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Karampikas V, Gavriil P, Goumenos S, Trikoupis IG, Roustemis AG, Altsitzioglou P, Kontogeorgakos V, Mavrogenis AF, Papagelopoulos PJ. Risk factors for peri-megaprosthetic joint infections in tumor surgery: A systematic review. SICOT J 2024; 10:19. [PMID: 38819289 PMCID: PMC11141517 DOI: 10.1051/sicotj/2024008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/05/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Peri-megaprosthetic joint infections (PJI) in tumor surgery are complex and challenging complications that significantly impact the outcomes of the patients. The occurrence of PJI poses a substantial threat to the success of these operations. This review aims to identify and summarize the risk factors associated with PJI in tumor surgery with megaprosthetic reconstruction as well as to determine the overall risk of PJI in limb salvage surgery. METHODS A thorough examination of published literature, scrutinizing the incidence of PJI in tumor prostheses after limb salvage surgery was done. Research studies that documented the incidence of PJI in tumor patients who underwent limb salvage surgery, and explored the risk factors associated with the occurrence of PJI were deemed eligible. RESULTS A total of 15 studies were included in the analysis and underwent comprehensive examination. After the exploration of key parameters, several significant risk factors for PJI concerning the type of implant coating, surgical site characteristics, patient demographics, and procedural factors were recorded. DISCUSSION The findings underscore the need for a nuanced approach in managing tumor patients undergoing limb salvage surgery and megaprosthetic reconstruction, with emphasis on individualized risk assessments and individualized preventive strategies.
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Affiliation(s)
- Vasileios Karampikas
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Street, 15562, Holargos, Athens, Greece
| | - Panayiotis Gavriil
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Street, 15562, Holargos, Athens, Greece
| | - Stavros Goumenos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Street, 15562, Holargos, Athens, Greece
| | - Ioannis G Trikoupis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Street, 15562, Holargos, Athens, Greece
| | - Anastasios G Roustemis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Street, 15562, Holargos, Athens, Greece
| | - Pavlos Altsitzioglou
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Street, 15562, Holargos, Athens, Greece
| | - Vasileios Kontogeorgakos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Street, 15562, Holargos, Athens, Greece
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Street, 15562, Holargos, Athens, Greece
| | - Panayiotis J Papagelopoulos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Street, 15562, Holargos, Athens, Greece
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Sadek WMS, Ebeid WA, Ghoneimy AE, Ebeid E, Senna WGA. Functional and Oncological Outcome of Patients with Distal Femoral Osteosarcoma Managed by Limb Salvage Using Modular Endoprosthesis. Ann Surg Oncol 2023; 30:5150-5158. [PMID: 37273024 PMCID: PMC10319677 DOI: 10.1245/s10434-023-13679-x] [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: 01/12/2023] [Accepted: 05/10/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND The aim of the study was to assess the functional and oncological outcomes of patients with distal femoral osteosarcoma managed by limb salvage using modular endoprosthesis as well as to assess related complications. PATIENTS AND METHODS A total of 82 patients were included in our study. Functional outcome was assessed using MSTS score and knee range of motion. Oncological outcome was assessed regarding local recurrence, chest metastasis, and patient survivorship. Complications were classified according to Henderson et al. RESULTS: The mean MSTS score was 26.21 (87.4%) (range 8-30 points) with 70.7% of patients having more than 90° of flexion. The incidence of local recurrence was 3.7% (3 patients), while the incidence of chest metastasis was 14.6% (12 patients). Aseptic loosening (type 2 failure) was the commonest complication (19.5%), followed by infection (15.9%). The 5- and 10-year survivorships of the limb were 98.8%, while the 5- and 10-year survivorships of the prosthesis were 67.7% and 52.4%, respectively. CONCLUSION This study showed that patients with osteosarcoma distal femur who are treated by chemotherapy and limb salvage have an excellent long-term prognosis in terms of patient as well as limb survivorship. The use of modular endoprosthesis in these patients offer an acceptable function, with two-thirds of the patients retaining their prosthesis after 5 years and more than half retaining them after 10 years.
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Affiliation(s)
| | - Walid Atef Ebeid
- Department of Orthopaedics and Traumatology, Cairo University, Cairo, Egypt
| | - Ahmed El Ghoneimy
- Department of Orthopaedics and Traumatology, Cairo University, Cairo, Egypt
| | - Emad Ebeid
- Department of Paediatric Oncology and Haematology, National Cancer Institute, Cairo University, Cairo, Egypt
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Giglio V, Gazendam A, Schneider P, Ghert M, Wilson D. The Impact of Implant Fixation Type on Reoperation Rates Following Endoprosthetic Reconstruction Surgery. J Bone Joint Surg Am 2023; 105:15-21. [PMID: 37466575 DOI: 10.2106/jbjs.22.00886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Prospective evidence supporting the use of cemented or uncemented implants in endoprosthetic reconstruction is lacking. The present study aimed to determine the effect of cemented fixation compared with uncemented fixation on the rate of all-cause reoperation at 1 year postoperatively. METHODS This is a secondary analysis of the Prophylactic Antibiotic Regimens In Tumor Surgery (PARITY) trial. A total of 503 patients who underwent surgical excision and endoprosthetic reconstruction of a lower-extremity bone tumor were included in this analysis. A multivariate Cox proportional hazards model was utilized to assess the independent relationship between fixation group and implant survivorship, with all-cause reoperation as the end point. RESULTS There were 388 cemented implants and 115 uncemented implants. Participants had a mean age of 42.7 years (standard deviation, 22.0 years), and 59% were male. Overall, 131 reoperations were identified over the 1-year follow-up period. There were no significant differences found in all-cause reoperation (hazard ratio [HR], 1.05; 95% confidence interval [CI], 0.70 to 1.57; p = 0.761), septic reoperation, or aseptic reoperation between cemented and uncemented fixation at 1 year postoperatively. The Cox regression analysis demonstrated that total operative time (HR per hour, 1.10; 95% CI, 1.02 to 1.20; p = 0.019) was an independent predictor of reoperation. The risk of reoperation was lower in patients with benign aggressive disease (HR, 0.11; 95% CI, 0.02 to 0.80; p = 0.029) or metastatic bone disease (HR, 0.30; 95% CI, 0.11 to 0.85; p = 0.023). Patients who underwent cemented fixation showed clinically meaningful functional improvement at 1 year postoperatively. CONCLUSIONS Cemented compared with uncemented fixation has no effect on 1-year all-cause reoperation rates in endoprosthetic reconstruction surgery. Further research is required to investigate the long-term survival of cemented versus uncemented implants. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Victoria Giglio
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Aaron Gazendam
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | | | - Michelle Ghert
- Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - David Wilson
- Department of Surgery, Division of Orthopaedic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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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] [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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Tsantes AG, Altsitzioglou P, Papadopoulos DV, Lorenzo D, Romanò CL, Benzakour T, Tsukamoto S, Errani C, Angelini A, Mavrogenis AF. Infections of Tumor Prostheses: An Updated Review on Risk Factors, Microbiology, Diagnosis, and Treatment Strategies. BIOLOGY 2023; 12:biology12020314. [PMID: 36829589 PMCID: PMC9953401 DOI: 10.3390/biology12020314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/01/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023]
Abstract
Several causes contribute to the high infection rate in tumor prostheses, including extensive tissue dissection and patients' immunosuppression due to the neoplastic disease. Most of these infections develop within the first 2 years following surgery with 70% of them occurring during the first year, while they are often associated with a low pathogen burden. The pathogenesis of infections in tumor prostheses is linked to bacteria developing in biofilms. Approximately half of them are caused by Staphylococcus spp., followed by Streptococcus spp., Enterococcus spp., and Enterobacteriaceae spp., while multiple pathogens may be isolated in up to 25% of the cases, with coagulase-negative Staphylococci (CoNS) and Enterococccus spp. being the most frequent pair. Although early detection and timely management are essential for complete resolution of these challenging infections, prompt diagnosis is problematic due to the highly varying clinical symptoms and the lack of specific preoperative and intraoperative diagnostic tests. Surgical management with one- or two-stage revision surgery is the mainstay for successful eradication of these infections. The recent advances in laboratory diagnostics and the development of biofilm-resistant prostheses over the past years have been areas of great interest, as research is now focused on prevention strategies. The aim of this study is to review and consolidate the current knowledge regarding the epidemiology, risk factors, microbiology, and diagnosis of infections of tumor prostheses, and to review the current concepts for their treatment and outcomes.
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Affiliation(s)
- Andreas G. Tsantes
- Microbiology Department, “Saint Savvas” Oncology Hospital, 11522 Athens, Greece
- Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Pavlos Altsitzioglou
- First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Dimitrios V. Papadopoulos
- 2nd Academic Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 14233 Athens, Greece
| | - Drago Lorenzo
- Clinical Microbiology, Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | | | | | - Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, Nara 634-8521, Japan
| | - Costantino Errani
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Andrea Angelini
- Department of Orthopaedics and Orthopaedic Oncology, University of Padova, 35122 Padova, Italy
| | - Andreas F. Mavrogenis
- First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
- Correspondence: ; Tel.: +30-210-6542800
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Pereira CM, Pinto FFE, Nakagawa SA, Chung WT. Reconstruction with Unconventional Endoprostheses after Resection of Primary Distal Femoral Bone Tumors: Implant Survival and Functional Outcomes. Rev Bras Ortop 2022; 57:1030-1038. [PMID: 36540741 PMCID: PMC9757959 DOI: 10.1055/s-0042-1748966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/04/2022] [Indexed: 12/23/2022] Open
Abstract
Objective To evaluate the survival time, the failure rate and its causes, and the functional results of cemented endoprostheses, with a polyethylene body, used after resection of primary bone tumors of the distal femur. Methods A retrospective study including 93 primary and 77 review procedures performed between 1987 and 2014. Survival was obtained by the Kaplan Meyer analysis, and the risk factors for implant failure were assessed through the Cox proportional risk model. The causes of endoprosthesis failure were classified according to Henderson et al. into five types: soft-tissue failure, aseptic loosening, structural fracture, infection, and tumor recurrence. The functional evaluation was performed using the functional classification system of the Musculoskeletal Tumor Society (MSTS) of bone sarcomas of the lower extremity, Brazilian version (MSTS-BR). Results Osteosarcoma was the most common diagnosis; 64.5% of the patients were younger than 20 years of age; the mean follow-up was of 124.3 months. The failure rate of the primary implant was of 54.8%, and the mean survival was of 123 months. The estimated survival of the primary implant was of 63.6%, 43.5%, 24.1%, and 14.5% in 5, 10, 15, and 20 years respectively. The most common cause of failure was type 2 (37.3%). Age ≤ 26 years and right side were risk factors for failure. The mean MSTS-BR score was of 20.7 (range: 14 to 27). Conclusion The results obtained for the failure rate and survival of the implant are in accordance with those of the literature, so the procedure herein studied is adequate and yields satisfactory functional results, even in the long term.
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Affiliation(s)
- Cibele Marino Pereira
- Departamento de Ortopedia, AC Camargo Cancer Center, São Paulo, SP, Brasil,Endereço para correspondência Cibele Marino Pereira Rua Professor Antônio Prudente211–Liberdade, São Paulo, 01509-900, SPBrasil
| | | | | | - Wu Tu Chung
- Departamento de Ortopedia, AC Camargo Cancer Center, São Paulo, SP, Brasil
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Imaging following surgery for primary appendicular bone tumours. Skeletal Radiol 2021; 50:1527-1555. [PMID: 33481074 DOI: 10.1007/s00256-021-03712-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/22/2020] [Accepted: 01/10/2021] [Indexed: 02/02/2023]
Abstract
Primary bone tumours are uncommon, with sarcomas accounting for < 0.2% of all malignancies. The survival rate of primary bone sarcomas has significantly improved due to (neo)adjuvant therapy, while improved surgical techniques and development of new prostheses have shifted the surgical focus from amputation to limb preservation in the vast majority of patients. A wide variety of surgical options are available for the treatment of primary bone tumours which depend upon histological diagnosis, their appearance at the time of presentation and response to any (neo)adjuvant therapy as required. This review is intended to help radiologists familiarise themselves with the management of primary appendicular bone tumours and expected normal postoperative appearances for the various surgical techniques, and to recognise potential complications.
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Are Cemented Endoprosthetic Reconstructions Superior to Uncemented Endoprostheses in Terms of Postoperative Outcomes and Complications in Patients with Extremity-Located Bone Metastasis Scheduled for Adjuvant Radiotherapy? J Arthroplasty 2021; 36:1160-1167. [PMID: 33092933 DOI: 10.1016/j.arth.2020.09.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 09/09/2020] [Accepted: 09/18/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Adjuvant radiotherapy frequently is used for prevention of recurrence following resection and endoprosthetic reconstruction of bone metastases. Besides this positive effect, radiotherapy can negatively affect both cemented and uncemented endoprostheses. METHODS We retrospectively analyzed 130 extremities of 115 patients who underwent resection and cemented or uncemented endoprosthetic reconstruction for bone metastasis, followed by postoperative radiation therapy. The functional improvement was assessed by Karnofsky Performance Scale and Musculoskeletal Tumor Society (MSTS) scoring. The radiological evaluation mainly included analysis of "loosening areas" which were defined as the regions of osteolysis between the stem of the endoprostheses and the cement or cortex. The complications resulting in reconstruction failure and patient survival were recorded. RESULTS A survival analysis revealed that 21 (18.3%) patients were alive with disease and 94 (81.7%) died of disease at the time of study. The mean last follow-up Karnofsky Performance Scale and MSTS scores of the whole study cohort were 78.69 ± 8.66 and 82.15 ± 9.06, respectively. There were 8 (6.15%) complications resulting in reconstruction failure, including aseptic loosening (2), femoral stem breakage (2), periprosthetic fracture (2), and infection (2). The number and time of complications did not show a significant difference between the cemented and uncemented groups (P > .05). CONCLUSION This study demonstrated that there was no significant difference in complication rates of cemented or uncemented endoprosthetic reconstructions in patients with extremity-located bone metastases scheduled for adjuvant radiotherapy. The only result in favor of cemented prostheses was significantly higher MSTS functional scores at last follow-up.
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Does a Competing Risk Analysis Show Differences in the Cumulative Incidence of Revision Surgery Between Patients with Oncologic and Non-oncologic Conditions After Distal Femur Replacement? Clin Orthop Relat Res 2020; 478:1062-1073. [PMID: 31895069 PMCID: PMC7170673 DOI: 10.1097/corr.0000000000001106] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Distal femur replacement is frequently used for limb salvage after bone tumor resections. It is also used in patients with severe bone loss because of traumatic conditions or revision TKA. Some studies on distal femur replacement reported on revision-free survival without distinguishing between patients with oncologic diagnoses and those without, although these patients might be incomparable because of their differences in important patient- and disease-specific characteristics. This may lead to an inaccurate and undifferentiated interpretation of the results of survival analyses. QUESTIONS/PURPOSES (1) What is the overall cumulative incidence of revision surgery after cemented and cementless distal femoral replacement, as determined with a competing risk analysis? (2) Does the cumulative incidence of revision surgery change over time? (3) Are there differences in the cumulative incidence of revision surgery between patients with oncologic conditions and those without who are treated with cemented or cementless distal femoral replacement? METHODS A total of 403 patients were possible candidates for distal femoral replacement. Of these, 56 patients elected to undergo different procedures, 83 were excluded because an expendable growing prosthesis was implanted, and 28 were lost to follow-up. Therefore, 229 patients who underwent distal femoral replacement for oncologic or non-oncologic reasons between 1983 and 2016 were retrospectively included in this study. The type of fixation method (cemented or cementless) was obtained from the patients' medical records, operation reports, and radiographic analyses from plain radiographs. All radiographs were standardized and obtained at standard time intervals in our institution. No algorithm regarding the fixation approach was followed. According to our data, patients receiving cementless fixation were younger and therefore likely to be more active than those receiving cemented fixation. The median follow-up duration of the overall cohort was 85 months (range 0.1-391 months). Patients who died or had revision surgery before the 2-year minimum follow-up interval were adequately considered using competing risk calculation. The reasons for revision surgery were classified using the classification system proposed by the International Society for Limb Salvage. A competing risk analysis was performed to estimate the cumulative incidence function of revision, accounting for death as a competing event. To evaluate the influence of potential prognostic factors, including diagnosis (oncologic versus non-oncologic), fixation (cemented versus cementless), year of distal femoral replacement, age, and sex on the occurrence of revision surgery, univariate and multivariable Fine and Gray models were applied. RESULTS The competing risks analysis revealed cumulative incidences of revision surgery for any cause (Types 1 to 5) of 26% (95% CI, 20.3%-31.9%) at 12 months, 37.9% (95% CI, 31.3%-44.4%) at 24 months, 52.6% (95% CI, 45.1%-59.5%) at 5 years, and 58.2% (95% CI, 50.1%-65.4%) at 10 years for all patients. Rotating hinge-type prostheses showed a lower cumulative incidence of revision surgery (41.6%; 95% CI, 31.8%-51%) than fixed-hinge prostheses did (64%; 95% CI, 50.5%-74.5% ) at 5 years (Gray's test: p = 0.01). According to the multivariate Fine and Gray model, the year of surgery did not have any effect on the risk of revision surgery (1994 to 2003: hazard ratio 0.70; 95% CI, 0.46-1.07); 2004 to 2016: HR 0.83; 95% CI, 0.52-1.34; p = 0.26). The multivariate analysis, adjusted for disease, sex, age, cementation, and year of surgery, revealed a difference in the risk of revision surgery between patients with oncologic disease and those with non-oncologic disease (HR 0.44 for oncologic versus non-oncologic; 95% CI, 0.22-0.87; p = 0.02) and a reduction in the risk of overall revision with cemented fixation in patients with oncologic disease (HR 0.53; 95% CI, 0.29-0.98; p = 0.03). CONCLUSION This study indicates that even with newer implants, there was a high incidence of revision surgery after distal femoral replacement. According to our analysis, patients with oncologic diagnoses have a lower likelihood of revision when the stem is cemented whereas the type of fixation did not impact patients with non-oncologic diagnoses. Because of differences in patient demographics (age, etiology of disease, and use of chemotherapy) and outcomes of fixation, oncologic and non-oncologic patients should be analyzed separately in survival studies about distal femoral replacement. LEVEL OF EVIDENCE Level III, therapeutic study.
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Nagm A, Ogiwara T, Hongo K. Watertight Robust Osteoconductive Barrier for Complex Skull Base Reconstruction: An Expanded-endoscopic Endonasal Experimental Study. Neurol Med Chir (Tokyo) 2019; 59:79-88. [PMID: 30787233 PMCID: PMC6434420 DOI: 10.2176/nmc.oa.2018-0262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Endoscopic skull base reconstruction (ESBR) following expanded-endoscopic endonasal approaches (EEA) in high-risk non-ideal endoscopic reconstructive candidates remains extremely challenging, and further innovations are still necessary. Here, the aim is to study the reconstructive knowledge gap following expanded-EEA and to introduce the watertight robust osteoconductive (WRO)-barrier as an alternative durable option. Distinctively, we focused on 10 clinical circumstances. A 3D-skull base-water system model was innovated to investigate the ESBR under realistic conditions. A large-irregular defect (31 × 89 mm) extending from the crista galli to the mid-clivus was achieved. Then, WRO-barrier was fashioned and its tolerance was evaluated under stressful settings, including an exceedingly high (55 cmH2O) pressure, with radiological assessment. Next, the whole WRO-barrier was drilled to examine its practical-safe removal (simulating redo-EEA) and the whole experiment was repeated. Finally, WRO-barrier was kept into place to value its 18-month long-term high-tolerance. Results in all experiments of WRO-barriers were satisfactorily fashioned to conform the geometry of the created defect under realistic circumstances via EEA, tolerated an exceedingly high pressure without evidence of leak even under stressful settings, resisted sudden-elevated pressure, and remained in its position to maintain long-term watertight seal (18 months), efficiently evaluated with neuroimaging and simply removed-and-reconstructed when redo-EEA is needed. In conclusion, WRO-barrier as an osteoconductive watertight robust design for cranial base reconstruction possesses several distinct qualities that might be beneficial for patients with complex skull base tumours.
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Affiliation(s)
- Alhusain Nagm
- Department of Neurosurgery, Shinshu University School of Medicine.,Department of Neurosurgery, Faculty of Medicine, Al-Azhar University
| | | | - Kazuhiro Hongo
- Department of Neurosurgery, Shinshu University School of Medicine
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CORR Insights®: Chemotherapy Curtails Bone Formation From Compliant Compression Fixation of Distal Femoral Endoprostheses. Clin Orthop Relat Res 2019; 477:217-218. [PMID: 30516654 PMCID: PMC6345311 DOI: 10.1097/corr.0000000000000556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Comprehensive Treatment and Rehabilitation of Patients With Osteosarcoma of the Mandible. IMPLANT DENT 2018; 27:332-341. [PMID: 29652755 DOI: 10.1097/id.0000000000000756] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The article studies state-of-the art physical therapeutic techniques as a high degree of relevance to minimize invalidation and improve quality of life for patients with dental osteosarcoma. MATERIALS AND METHODS A randomized controlled clinical trial was conducted in 21 patients with osteogenic sarcoma of mandible (C41.1). There were 10 patients in the experimental group and 11 patients in the control group. RESULTS A comprehensive treatment and rehabilitation program for patients with osteosarcoma of mandible was developed. The first part of the program comprised 3 basic phases: preop chemotherapy, surgery, and postop rehabilitation. The surgical treatment further included resection of an affected part of the mandible and primary repair of the defect with jaw fragments and an autoimplant joined together with the help of positioning devices. The postop rehabilitation included postop chemotherapy and mesodiencephalic modulation (MDM). The second part of the program comprised preop examination, modeling, using stereolytic 3-dimensional models of the mandible, corrective surgeries, including implantation into the autoimplant-a fragment of patient's fibula, and building of a removable titanium alloy-based denture. MDM sessions were administered after each invasive intervention. CONCLUSIONS Higher psychological and physical well-being was observed in the experimental group as compared with the control group (P < 0.01) in 2 weeks after the first surgery and 2 months after scheduled corrective surgeries, which finished in denture installation.
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Limb salvage in the upper limb: a review. CURRENT ORTHOPAEDIC PRACTICE 2017. [DOI: 10.1097/bco.0000000000000565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Radiographic assessment of distal femur cemented stems in tumor endoprostheses. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:821-827. [DOI: 10.1007/s00590-017-1965-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 04/13/2017] [Indexed: 11/25/2022]
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15
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Tan TJ, Aljefri AM, Clarkson PW, Masri BA, Ouellette HA, Munk PL, Mallinson PI. Imaging of limb salvage surgery and pelvic reconstruction following resection of malignant bone tumours. Eur J Radiol 2015; 84:1782-90. [PMID: 26104572 DOI: 10.1016/j.ejrad.2015.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 06/02/2015] [Indexed: 11/16/2022]
Abstract
Advances in reconstructive orthopaedic techniques now allow for limb salvage and prosthetic reconstruction procedures to be performed on patients who would otherwise be required to undergo debilitating limb amputations for malignant bone tumours. The resulting post-operative imaging of such cases can be daunting for the radiologist to interpret, particularly in the presence of distorted anatomy and unfamiliar hardware. This article reviews the indications for limb salvage surgery, prosthetic reconstruction devices involved, expected post-operative imaging findings, as well as the potential hardware related complications that may be encountered in the management of such cases.
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Affiliation(s)
- Tien Jin Tan
- Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada.
| | - Ahmad M Aljefri
- Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Paul W Clarkson
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Bassam A Masri
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Hugue A Ouellette
- Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Peter L Munk
- Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Paul I Mallinson
- Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
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