Department of Orthopedics, Sarcoma Service, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - R. Lor Randall
- Department of Orthopedic Surgery, University of California, Davis, UC Davis Medical Center, Sacramento, CA, USA
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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] [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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Parlee L, Kagan R, Doung YC, Hayden JB, Gundle KR. Compressive osseointegration for endoprosthetic reconstruction. Orthop Rev (Pavia) 2020; 12:8646. [PMID: 33312488 PMCID: PMC7726822 DOI: 10.4081/or.2020.8646] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/20/2020] [Indexed: 02/02/2023] Open
Abstract
This review summarizes the biomechanical concepts, clinical outcomes and limitations of compressive osseointegration fixation for endoprosthetic reconstruction. Compressive osseointe - gration establishes stable fixation and integration through a novel mechanism; a Belleville washer system within the spindle applies 400-800 PSI force at the boneimplant interface. Compressive osseointegration can be used whenever standard endoprosthetic reconstruction is indicated. However, its mode of fixation allows for a shorter spindle that is less limited by the length of remaining cortical bone. Most often compressive osseointegration is used in the distal femur, proximal femur, proximal tibia, and humerus but these devices have been customized for use in less traditional locations. Aseptic mechanical failure occurs earlier than with standard endoprosthetic reconstruction, most often within the first two years. Compressive osseointegration has repeatedly been proven to be non-inferior to standard endoprosthetic reconstruction in terms of aseptic mechanical failure. No demographic, device specific, oncologic variables have been found to be associated with increased risk of aseptic mechanical failure. While multiple radiographic parameters are used to assess for aseptic mechanical failure, no suitable method of evaluation exists. The underlying pathology associated with aseptic mechanical failure demonstrates avascular bone necrosis. This is in comparison to the bone hypertrophy and ingrowth at the boneprosthetic interface that seals the endosteal canal, preventing aseptic loosening.
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Affiliation(s)
- Lindsay Parlee
- Department of Orthopedics and Rehabilitation, Oregon Health and Science University
| | - Ryland Kagan
- Department of Orthopedics and Rehabilitation, Oregon Health and Science University
| | - Yee-Cheen Doung
- Department of Orthopedics and Rehabilitation, Oregon Health and Science University
| | - James B Hayden
- Department of Orthopedics and Rehabilitation, Oregon Health and Science University
| | - Kenneth R Gundle
- Department of Orthopedics and Rehabilitation, Oregon Health and Science University.,Operative Care Division, Portland VA Medical Center, OR, USA
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Proximal femoral reconstructions: A European “Italian” experience. A case series. CURRENT ORTHOPAEDIC PRACTICE 2019. [DOI: 10.1097/bco.0000000000000813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chemotherapy Curtails Bone Formation From Compliant Compression Fixation of Distal Femoral Endoprostheses. Clin Orthop Relat Res 2019; 477:206-216. [PMID: 30260861 PMCID: PMC6345286 DOI: 10.1097/corr.0000000000000512] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Modulated compliant compressive forces may contribute to durable fixation of implant stems in patients with cancer who undergo endoprosthetic reconstruction after tumor resection. Chemotherapy effects on bone hypertrophy and osteointegration have rarely been studied, and no accepted radiologic method exists to evaluate compression-associated hypertrophy. QUESTIONS/PURPOSES (1) What was the effect of chemotherapy on the newly formed bone geometry (area) at 1 year and the presumed osteointegration? (2) What clinical factors were associated with the degree of hypertrophy? (3) Did the amount of bone formation correlate with implant fixation durability? (4) Was the amount of new bone generation or chemotherapy administration correlated with Musculoskeletal Tumor Society (MSTS) score? METHODS Between 1999 and 2013, we performed 245 distal femoral reconstructions for primary or revision oncologic indications. We evaluated 105 patients who received this implant. Ten were excluded because they lacked 2 years of followup and two were lost to followup, leaving 93 patients for review. All underwent distal femur reconstruction with the compliant compressive fixation prosthesis; 49 received postoperative chemotherapy and 44 did not. During this period, the implant was used for oncology patients < 60 years of age without metastases and with > 8 cm of intact, nonirradiated bone distal to the lesser trochanter and ≥ 2.5 mm of cortex. Our cohort included patients with painful loosening of cemented or uncemented stemmed femoral megaprostheses when revision with the compliant compressive device was feasible. Patients with high-grade sarcomas all received chemotherapy, per active Children's Oncology Group protocols, for their tumor diagnosis. At each imaging time point (3, 6, 9, 12, 18, 24 months), we measured the radiographic area of the bone under compression using National Institutes of Health open-access software, any shortening of the spindle-anchor plug segment distance as reflected by the exposed traction bar length, and prosthesis survivorship. Clinical and functional status and MSTS scores were recorded at each followup visit. Duration of prosthesis retention without aseptic loosening or mechanical failure was evaluated using Kaplan-Meier analysis, censoring patients at last followup. RESULTS Chemotherapy was associated with the amount of overall bone formation in a time-dependent fashion. In the 12 months after surgery there was more bone formation in patients who did not receive postoperative chemotherapy than those who did (60.2 mm, confidence interval [CI] 49.3-71.1 versus 39.1, CI 33.3-44.9; p = 0.001). Chemotherapy was not associated with prosthesis survival. Ten-year implant survival was 85% with chemotherapy and 88% without chemotherapy (p = 0.74). With the number of patients we had, we did not identify any clinical factors that were associated with the amount (area) of hypertrophy. The hypertrophied area was not associated with the durability of implant fixation. MSTS scores were lower in patients treated with chemotherapy (25 versus 28; p = 0.023), but were not correlated with new bone formation. CONCLUSIONS The relationships among chemotherapy, bone formation, and prosthetic survivorship are complex. Because bone formation is less in the first year when the patient is being treated with chemotherapy, it is not clear if the rehabilitation schedule should be different for those patients receiving chemotherapy compared with those who do not. The relationship between early bone formation and the timing of weightbearing rehabilitation should be evaluated in a multicenter study. LEVEL OF EVIDENCE Level III, therapeutic study.
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Boland PJ. CORR Insights ®: Use of Compressive Osteointegration Endoprostheses for Massive Bone Loss From Tumor and Failed Arthroplasty: A Viable Option in the Upper Extremity. Clin Orthop Relat Res 2017; 475:1712-1715. [PMID: 28374348 PMCID: PMC5406361 DOI: 10.1007/s11999-017-5332-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 03/21/2017] [Indexed: 01/31/2023]
Affiliation(s)
- Patrick J. Boland
- Orthopaedic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
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10
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McGough RL, Goodman MA, Randall RL, Forsberg JA, Potter BK, Lindsey B. The Compress® transcutaneous implant for rehabilitation following limb amputation. Unfallchirurg 2017; 120:300-305. [DOI: 10.1007/s00113-017-0339-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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