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Westphal LM, Theil C, Gosheger G, Ellerbrock M, Deventer N, Schneider KN. Patients Regularly Return to Medium- and Low-Impact Types of Sporting Activities Following Distal Femoral or Proximal Tibial Replacement After Resection of a Primary Bone Sarcoma. J Arthroplasty 2024:S0883-5403(24)00613-2. [PMID: 38880406 DOI: 10.1016/j.arth.2024.06.014] [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: 02/29/2024] [Revised: 06/07/2024] [Accepted: 06/10/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND Little is known about the resumption of sporting activities following megaprosthetic reconstruction of the distal femur and proximal tibia after resection of a bone sarcoma. Thus, the aims of our study were: (1) to assess the functional outcome; (2) to evaluate pre- and post-operatively performed sporting activities; and (3) to identify potential beneficial and limiting factors. METHODS Between 1993 and 2015, a total of 230 patients underwent distal femoral replacement (DFR), and 96 patients underwent proximal tibial replacement (PTR). The exclusion criteria were death, amputation, living overseas, and a congenital disability. Functional outcome and sporting activities were assessed using the Musculoskeletal Tumor Society Score (MSTS), Toronto Extremity Salvage Score (TESS), Forgotten Joint Score (FJS), subjective knee value (SKV), the Tegner activity score (TS), and the modified weighted activity score (WAS). RESULTS There were 93 patients who had a median follow-up of 182 months (interquartile range (IQR) 130 to 260) after DFR with the following median scores: MSTS 18 (IQR 12 to 23), TESS 75% (IQR 60 to 84), FJS 25 (IQR 8 to 40), SKV 53% (IQR 40 to 70), TS 3 (IQR 3 to 4), and WAS 4 (IQR 0 to 8). There were 42 patients who had a median follow-up of 193 months (IQR 137 to 244) after PTR had the following median scores: MSTS 17 (IQR 15 to 22), TESS 78% (IQR 68 to 88), FJS 32 (IQR 20 to 46), SKV 60% (IQR 40 to 70), TS 3 (IQR 3 to 4), and WAS 4 (IQR 1 to 10). Postoperatively, 61% of DFR and 76% of PTR patients participated in at least one sporting activity. CONCLUSIONS The functional outcome is overall good with a regular resumption of sporting activities. Patients' age at surgery and higher preoperative sporting levels were associated with better functional outcomes and higher postoperative sporting activity.
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Affiliation(s)
- Lucia M Westphal
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Münster, Germany
| | - Christoph Theil
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Münster, Germany
| | - Georg Gosheger
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Münster, Germany
| | - Moritz Ellerbrock
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Münster, Germany
| | - Niklas Deventer
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Münster, Germany
| | - Kristian N Schneider
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Münster, Germany
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2
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Fernando-Canavan L, Abraham P, Devlin N, Tran-Duy A. Health-related quality of life in patients with extremity bone sarcoma after surgical treatment: a systematic review. Qual Life Res 2024; 33:1157-1174. [PMID: 38079025 DOI: 10.1007/s11136-023-03554-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 04/26/2024]
Abstract
PURPOSE We conducted a systematic review of studies reporting on measurement of health-related quality of life (HRQoL), with a special focus on the use of the preference-weighted instruments, in patients with extremity bone sarcoma treated with limb-salvage surgery or amputation. METHODS We searched MedLine, Embase, Cochrane Library and Web of Science for English-language studies reporting on HRQoL of patients with bone sarcoma from inception to 28 August 2023. All records found were independently reviewed by two reviewers. We used the Newcastle-Ottawa Scale (NOS) and the CONSORT 2010 checklist to assess the quality of the cohort and randomised studies, respectively. RESULTS The search identified 1225 records, of which 16 studies were included for data extraction. Only one study used a preference-weighted instrument for measuring HRQoL in a small sample of patients (n = 28). Ten studies used the generic SF-36 questionnaire, but no preference-weighted HRQoL based on SF-6D was derived from the SF-36 scores. Most studies comparing HRQoL between amputation and limb-salvage surgery reported no significant differences. Twelve cohort studies scored six or more out of nine points based on the NOS. The only randomised study scored 54% on the CONSORT 2010 checklist. CONCLUSIONS The approaches used to measure HRQoL were inconsistent and outcome scores varied substantially. Only one study used preference-weighted instruments for HRQoL measurement. Future research into the surgical treatment of extremity bone sarcoma should consider the use of preference-weighted instruments to measure HRQoL, which will therefore enable economic evaluation for the growing orthopaedic armamentarium of novel surgical interventions. REGISTRATION This systematic review was registered with the PROSPERO International prospective register of systematic reviews (CRD42021282380).
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Affiliation(s)
- Liam Fernando-Canavan
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Patrick Abraham
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Nancy Devlin
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - An Tran-Duy
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
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3
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Cabrolier J, Werier J. Management of Ipsilateral Fractures After Rotationplasty: A Report of 2 Cases and Review of the Literature. JBJS Case Connect 2024; 14:01709767-202403000-00048. [PMID: 38517988 DOI: 10.2106/jbjs.cc.23.00625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
CASE Rotationplasty is a surgical procedure used for restoring functionality after skeletal tumor resection. Multiple complications have been described, including the potential occurrence of fractures. Literature on fracture management after rotationplasty is limited. In this article, we present 2 cases of late ipsilateral fractures in rotated limbs successfully treated with intramedullary nailing. CONCLUSION Effective management of fractures after rotationplasty requires thorough understanding of the rotated limb anatomy and careful planning. The clinical considerations presented in this article aim to provide guidance for surgeons to achieve successful outcomes in the management of fractures after rotationplasty.
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Affiliation(s)
- Jorge Cabrolier
- Clinica Alemana - Universidad Del Desarrollo, Santiago, Chile
- Division of Orthopaedic Surgery, Instituto Traumatológico Teodoro Gebauer, Santiago, Chile
| | - Joel Werier
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario Canada
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4
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Fukushima T, Okita Y, Watanabe N, Yokota S, Nakano J, Tanaka Y, Kawai A. Progress in muscle strength of the reconstructed knee and quality of life of the patient after knee rotationplasty: A case report. Prosthet Orthot Int 2023; 47:651-654. [PMID: 37498771 DOI: 10.1097/pxr.0000000000000253] [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] [Received: 06/06/2022] [Accepted: 06/09/2023] [Indexed: 07/29/2023]
Abstract
Knee rotationplasty (KRP) is a function-preserving surgery that serves as an alternative to above-knee amputation in patients diagnosed with malignant bone and soft tissue tumors around the knee joint. However, the short-term progress of the reconstructed knee in terms of muscle strength is unclear after KRP. This case report describes the progress of a 37-year-old man diagnosed with synovial sarcoma in the distal femur, 1 year after undergoing KRP. Changes in muscle strength of the reconstructed knee and physical function are reported. Physical therapy was started on postoperative day 1 after the KRP, and mobilization proceeded step-by-step with sitting, wheelchair transfer, and crutch walking. Active and passive range-of-motion exercises of the reconstructed knee were started on postoperative day 5. The isometric reconstructed knee extension strength, 10-m walk test, timed up and go test, Musculoskeletal Tumor Society score, Toronto Extremity Salvage Score, and quality of life (QOL) were evaluated. One month postoperatively, muscle strength had increased, and at 6 and 12 months postoperatively, isometric knee extension strength and physical function had improved. Furthermore, activities of daily living and QOL gradually improved over the course of the 12 months. Our case shows the previously unknown course of reconstructed knee muscle strength in the early post-KRP period, with corresponding improvements in physical function, activities of daily living, and QOL.
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Affiliation(s)
- Takuya Fukushima
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
- Faculty of Rehabilitation, Kansai Medical University, Osaka, Japan
| | - Yusuke Okita
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
| | - Noriko Watanabe
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
| | - Shota Yokota
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
| | - Jiro Nakano
- Faculty of Rehabilitation, Kansai Medical University, Osaka, Japan
| | - Yohei Tanaka
- Department of Rehabilitation Medicine, JR Tokyo General Hospital, Tokyo, Japan
| | - Akira Kawai
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
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5
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Filis P, Varvarousis D, Ntritsos G, Dimopoulos D, Filis N, Giannakeas N, Korompilias A, Ploumis A. Rotationplasty outcomes assessed by gait analysis following resection of lower extremity bone neoplasms. Bone Jt Open 2023; 4:817-824. [PMID: 37907080 PMCID: PMC10618047 DOI: 10.1302/2633-1462.411.bjo-2023-0101.r1] [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] [Indexed: 11/02/2023] Open
Abstract
Aims The standard of surgical treatment for lower limb neoplasms had been characterized by highly interventional techniques, leading to severe kinetic impairment of the patients and incidences of phantom pain. Rotationplasty had arisen as a potent limb salvage treatment option for young cancer patients with lower limb bone tumours, but its impact on the gait through comparative studies still remains unclear several years after the introduction of the procedure. The aim of this study is to assess the effect of rotationplasty on gait parameters measured by gait analysis compared to healthy individuals. Methods The MEDLINE, Scopus, and Cochrane databases were systematically searched without time restriction until 10 January 2022 for eligible studies. Gait parameters measured by gait analysis were the outcomes of interest. Results Three studies were eligible for analyses. Compared to healthy individuals, rotationplasty significantly decreased gait velocity (-1.45 cm/sec; 95% confidence interval (CI) -1.98 to -0.93; p < 0.001), stride length (-1.20 cm; 95% CI -2.31 to -0.09; p < 0.001), cadence (-0.83 stride/min; 95% (CI -1.29 to -0.36; p < 0.001), and non-significantly increased cycle time (0.54 sec; 95% CI -0.42 to 1.51; p = 0.184). Conclusion Rotationplasty is a valid option for the management of lower limb bone tumours in young cancer patients. Larger studies, with high patient accrual, refined surgical techniques, and well planned rehabilitation strategies, are required to further improve the reported outcomes of this procedure.
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Affiliation(s)
- Panagiotis Filis
- Department of Medical Oncology, University of Ιoannina, Ιoannina, Greece
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Dimitrios Varvarousis
- Division of Physical Medicine and Rehabilitation, Department of Surgery, University of Ioannina Medical School, Ioannina, Greece
| | - Georgios Ntritsos
- Department of Informatics and Telecommunications, University of Ioannina, Arta, Greece
| | - Dimitrios Dimopoulos
- Division of Physical Medicine and Rehabilitation, Department of Surgery, University of Ioannina Medical School, Ioannina, Greece
| | - Nikolaos Filis
- Medical School, University of Ioannina, Ιoannina, Greece
| | - Nikolaos Giannakeas
- Department of Informatics and Telecommunications, University of Ioannina, Arta, Greece
| | - Anastasios Korompilias
- Division of Orthopaedic Surgery, Department of Surgery, University of Ioannina Medical School, Ioannina, Greece
| | - Avraam Ploumis
- Division of Physical Medicine and Rehabilitation, Department of Surgery, University of Ioannina Medical School, Ioannina, Greece
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Benedetti MG, Tarricone I, Monti M, Campanacci L, Regazzi MG, De Matteis T, Platano D, Manfrini M. Psychological Well-Being, Self-Esteem, Quality of Life and Gender Differences as Determinants of Post-Traumatic Growth in Long-Term Knee Rotationplasty Survivors: A Cohort Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050867. [PMID: 37238416 DOI: 10.3390/children10050867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023]
Abstract
Rotationplasty (RP) is a special surgical technique for bone tumors of the lower limb and is the chosen procedure for children under 6 with bone sarcoma in the distal femur. Leg reconstruction results in an unusual aspect of the limb potentially giving life-long emotional outcomes, especially considering the young age of most RP patients. Although the high level of the quality of life of these patients has been previously reported, aspects related to long-term psychological well-being, self-esteem and life satisfaction, particularly regarding the gender, procreation and parenting, have never been explored. The aim of this study was to assess the general degree of psychological well-being of RP patients, with specific reference to gender, procreation and parenting. Twenty long-term RP survivors of high-grade bone sarcoma participated in the study. They were administered the following validated questionnaires: HADS for psychological well-being (degree of anxiety and depression), Temperament and Character Inventory (TCI), RSES for self-esteem, SF-36 for quality of life, SWLS extended to life satisfaction, and ABIS for body image integration. Data on education, marriage, employment and parenthood were gathered. All the scores obtained were very close to normal references. The only gender difference was found for the TCI Cooperativeness scale, which was higher in women than in men. A satisfactory psychological well-being in terms of both self-esteem and integration of the prosthetic joint limb into one's body image, with relatively limited amount of anxiety/depression, good quality of life, and good temperament and character traits, was found. No major gender differences were reported.
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Affiliation(s)
- Maria Grazia Benedetti
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy
| | - Ilaria Tarricone
- Bologna Transcultural Psychosomatic Team (BoTPT), Department of Medical and Surgical Sciences, Alma Mater Studiorum Bologna University, 40126 Bologna, Italy
| | - Manuela Monti
- Centre for the Promotion of Health and Psychological Well-Being, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Laura Campanacci
- 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Maria Giulia Regazzi
- Bologna Transcultural Psychosomatic Team (BoTPT), Department of Medical and Surgical Sciences, Alma Mater Studiorum Bologna University, 40126 Bologna, Italy
| | - Tiziano De Matteis
- Bologna Transcultural Psychosomatic Team (BoTPT), Department of Medical and Surgical Sciences, Alma Mater Studiorum Bologna University, 40126 Bologna, Italy
| | - Daniela Platano
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy
- Physical Medicine and Rehabilitation Unit, AUSL Romagna, 48100 Ravenna, Italy
| | - Marco Manfrini
- 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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7
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Buldu MT, Sacchetti F, Yasen AT, Furtado S, Parisi V, Gerrand C. Return to sports following lower limb musculoskeletal tumor surgery-A systematic review. Scand J Med Sci Sports 2023. [PMID: 37157882 DOI: 10.1111/sms.14382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/23/2022] [Accepted: 04/15/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Survivors of primary malignant musculoskeletal tumors often face long-term disability. Clinicians at present are unable to provide evidence-based advice about returning to sports, which is important for active patients. PURPOSES Identify patients returning to sports. Describe the sporting activities in which patients participate. Identify the outcome measures used to assess return to sport. Identify barriers preventing return to sports. STUDY DESIGN Systematic review. METHODS A comprehensive search strategy was used to identify relevant studies combining the following concepts: (1) Bone/Soft tissue tumor, (2) Lower limb, (3) Surgical interventions, and (4) Sports. Studies were selected according to eligibility criteria with the consensus of three authors (MTB, FS, and CG). RESULTS Twenty-two studies were selected, published between 1985 and 2020, including 1005 patients. Fifteen of the 22 studies had valid data on return to sports, with 705 participants, of which 412 (58.4%) returned to some form of sport such as swimming and cycling, at a mean follow-up period of 7.6 years. Four studies directly compared limb sparing surgery and amputation; none of these were able to identify a difference in sports participation or ability. CONCLUSION There is insufficient published research to provide guidance for patients with respect to return to sports following musculoskeletal tumors. Future prospective studies are needed to collect better pre- and post-treatment data at multiple time intervals. Validated clinical and patient sports participation outcomes such as type of sports, level, frequency, and validated sports-specific outcome scores should be recorded. In particular, more comparison between limb sparing surgery and amputation would be welcome.
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Affiliation(s)
| | - Federico Sacchetti
- Ortopedia Oncologica e Ricostruttiva, CTO-Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Adam T Yasen
- Royal National Orthopaedic Hospital, Middlesex, UK
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8
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Ellerbrock M, Theil C, Gosheger G, Deventer N, Klingebiel S, Rickert C, Schneider KN. Function and return to sports after proximal humeral replacement in patients with primary bone sarcoma. J Orthop Traumatol 2022; 23:59. [PMID: 36571630 PMCID: PMC9792634 DOI: 10.1186/s10195-022-00678-z] [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: 09/16/2022] [Accepted: 12/04/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Improved patient and limb survival rates have led to an increased interest in the functional outcome and return to sports of patients undergoing megaprosthetic reconstruction in musculoskeletal oncology. This study evaluates the functional outcome and postoperatively performed level of sports in patients undergoing proximal humeral replacement (PHR) following resection of a primary bone sarcoma and identifies potential beneficial and limiting factors. PATIENTS AND METHODS Between 2007 and 2020, a total of 606 patients underwent resection of a primary bone sarcoma and reconstruction with a single-design modular implant. For 112 (18%) patients, the location of the tumour was the proximal humerus. Exclusion criteria were death (n = 65), patients living overseas (n = 8), and subsequent amputation (n = 1), leaving 38 patients for evaluation, of whom 32 were available for the study (13 women, median age 42 years). Clinical data regarding oncological and surgical treatment as well as subsequent complications were obtained from the patients' electronic medical records. Functional outcome was determined using the Musculoskeletal Tumor Society Score (MSTS) and Toronto Extremity Salvage Score (TESS) as well as the Subjective Shoulder Value (SSV). Return to sports was assessed using the Tegner Activity Score (TS) and the modified Weighted Activity Score (WAS). RESULTS At the last follow-up after a median of 30 months (IQR 22-58), median MSTS was 18 (IQR 12-24), median TESS was 80% (IQR 69-87), median SSV was 35% (IQR 10-58), median TS was 5 (IQR 4-6) and median WAS was 5 (IQR 0-10). Preservation of the axillary nerve, a reverse shoulder reconstruction and a WAS of > 10 prior to surgery were associated with better functional outcome and return to sports activity scores. CONCLUSION Following PHR, good to excellent functional outcomes are possible, and patients regularly return to participate in sports activities-most commonly in low-impact types of sports, but some individuals are even able to participate in high-impact sports activities. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Moritz Ellerbrock
- Department of Orthopaedics and Tumor Orthopaedics, Albert-Schweitzer Campus 1, 48149 Münster, Germany
| | - Christoph Theil
- Department of Orthopaedics and Tumor Orthopaedics, Albert-Schweitzer Campus 1, 48149 Münster, Germany
| | - Georg Gosheger
- Department of Orthopaedics and Tumor Orthopaedics, Albert-Schweitzer Campus 1, 48149 Münster, Germany
| | - Niklas Deventer
- Department of Orthopaedics and Tumor Orthopaedics, Albert-Schweitzer Campus 1, 48149 Münster, Germany
| | - Sebastian Klingebiel
- Department of Orthopaedics and Tumor Orthopaedics, Albert-Schweitzer Campus 1, 48149 Münster, Germany
| | - Carolin Rickert
- Department of Orthopaedics and Tumor Orthopaedics, Albert-Schweitzer Campus 1, 48149 Münster, Germany
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9
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Michielsen A, van Es M, Verschuren O, van Wijk I. Participation in sports of Dutch children with lower limb deficiencies. J Pediatr Rehabil Med 2022:PRM210066. [PMID: 36314225 DOI: 10.3233/prm-210066] [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] [Indexed: 11/06/2022] Open
Abstract
PURPOSE The primary aim was to describe sports participation of Dutch children and adolescents with lower limb deficiencies (LLD). The secondary aim was to explore perceived limitations concerning sports participation. METHODS A total of 103 children and adolescents with LLD, aged 8-18 years (mean 11.7 years), were asked about their sports participation using a study-specific self-report questionnaire. RESULTS Children and adolescents with LLD frequently (78%) participated in sports activities, and most of them (68%) participated in the sport of their preference. Just over half of all children (52%) perceived an inability to participate in specific sports. Physical performance (running) and endurance were mentioned as the most limiting factors in participating in certain sports. CONCLUSION Children and adolescents with LLD in the Netherlands participate in a variety of sports. Despite dependency on lower limb prostheses in most cases, children and adolescents with LLD have a high potentiality of participating in sports.
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Affiliation(s)
- Anka Michielsen
- Department of Paediatric Rehabilitation, De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Maxine van Es
- Department of Paediatric Rehabilitation, De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Olaf Verschuren
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Iris van Wijk
- Department of Paediatric Rehabilitation, De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, The Netherlands
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10
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Sommerauer L, Phyo A, Pion E, Zucal I, Klingelhoefer E, Thu S, Win T, Khin S, Kyaw T, Zaw HH, Htwe MM, Fabbri N, Haerteis S, Aung T. Modified Borggreve-Van Nes-Winkelmann rotationplasty for surgery in developing countries. BMC Surg 2022; 22:333. [PMID: 36071411 PMCID: PMC9454124 DOI: 10.1186/s12893-022-01780-z] [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: 03/23/2022] [Accepted: 08/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Amputation is still the most common therapy for patients suffering from osteosarcoma in Myanmar, despite the fact that limb salvage surgery e.g. Borggreve-Van Nes-Winkelmann rotationplasty for malignant tumors located within the distal femur or proximal tibia is the current state-of-the-art reconstructive procedure. A safe and reliable operation technique is crucial in order to perform a complex surgical procedure like the rotationplasty in lower-middle income economies with limited infrastructure and resources. The authors present seven cases of patients with osteosarcomas that received a Borggreve-Van Nes-Winkelmann rotationplasty with an evaluation of the procedures focusing on safety and sustainability. METHODS From 2019 until 2020, seven young patients with osteosarcomas of the distal femur or proximal tibia were treated with Borggreve-Van Nes-Winkelmann rotationplasties in the Orthopaedic Hospital in Mandalay, Myanmar. As modification of the standard procedure the dissection and subsequent clamping of the femoral artery in order to minimize blood loss as well as the formation of an adipocutaneous flap that minimizes swelling and decreases the pressure on the vessels were successfully performed. This modified procedure resembles a safe and simplified surgical technique that is feasible under the circumstances of lower-middle income economies with good outcomes. RESULTS All patients showed good functional and aesthetic results. One of the seven patients needed secondary wound closure due to wound dehiscence. CONCLUSIONS A simplified and safe operation technique for the performance of the Van Nes-Borggreve rotationplasty was adapted to the given constraints in lower-middle income economies and proved to be successful. Trial registration All patients approved to participate in the study and have given consent to publication.
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Affiliation(s)
- Laura Sommerauer
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, Clinic Traunstein, Traunstein, Germany
| | - Aung Phyo
- Sarcoma and Musculoskeletal Oncoplastic Division, Department of Orthopaedic Surgery, University of Medicine, Mandalay, Myanmar
| | - Eric Pion
- Institute for Molecular and Cellular Anatomy, University of Regensburg, Regensburg, Germany
| | - Isabel Zucal
- Institute for Molecular and Cellular Anatomy, University of Regensburg, Regensburg, Germany.,Surgery Department, Kantonsspital Aarau, Tellstrasse 25, 5001, Aarau, Switzerland.,Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Eric Klingelhoefer
- Department of Plastic, Aesthetic and Reconstructive Microsurgery, Specialized Burn Center, Trauma Center Murnau, Murnau, Germany
| | - Si Thu
- Sarcoma and Musculoskeletal Oncoplastic Division, Department of Orthopaedic Surgery, University of Medicine, Mandalay, Myanmar
| | - Than Win
- Sarcoma and Musculoskeletal Oncoplastic Division, Department of Orthopaedic Surgery, University of Medicine, Mandalay, Myanmar
| | - Sopyay Khin
- Sarcoma and Musculoskeletal Oncoplastic Division, Department of Orthopaedic Surgery, University of Medicine, Mandalay, Myanmar
| | - Thura Kyaw
- Sarcoma and Musculoskeletal Oncoplastic Division, Department of Orthopaedic Surgery, University of Medicine, Mandalay, Myanmar
| | - Hein Htet Zaw
- Sarcoma and Musculoskeletal Oncoplastic Division, Department of Orthopaedic Surgery, University of Medicine, Mandalay, Myanmar
| | - Maung Mg Htwe
- Sarcoma and Musculoskeletal Oncoplastic Division, Department of Orthopaedic Surgery, University of Medicine, Mandalay, Myanmar
| | - Nicola Fabbri
- Orthopaedic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Silke Haerteis
- Institute for Molecular and Cellular Anatomy, University of Regensburg, Regensburg, Germany
| | - Thiha Aung
- Sarcoma and Musculoskeletal Oncoplastic Division, Department of Orthopaedic Surgery, University of Medicine, Mandalay, Myanmar. .,Institute for Molecular and Cellular Anatomy, University of Regensburg, Regensburg, Germany. .,Faculty of Applied Healthcare Science, Deggendorf Institute of Technology, 94469, Deggendorf, Germany. .,Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Medical Centre Regensburg, Regensburg, Germany.
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11
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Soini V, Haara M, Raitio A, Syvänen J. Distal Femoral Focal Deficiency. J Am Acad Orthop Surg Glob Res Rev 2022; 6:e22.00091. [PMID: 36067232 PMCID: PMC9423013 DOI: 10.5435/jaaosglobal-d-22-00091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/18/2022] [Indexed: 06/15/2023]
Abstract
Distal femoral focal deficiency is an extremely rare type of congenital femoral deficiency that comprises hypoplasia of the distal femur, with a normally developed hip. We represent a unique case of distal femoral hypoplasia and deficiency of knee extensors, childhood follow-up and final treatment with exarticulation, and a comparison with previous literature.
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Affiliation(s)
- Venla Soini
- From the Department of Paediatric Surgery and Paediatric Orthopaedic Surgery, University of Turku and Turku University Hospital, Turku, Finland (Dr. Soini, Dr. Raitio, Dr. Syvänen), and the Department of Paediatric Orthopaedic Surgery, Helsinki University Hospital, Helsinki, Finland (Dr. Haara)
| | - Mikko Haara
- From the Department of Paediatric Surgery and Paediatric Orthopaedic Surgery, University of Turku and Turku University Hospital, Turku, Finland (Dr. Soini, Dr. Raitio, Dr. Syvänen), and the Department of Paediatric Orthopaedic Surgery, Helsinki University Hospital, Helsinki, Finland (Dr. Haara)
| | - Arimatias Raitio
- From the Department of Paediatric Surgery and Paediatric Orthopaedic Surgery, University of Turku and Turku University Hospital, Turku, Finland (Dr. Soini, Dr. Raitio, Dr. Syvänen), and the Department of Paediatric Orthopaedic Surgery, Helsinki University Hospital, Helsinki, Finland (Dr. Haara)
| | - Johanna Syvänen
- From the Department of Paediatric Surgery and Paediatric Orthopaedic Surgery, University of Turku and Turku University Hospital, Turku, Finland (Dr. Soini, Dr. Raitio, Dr. Syvänen), and the Department of Paediatric Orthopaedic Surgery, Helsinki University Hospital, Helsinki, Finland (Dr. Haara)
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12
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Gulia A, Prajapati A, Gupta S, Exner U, Puri A. Rotationplasty after failed limb salvage: an alternative to amputation. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03333-9. [PMID: 35864216 DOI: 10.1007/s00590-022-03333-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 06/27/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Limb salvage procedures for musculoskeletal tumors have inherent complications. Though most complications can be managed with retention of the reconstructions, occasionally salvaging these reconstructions is not possible. We evaluated the outcomes of patients undergoing rotationplasty after multiple failed revisions of limb salvage surgery and document the success rate of this "salvage" technique and the subsequent functional outcome of these patients. METHOD Between January 1, 1999, and December 31, 2018, 14 patients (12 male and 2 female) with a median age of 24 years (11-51 years) underwent rotationplasty after multiple failed revisions of limb salvage surgery. Indication for rotationplasty was infection (10 patients), failed megaprosthesis (2 patients), unstable biological reconstruction (1 patient) and local recurrence (1 patient). The mean number of surgeries done before the patient underwent rotationplasty was 5 (range 2-7). RESULTS One patient developed a vascular complication (venous congestion) immediately after rotationplasty and underwent an early amputation. The remaining 13 patients had no surgical complications. Mean Musculo Skeletal Tumor Society score in 13 evaluable patients was 26 (23-30). CONCLUSION Our study demonstrates the utility of rotationplasty as a "salvage" procedure after multiple failed lower limb salvage surgeries. It offers good success rates, low rates of complications and good functional outcomes in carefully selected cases.
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Affiliation(s)
- Ashish Gulia
- Bone and Soft Tissue Services, Department of Surgical Oncology, Tata Memorial Hospital and Homi Bhabha National Institute (HBNI), Mumbai, India.
| | - Ashwin Prajapati
- Bone and Soft Tissue Services, Department of Surgical Oncology, Tata Memorial Hospital and Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Srinath Gupta
- Bone and Soft Tissue Services, Department of Surgical Oncology, Tata Memorial Hospital and Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Ulrich Exner
- FMH Orthopädische Chirurgie Und Traumatologie, Orthopaedie Zentrum Zuerich Ozz, 8038, Zurich, Germany
| | - Ajay Puri
- Bone and Soft Tissue Services, Department of Surgical Oncology, Tata Memorial Hospital and Homi Bhabha National Institute (HBNI), Mumbai, India
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Dreyer F, Fikentscher T, Bigdeli A, Walther M, Harrasser N. [Implantation of a pseudo knee prosthesis after rotationplasty: a case report]. ORTHOPADIE (HEIDELBERG, GERMANY) 2022; 51:590-594. [PMID: 35776153 DOI: 10.1007/s00132-022-04233-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/18/2022] [Indexed: 06/15/2023]
Abstract
Rotationplasty of the knee joint is an established biological reconstruction method with excellent clinical results for patients with tumor-associated resection of the knee joint. The changed biomechanics of the pseudo knee and high demand of the generally young patients commonly leads to the development of osteoarthritic changes in this area. We report on the implantation of an ankle prosthesis in the area of the pseudo knee joint, which made it possible to use a conventional exoprosthesis. Nine months postsurgery we found clinically good results and a satisfied patient.
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Affiliation(s)
- Florian Dreyer
- Abteilung für Fuß- und Sprunggelenkchirurgie, Artemed Klinikum München Süd, Am Isarkanal 30, 81379, München, Deutschland.
| | - Tobias Fikentscher
- Abteilung für Fuß- und Sprunggelenkchirurgie, Artemed Klinikum München Süd, Am Isarkanal 30, 81379, München, Deutschland
| | - Amir Bigdeli
- Abteilung für Diagnostische und Interventionelle Radiologie, Artemed Klinikum München Süd, Am Isarkanal 30, 81379, München, Deutschland
| | - Markus Walther
- Fachzentrum für Fuß- und Sprunggelenkchirurgie, Schön Klinik München-Harlaching, Harlachinger Str. 51, 81547, München, Deutschland
| | - Norbert Harrasser
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
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14
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Gusho CA, Patel V, Lee L, Blank AT. What factors are important to new patients when selecting an orthopedic oncologist? World J Orthop 2022; 13:472-480. [PMID: 35633746 PMCID: PMC9125000 DOI: 10.5312/wjo.v13.i5.472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 03/16/2022] [Accepted: 04/22/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Understanding how patients choose a provider may improve the overall experience by identifying ways to tailor a clinical practice.
AIM To identify factors that patients consider important when choosing an orthopedic oncologist.
METHODS New patients presenting to an orthopedic oncology clinic within a tertiary academic medical center from January 2019 to August 2020 were invited to complete an anonymous survey. The questionnaire consisted of 27 items including a Likert-type assessment of the importance of selection factors.
RESULTS A total of 101 new patients with a median age of 66 years (range, 14 years to 91 years) responded. Most were referred by another doctor (n = 63, 62.4%), and of the referring providers, the most frequent specialty was orthopedic surgery (n = 32, 51%). Using a Likert-type scale with 1 representing ‘least important’ and 5 representing ‘most important’, the most important factor was the hospital reputation (mean, 4.65; SD, 0.85). Additional factors of importance were the number of years in practice (3.87 ± 1.3) and a primary care provider referral (3.71 ± 1.6). Patients younger than 40 years old found social media (P = 0.016) and internet presence (P = 0.035) of their surgeon to be more important than older patients. In contrast, older patients considered care within an academic center to be of greater importance than younger patients (P = 0.014).
CONCLUSION This investigation suggests a primary care referral, as well as hospital and physician reputation, are among the most important factors when selecting an orthopedic oncologist. Furthermore, social media utilization appears to be more important for younger patients.
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Affiliation(s)
- Charles A Gusho
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, United States
| | - Vishal Patel
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, United States
| | - Linus Lee
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, United States
| | - Alan T Blank
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, United States
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15
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Gaillard J, Fouasson-Chailloux A, Eveno D, Bokobza G, Da Costa M, Heidar R, Pouedras M, Nich C, Gouin F, Crenn V. Rotationplasty Salvage Procedure as an Effective Alternative to Femoral Amputation in an Adult With a History of Osteosarcoma: A Case Report and Review. Front Surg 2022; 8:820019. [PMID: 35071319 PMCID: PMC8776644 DOI: 10.3389/fsurg.2021.820019] [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] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/16/2021] [Indexed: 12/29/2022] Open
Abstract
Rotationplasty or Borggreve-Van Ness surgery is lower limb salvage surgery, indicated mainly in the management of femoral bone sarcoma and congenital femur malformations in children. It can also be an interesting surgery option for managing chronic osteoarticular infections, or in cases of non union when curative therapy is no longer an option, as an alternative to femoral amputation. The principle of this surgery is to remove the affected knee and to apply a rotation of 180° to the distal part of the lower limb in order to give the ankle the function of a neo-knee. With the help of an adapted prosthesis, the aim is to allow patients to resume their social and professional activities by keeping most of their lower limb, thus avoiding the known complications of amputation (ghost limb pain, proprioceptive deficit, psychological disorders). Nevertheless, this surgery is complex and exceptional, with vascular, infectious, and psychological risks - the chimeric aspect of the lower limb may cause significant ill-being for the patient. This article reports the case of a 38-year-old patient consulting for management of a complex septic distal femoral non-union following osteosarcoma considered as being in remission. The patient underwent rotationplasty surgery on his left lower limb, with very good functional results and no surgical revision to date. In light of this particular case, we propose a didactic overview of the literature data concerning this surgery, especially in adulthood.
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Affiliation(s)
- Jean Gaillard
- Orthopedics and Trauma Department, University Hospital Hotel-Dieu, CHU de Nantes, Nantes, France
| | - Alban Fouasson-Chailloux
- Physical and Rehabilitation Department, University Hospital Saint Jacques, CHU de Nantes, Nantes, France
| | - Dominique Eveno
- Physical and Rehabilitation Department, Maubreuil & La Tourmaline, Saint-Herblain, France
| | - Guillaume Bokobza
- Physical and Rehabilitation Department, Maubreuil & La Tourmaline, Saint-Herblain, France
| | - Marta Da Costa
- Physical and Rehabilitation Department, Maubreuil & La Tourmaline, Saint-Herblain, France
| | - Romain Heidar
- Anesthesia and Resuscitation Department, University Hospital Hotel-Dieu, CHU de Nantes, Nantes, France
| | - Marie Pouedras
- Orthopedics and Trauma Department, University Hospital Hotel-Dieu, CHU de Nantes, Nantes, France
| | - Christophe Nich
- Orthopedics and Trauma Department, University Hospital Hotel-Dieu, CHU de Nantes, Nantes, France
- Laboratoire d'étude des Sarcomes Osseux et Remodelage des Tissus Calcifiés, PhyOs, INSERM UMR 1238, Université de Nantes, Nantes, France
| | - François Gouin
- Department of Surgery, Centre de lutte Contre le CancerLéon Bérard, Lyon, France
| | - Vincent Crenn
- Orthopedics and Trauma Department, University Hospital Hotel-Dieu, CHU de Nantes, Nantes, France
- Laboratoire d'étude des Sarcomes Osseux et Remodelage des Tissus Calcifiés, PhyOs, INSERM UMR 1238, Université de Nantes, Nantes, France
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Khan H, Ul Ain N, Khurshid H, Bhatti DS. Rotationplasty for Spindle Cell Tumor of Tibia. Cureus 2021; 13:e20850. [PMID: 35141095 PMCID: PMC8801174 DOI: 10.7759/cureus.20850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2021] [Indexed: 11/20/2022] Open
Abstract
Rotationplasty has gained popularity for lower limb salvage in oncological resection in place of amputation. It provides more reliable and functional results, with overwhelming cosmetic concerns. We discuss the use of this functional and oncologically reliable technique for an 18-year-old male patient who presented with malignant spindle cell carcinoma. With a multidisciplinary team (MDT) approach and involvement of occupational therapy and rehabilitation, we achieved satisfactory results with no discernible impact on the social and emotional functioning of our patient.
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17
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Wirth T, Manfrini M, Mascard E. Lower limb reconstruction for malignant bone tumours in children. J Child Orthop 2021; 15:346-357. [PMID: 34476024 PMCID: PMC8381393 DOI: 10.1302/1863-2548.15.210126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 02/03/2023] Open
Abstract
Malignant bone tumours of the lower limb represent the majority of cases in both osteosarcoma and Ewing sarcoma in the growth period. Surgical treatment represents a key element of treatment. Different localizations and age groups require a differentiated surgical approach. Life and limb salvage are first on the list of treatment goals, followed by functional and cosmetic considerations. This review article delivers and discusses current surgical treatment strategies and outcomes for lower limb malignant bone tumours in children.
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Affiliation(s)
- Thomas Wirth
- Department of Orthopaedics, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany,Correspondence should be sent to T. Wirth, MD, PhD, Department of Orthopaedics, Klinikum Stuttgart, Olgahospital, Kriegsbergstraße 62, D-70174 Stuttgart, Germany. E-Mail:
| | - Marco Manfrini
- Department of Musculoskeletal Oncology Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Eric Mascard
- Department of Paediatric Orthopaedic Surgery, Necker University Hospital, Paris, France
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18
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Surgical prevention of terminal neuroma and phantom limb pain: a literature review. Arch Plast Surg 2021; 48:310-322. [PMID: 34024077 PMCID: PMC8143949 DOI: 10.5999/aps.2020.02180] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/08/2021] [Indexed: 12/02/2022] Open
Abstract
The incidence of extremity amputation is estimated at about 200,000 cases annually. Over 25% of patients suffer from terminal neuroma or phantom limb pain (TNPLP), resulting in pain, inability to wear a prosthetic device, and lost work. Once TNPLP develops, there is no definitive cure. Therefore, there has been an emerging focus on TNPLP prevention. We examined the current literature on TNPLP prevention in patients undergoing extremity amputation. A literature review was performed using Ovid Medline, Cochrane Collaboration Library, and Google Scholar to identify all original studies that addressed surgical prophylaxis against TNPLP. The search was conducted using both Medical Subject Headings and free-text using the terms “phantom limb pain,” “amputation neuroma,” and “surgical prevention of amputation neuroma.” Fifteen studies met the inclusion criteria, including six prospective trials, two comprehensive literature reviews, four retrospective chart reviews, and three case series/technique reviews. Five techniques were identified, and each was incorporated into a target-based classification system. A small but growing body of literature exists regarding the surgical prevention of TNPLP. Targeted muscle reinnervation (TMR), a form of physiologic target reassignment, has the greatest momentum in the academic surgical community, with multiple recent prospective studies demonstrating superior prevention of TNPLP. Neurorrhaphy and transposition with implantation are supported by less robust evidence, but merit future study as alternatives to TMR.
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Mahmoud A, Aboujaib MF, Meda MR. Long-term follow-up of patients with rotationplasty. Int J Surg Case Rep 2021; 79:295-298. [PMID: 33508611 PMCID: PMC7840439 DOI: 10.1016/j.ijscr.2021.01.045] [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: 12/20/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 11/05/2022] Open
Abstract
Rotationplasty creates a neo-knee joint that acts similarly to the knee joint. Young patients’ limb-salvage procedures should insist on nearly full return to high activity daily life activities. Rotationplasty is considered a reasonable indication in patients with low-income status.
Introduction and importance Rotationplasty considered a limb-salvage procedure and has a lot of advantages when comparing it with endoprostheses or above-knee amputation. Case presentation We report two cases of young patients with osteosarcoma with rotationplasty being performed for both of them. Clinical discussion Patients with rotationplasty have less restrictions in daily life activities due to pain comparing with patients with endoprostheses. Conclusion Our aim here is to confirm that rotationplasty is an applicable, successful and alternative procedure to endoprostheses or above-knee amputation, when doing it based on an accurate indication and patients regain their previous daily life activities and satisfaction.
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Affiliation(s)
- Ali Mahmoud
- Department of Orthopedic Surgery, Damascus University, Damascus, Syria; Albairouni University Hospital, Damascus, Syria(1)
| | - Muhammed Fayez Aboujaib
- Department of Orthopedic Surgery, Damascus University, Damascus, Syria; Albairouni University Hospital, Damascus, Syria(1).
| | - Muhammad Rafat Meda
- Department of Orthopedic Surgery, Damascus University, Damascus, Syria; Albairouni University Hospital, Damascus, Syria(1)
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20
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Zhao X, Liu Y, Li J, Bi J, Xu M. [Application of rotationplasty in treatment of osteosarcoma of distal femur in children]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:1215-1220. [PMID: 33063482 DOI: 10.7507/1002-1892.202003083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effectiveness of rotationplasty in treating osteosarcoma of distal femur in children. Methods A clinical data of 10 children with osteosarcoma of distal femur treated with rotationplasty between March 2014 and June 2016 was retrospectively analyzed. There were 7 boys and 3 girls with an average age of 6.7 years (range, 4-10 years). There were 4 cases of osteoblastic osteosarcoma, 4 cases of mixed osteosarcoma, and 2 cases of chondroblastic osteosarcoma. All children were staged as Enneking stage ⅡB. The disease duration ranged from 3.5 to 6.0 months (mean, 4.6 months). The lower limb functional scoring system of 1993 Musculoskeletal Tumor Society (MSTS93), Toronto Extremity Salvage Score (TESS), and knee mobility were used to evaluate postoperative function. Tumor recurrence and metastases were monitored by radiograph. Results Poor superficial incision healing occurred in 1 patient, and healed after dressing change. The other incisions healed by first intention. All children were followed up 24-72 months (mean, 52.6 months). No local recurrence was observed during follow-up. Three of the ten patients suffered from metastases including 1 dying of multiple organ dysfunction syndrome, 1 alive with tumor, and 1 tumor free survival. Painful callosities and ulcers which related to prosthetic wear occurred in 2 patients and turned up after optimizing prosthetic fit and physiotherapy. The fracture healing time was 2.5-5.0 months (mean, 3.5 months). All children could walk independently at 4 months postoperatively. At last follow-up, the MSTS93 score was 19-25 (mean, 22) and the TESS score was 87-93 (mean, 90). The extension of knee joint mobility with artificial limbs was 0°-10° (mean, 5°), and the flexion of knee joint mobility with artificial limbs was 85°-95° (mean, 90.5°). Conclusion Rotationplasty in treating osteosarcoma of distal femur in children with limb salvage difficulties can effectively preserve the limb function and improve the quality of life, and it can be used as an alternative to amputation.
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Affiliation(s)
- Xuelin Zhao
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - Yatao Liu
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - Jianxiong Li
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - Jingyou Bi
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - Meng Xu
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, P.R.China
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21
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Haynes KK, Rosenthal HG. The Ever-Changing World of Limb Salvage Surgery for Malignant Bone Tumors. Nurs Clin North Am 2020; 55:251-266. [PMID: 32389258 DOI: 10.1016/j.cnur.2020.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The treatment of malignant bone tumors, also called bone sarcomas, has changed dramatically over the past 50 years owing to the advances in chemotherapy, immunotherapy, targeted therapy, radiation, prosthetic technology, and surgical advances. There are 3 main primary bone cancers: osteosarcoma, Ewing's sarcoma (or Ewing's family of sarcoma), and chondrosarcoma. Before advances in limb preservation techniques and before the development of prosthetic replacement, the treatment for a malignant bone tumor of the extremity was amputation. This article discusses the progression of surgical treatment of malignant bone cancers.
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Affiliation(s)
- Kimberly K Haynes
- The University of Kansas Hospital Sarcoma Center, 10730 Nall Avenue, Suite 201, Overland Park, KS 66211, USA.
| | - Howard G Rosenthal
- The University of Kansas Hospital Sarcoma Center, 10730 Nall Avenue, Suite 201, Overland Park, KS 66211, USA
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Jiang Y, Wang T, Wei Z. Construction and Validation of Nomograms for Predicting the Prognosis of Juvenile Osteosarcoma: A Real-World Analysis in the SEER Database. Technol Cancer Res Treat 2020; 19:1533033820947718. [PMID: 33054584 PMCID: PMC7570778 DOI: 10.1177/1533033820947718] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/21/2020] [Accepted: 07/09/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Osteosarcoma is one of the most common malignant bone tumors, with a high incidence in adolescence. The objective of this study was to construct prognostic nomograms for predicting the prognosis of juvenile osteosarcoma. METHODS Patients with osteosarcoma diagnosed between 2004 and 2015 were identified in the Surveillance, Epidemiology, and End Results (SEER) database. The essential clinical predictors were identified with univariate and multivariate Cox analysis. Nomograms were constructed to predict the 3- and 5-year cancer- specific survival (CSS) and overall survival (OS). Concordance index (C-index) and calibration plots were performed to validate the predictive performance of nomograms. RESULTS We enrolled 736 adolescents with osteosarcoma from the SEER database, with 516 samples grouped into a training cohort and 220 samples grouped into a validation cohort. In multivariate analysis of the training cohort, predictors including tumor size, surgery treatment and AJCC stage were found to be associated with OS and CSS, while age was only associated with CSS. Construction of nomograms based on these predictors was performed to evaluate the prognosis of adolescents with osteosarcoma. The C-index and calibration curves also showed the satisfactory performance of these nomograms for prognosis prediction. CONCLUSION The developed nomograms are useful tools for precisely predicting the prognosis of adolescents with osteosarcoma, which could enable patients to be more accurately managed in clinical practice.
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Affiliation(s)
- Yao Jiang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Tianyu Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zizheng Wei
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
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Piscione J, Barden W, Barry J, Malkin A, Roy T, Sueyoshi T, Mazil K, Salomon S, Dandachli F, Griffin A, Saint-Yves H, Giuliano P, Gupta A, Ferguson P, Scheinemann K, Ghert M, Turcotte RE, Lafay-Cousin L, Werier J, Strahlendorf C, Isler M, Mottard S, Afzal S, Anderson ME, Hopyan S. The Pediatric Toronto Extremity Salvage Score (pTESS): Validation of a Self-reported Functional Outcomes Tool for Children with Extremity Tumors. Clin Orthop Relat Res 2019; 477:2127-2141. [PMID: 31299028 PMCID: PMC7000085 DOI: 10.1097/corr.0000000000000756] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 03/12/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND The physical function of children with sarcoma after surgery has not been studied explicitly. This paucity of research is partly because of the lack of a sufficiently sensitive pediatric functional measure. The goal of this study was to establish and validate a standardized measure of physical function in pediatric patients with extremity tumors. QUESTIONS/PURPOSES (1) What is the best format and content for new upper- and lower-extremity measures of physical function in the pediatric population? (2) Do the new measures exhibit floor and/or ceiling effects, internal consistency, and test-retest reliability? (3) Are the new measures valid? METHODS In Phase 1, interviews with 17 consecutive children and adolescents with bone tumors were conducted to modify the format and content of draft versions of the pediatric Toronto Extremity Salvage Score (pTESS). In Phase 2, the pTESS was formally translated into French. In Phase 3, 122 participants between 7 and 17.9 years old with malignant or benign-aggressive bone tumors completed the limb-specific measure on two occasions. Older adolescents also completed the adult TESS. Floor and ceiling effects, internal consistency, test-retest reliability, and validity were evaluated. RESULTS Feedback from interviews resulted in the removal, addition, and modification of draft items, and the pTESS-Leg and pTESS-Arm questionnaires were finalized. Both versions exhibited no floor or ceiling effects and high internal consistency (α > 0.92). The test-retest reliability was excellent for the pTESS-Leg (intraclass correlation coefficient [ICC] = 0.94; 95% CI, 0.90-0.97) and good for the pTESS-Arm (ICC = 0.86; 95% CI, 0.61-0.96). Known-group validity (ability to discriminate between groups) was demonstrated by lower mean pTESS-Leg scores for participants using gait aids or braces (mean = 68; SD = 21) than for those who did not (mean = 87; SD = 11; p < 0.001). There was no significant difference between pTESS arm scores among respondents using a brace (n = 5; mean = 73; SD = 11) and those without (n = 22; mean = 83; SD = 19; p = 0.13). To evaluate construct validity, we tested a priori hypotheses. The duration since chemotherapy correlated moderately with higher pTESS-Leg scores (r = 0.4; p < 0.001) but not with pTESS-Arm scores (r = 0.1; p = 0.80), and the duration since tumor resection correlated moderately with higher pTESS-Leg scores (r = 0.4; p < 0.001) but not pTESS-Arm scores (r = 0.2; p = 0.4). Higher VAS scores (that is, it was harder to do things) antecorrelated with both pTESS versions (pTESS-Leg: r = -0.7; p < 0.001; pTESS-Arm: r = -0.8; p < 0.001). To assess criterion validity, we compared the pTESS with the current "gold standard" (adult TESS). Among adolescents, strong correlations were observed between the TESS and pTESS-Leg (r = 0.97, p < 0.001) and pTESS-Arm (r = 0.9, p = 0.007). CONCLUSIONS Both pTESS versions exhibited no floor or ceiling effects and had high internal consistency. The pTESS-Leg demonstrated excellent reliability and validity, and the pTESS-Arm demonstrated good reliability and reasonable validity. The pTESS is recommended for cross-sectional evaluation of self-reported physical function in pediatric patients with bone tumors. LEVEL OF EVIDENCE Level II, outcome measurement development.
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Affiliation(s)
- Janine Piscione
- J. Piscione, W. Barden, Rehabilitation Department, Hospital for Sick Children, Toronto, Canada J. Barry, H. Saint-Yves, M. Isler, S. Mottard, Service d'orthopédie, Hôpital Maisonneuve-Rosemont et Université de Montréal, Montréal, Canada A. Malkin, T. Roy, S. Hopyan, Division of Orthopaedic Surgery, Hospital for Sick Children, Toronto, Canada T. Sueyoshi, C. Strahlendorf, Division of Hematology and Oncology, BC Children's Hospital and University of British Columbia, Vancouver, Canada K. Mazil, P. Giuliano, L. Lafay-Cousin, Department of Oncology, Alberta Children's Hospital and University of Calgary, Calgary, Canada S. Salomon, F. Dandachli, R. E. Turcotte, Divisions of Orthopaedic Surgery and Surgical Oncology, McGill University Health Centre and McGill University, Montréal, Canada A. Griffin, P. Ferguson, Division of Orthopaedic Surgery, Mt Sinai Hospital and University of Toronto, Toronto, Canada A. Gupta, Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada K. Scheinemann, Division of Hematology/Oncology, McMaster University Health Sciences Centre, Hamilton, Canada M. Ghert, Division of Orthopaedic Surgery, Juravinski Cancer Centre and McMaster University, Hamilton, Canada J. Werier, Division of Paediatric Orthopaedic Surgery, Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada S. Afzal, Division of Hematology/Oncology, IWK Health Centre and Dalhousie University, Halifax, Canada M. E. Anderson, Orthopedic Center, Boston Children's Hospital, Jimmy Fund Clinic/Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA S. Hopyan, Program in Developmental and Stem Cell Biology, Hospital for Sick Children, Departments of Surgery and Molecular Genetics, University of Toronto, Toronto, Canada
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Kakimoto T, Matsumine A, Asanuma K, Matsubara T, Nakamura T, Sudo A. The clinical outcomes of total femur prosthesis in patients with musculoskeletal tumors. SICOT J 2019; 5:23. [PMID: 31250806 PMCID: PMC6598423 DOI: 10.1051/sicotj/2019020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 06/01/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction: Reconstruction using a total femur prosthesis (TFP) remains a challenging procedure in musculoskeletal tumor surgery. The purpose of this study was to show the clinical outcomes of total femur replacement (TFR) in our institute. Methods: Nine patients underwent reconstruction with a TFP after the wide resection of malignant bone and soft-tissue tumors of the femur between January 2003 and April 2014. The mean age of the patients at the time of TFR was 47.5 years, and the mean follow-up period was 52.9 months. The histological diagnoses were as follows: bone sarcoma (n = 4), soft-tissue sarcoma invading the femoral bones (n = 4), and metastatic bone tumor (n = 1). Results: The oncological outcomes were as follows: three patients achieved continuous disease free, two patients were alive with disease, and four patients died from disease. The 3- and 5-year overall survival rates were 88.9% and 55.6%, respectively. The rate of the overall survival in patients with primary bone tumors (100% at 5 years) was significantly better than that in patients with primary soft tissue sarcomas (0% at 5 years) (p = 0.015). A deep infection occurred postoperatively in one patient, but the patient was successfully treated with surgical debridement and revision surgery. There were no patients who showed dislocation or aseptic loosening. The mean Musculo-Skeletal Tumor Society functional score was 58.5% (46.7–80.0), with scores of 65.5% in patients with a primary bone tumor and 50.8% in those with a primary soft-tissue sarcoma. Discussion: In the present study, the patients who underwent TFR due to bone invasion by soft tissue sarcoma had a worse prognosis than the bone sarcoma patients.
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Affiliation(s)
- Takuya Kakimoto
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie 514-8507, Japan
| | - Akihiko Matsumine
- Department of Orthopedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, Matsuoka-shimoaizuki 23-3, Eiheiji, Fukui 910-1193, Japan
| | - Kunihiro Asanuma
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie 514-8507, Japan
| | - Takao Matsubara
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie 514-8507, Japan
| | - Tomoki Nakamura
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie 514-8507, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie 514-8507, Japan
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A Comparison of Limb Salvage Versus Amputation for Nonmetastatic Sarcomas Using Patient-reported Outcomes Measurement Information System Outcomes. J Am Acad Orthop Surg 2019; 27:e381-e389. [PMID: 30958808 DOI: 10.5435/jaaos-d-17-00758] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The Patient-reported Outcomes Measurement Information System (PROMIS) is a scoring tool that allows comparisons between patients with rare conditions and more common ailments, or the general US population. PROMIS outcomes were compared between the limb salvage and amputee patients for nonmetastatic sarcomas to the US population. METHODS One hundred thirty-eight patients were included in the analysis. Patients were divided into the limb salvage and amputee cohorts, as well as based on the follow-up (1 to 11 or 12+ months). RESULTS Seven PROMIS domains were evaluated, and higher scores were found in both the limb salvage group and patients >12 months from surgery. The limb salvage group also had improved emotional health compared with the US population. DISCUSSION Improvements in PROMIS values are observed in limb salvage patients and in patients >12 months from surgery. Limb salvage patients demonstrate improved emotional health compared with the US population.
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A Critical Review of the Impact of Sarcoma on Psychosocial Wellbeing. Sarcoma 2019; 2019:9730867. [PMID: 30911268 PMCID: PMC6397984 DOI: 10.1155/2019/9730867] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/09/2019] [Accepted: 01/15/2019] [Indexed: 12/11/2022] Open
Abstract
Background Previous reviews of outcomes in specific sarcoma populations suggest patients have poor quality of life. In most of these reviews, there is a predominant focus on physical function rather than psychosocial outcome. The aim of this review was to describe the psychosocial impact of diagnosis and treatment on patients with all types of sarcoma. Methods Searches were conducted through six electronic databases for publications of any study design using a validated patient-reported outcome measure reporting the psychosocial impact in this population. Results Eighty-two studies fulfilled the inclusion criteria. Most (65%) were assessed of being of reasonable quality. The most common aspect of psychosocial wellbeing measured was quality of life (80%). Due to the heterogeneity of methods, outcomes, and populations, it was not possible to make definitive conclusions. It seems there is an improvement in the physical aspects of quality of life over time but not in psychosocial function or mental health. There was no change in mental health scores, but patients reported an improvement in adjusting to normal life. There are no differences according to the type of surgery patients receive, and psychosocial outcomes tend to be poorer than the general population. There is no consistency in identifying the factors that predict/influence psychosocial wellbeing. Conclusion The published literature does not provide a clear understanding of the impact of sarcoma diagnosis and treatment on psychosocial wellbeing. Instead, the review demonstrates a need for well-designed studies in this area and a more consistent approach to the measurement of patient-reported outcomes, which include psychosocial domains. Recommendations for future research have been proposed.
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An Evaluation of PROMIS Health Domains in Sarcoma Patients Compared to the United States Population. Sarcoma 2019; 2019:9725976. [PMID: 30799982 PMCID: PMC6360068 DOI: 10.1155/2019/9725976] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/03/2018] [Accepted: 12/18/2018] [Indexed: 12/22/2022] Open
Abstract
Background The Patient Reported Outcomes Measurement Information System (PROMIS) is a patient-directed system that allows comparisons across medical conditions. With this tool, comparisons can now be made between rare conditions, such as sarcomas, and more common ailments, of the United States general population. This allows comparisons between rare conditions, such as sarcomas, to more common ailments, or even the United States (US) general population. Objectives Our purpose was to use PROMIS to compare outcomes in patients that had undergone resection of a nonmetastatic sarcoma to the US population. Methods One hundred thirty-eight patients were included in the analysis. These patients were divided into early (<2 years) and late follow-up (>2 years). Results We evaluated results from seven health domains and found significantly lower scores in the physical function and depression domains. These differences were present in both the early and late cohorts when compared to the US population. Conclusion While physical function was found to be worse in the sarcoma cohorts, we observed significantly improved levels of depression in these patients when compared to the US population. This finding was maintained over time and is an important reminder that a patient's goals and desires change following a cancer diagnosis and must be taken into consideration when planning treatment and determining a successful outcome.
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Florou V, Nascimento AG, Gulia A, de Lima Lopes G. Global Health Perspective in Sarcomas and Other Rare Cancers. Am Soc Clin Oncol Educ Book 2018; 38:916-924. [PMID: 30231406 DOI: 10.1200/edbk_200589] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Sarcomas, rare and heterogenous malignancies that comprise less than 1% of all cancers, have poor outcomes in the metastatic and refractory setting. Their management requires a multidisciplinary approach that consists of medical and surgical oncologists, radiation oncologists, and pathologists as well as ancillary support. In addition to systemic treatments, most patients will require surgical resection and radiation therapy, which mandates the use of the latest technologies and specialized expertise. Management guidelines have been developed in high-income countries, but their applicability in low-income countries, where resources may be limited, remains a challenge. In this article, we propose the best possible evidence-based practices specifically for income-constrained settings to overcome this challenge. In addition, we review the different methods that can be used in low-income countries to access new and expensive treatments, which often times carry prohibitive costs for these areas.
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Affiliation(s)
- Vaia Florou
- From the Sylvester Comprehensive Cancer Center at the University of Miami, Miami, FL; AC Camargo Cancer Center, Sao Paulo, Brazil; Tata Memorial Hospital, New Delhi, India
| | - Antonio G Nascimento
- From the Sylvester Comprehensive Cancer Center at the University of Miami, Miami, FL; AC Camargo Cancer Center, Sao Paulo, Brazil; Tata Memorial Hospital, New Delhi, India
| | - Ashish Gulia
- From the Sylvester Comprehensive Cancer Center at the University of Miami, Miami, FL; AC Camargo Cancer Center, Sao Paulo, Brazil; Tata Memorial Hospital, New Delhi, India
| | - Gilberto de Lima Lopes
- From the Sylvester Comprehensive Cancer Center at the University of Miami, Miami, FL; AC Camargo Cancer Center, Sao Paulo, Brazil; Tata Memorial Hospital, New Delhi, India
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Misaghi A, Goldin A, Awad M, Kulidjian AA. Osteosarcoma: a comprehensive review. SICOT J 2018; 4:12. [PMID: 29629690 PMCID: PMC5890448 DOI: 10.1051/sicotj/2017028] [Citation(s) in RCA: 291] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 04/15/2017] [Indexed: 11/14/2022] Open
Abstract
Osteosarcoma (OS) is a relatively rare tumor of bone with a worldwide incidence of 3.4 cases per million people per year. For most of the twentieth century, five-year survival rates for classic OS were very low. In the 1970s, the introduction of adjuvant chemotherapy in the treatment of OS increased survival rates dramatically. The current article reviews the various types of OS and analyzes the clinical and histological features. We also examine historical and current literature to present a succinct review of methods for diagnosis and staging, as well as treatment, and we also discuss some of the future directions of treatment.
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Affiliation(s)
- Amirhossein Misaghi
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA
| | - Amanda Goldin
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA
| | - Moayd Awad
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA - School of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Anna A Kulidjian
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA
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Pérez-García A, Salom M, Villaverde-Doménech ME, Baixauli F, Simón-Sanz E. Free microvascular rotationplasty with nerve repair for rhabdomyosarcoma in a 18-month-old patient. Microsurgery 2017; 37:344-347. [PMID: 28198595 DOI: 10.1002/micr.30147] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 11/18/2016] [Accepted: 12/09/2016] [Indexed: 11/06/2022]
Abstract
Rotationplasty is a limb-sparing surgical option in lower limb malignancies. Sciatic or tibial nerve encasement has been considered an absolute contraindication to this procedure. We report a case of an 18-month-old girl with a rhabdomyosarcoma that affected the leg and popliteal fossa, with neurovascular involvement. Knee and proximal leg intercalary resection was performed followed by reconstruction with free microvascular rotationplasty and neurorraphy from tibial division of sciatic nerve to sural and tibial nerves, and from saphenous nerve to superficial peroneal nerve. Postoperative course was uneventful and ambulation with a provisional prosthesis was restarted during the sixth week after surgery. Bone consolidation was observed after two months. Eighteen months later, the patient had a good gait pattern with a below-knee prosthesis and had recovered sensation in the whole foot and ankle area. This case shows that rotationplasty with nerve repair may provide a sensate stump, which is vital for successful prosthetic adaptation. We believe it may be considered as an alternative to above-knee amputation in tumors with sciatic involvement.
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Affiliation(s)
- Alberto Pérez-García
- Department of Plastic Surgery and Burns, Hospital Universitario y Politécnico La Fe, Valencia
| | - Marta Salom
- Department of Traumatology and Orthopedic Surgery, Hospital Universitario y Politécnico La Fe, Valencia
| | | | - Francisco Baixauli
- Department of Traumatology and Orthopedic Surgery, Hospital Universitario y Politécnico La Fe, Valencia
| | - Eduardo Simón-Sanz
- Department of Plastic Surgery and Burns, Hospital Universitario y Politécnico La Fe, Valencia
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Abstract
Osteosarcoma is the most common primary malignancy of bone in children and young adults. This tumor has a very heterogeneous genetic profile and lacks any consistent unifying event that leads to the pathogenesis of osteosarcoma. In this review, some of the important genetic events involved in osteosarcoma will be highlighted. Additionally, the clinical diagnosis of osteosarcoma will be discussed, as well as contemporary chemotherapeutic and surgical management of this tumor. Finally, the review will discuss some of the novel approaches to treating this disease.
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Affiliation(s)
- Ryan A Durfee
- Department of Orthopaedic Surgery and Rehabilitation, University of Chicago, Chicago, IL, USA
| | - Maryam Mohammed
- Department of Orthopaedic Surgery and Rehabilitation, University of Chicago, Chicago, IL, USA
| | - Hue H Luu
- Department of Orthopaedic Surgery and Rehabilitation, University of Chicago, Chicago, IL, USA.
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Jackson TM, Bittman M, Granowetter L. Pediatric Malignant Bone Tumors: A Review and Update on Current Challenges, and Emerging Drug Targets. Curr Probl Pediatr Adolesc Health Care 2016; 46:213-228. [PMID: 27265835 DOI: 10.1016/j.cppeds.2016.04.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Osteosarcoma (OS) and the Ewing sarcoma family of tumors (ESFT) are the most common malignant bone tumors in children and adolescents. While significant improvements in survival have been seen in other pediatric malignancies the treatment and prognosis for pediatric bone tumors has remained unchanged for the past 3 decades. This review and update of pediatric malignant bone tumors will provide a general overview of osteosarcoma and the Ewing sarcoma family of tumors, discuss bone tumor genomics, current challenges, and emerging drug targets.
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Affiliation(s)
- Twana M Jackson
- Division of Pediatric Hematology Oncology, NYU Langone Medical Center, New York, NY.
| | - Mark Bittman
- Department of Radiology, NYU Langone Medical Center, New York, NY
| | - Linda Granowetter
- Division of Pediatric Hematology Oncology, NYU Langone Medical Center, New York, NY
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