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Guo Z, Zhang R, Que Y, Hu B, Xu S, Hu Y. Case Report: 3D-Printed Prosthesis for Limb Salvage and Joint Preservation After Tibial Sarcoma Resection. Front Surg 2022; 9:873272. [PMID: 35711702 PMCID: PMC9195185 DOI: 10.3389/fsurg.2022.873272] [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] [Received: 02/10/2022] [Accepted: 05/09/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Reconstruction of massive tibial defects in ankle joint-preserving surgery remains challenging though biological and prosthetic methods have been attempted. We surgically treated a patient with only 18-mm distal tibia remaining and reconstructed with a unique three-dimensional printed prosthesis. Case Presentation, Intervention, and Outcomes A 36-year-old male presented to our clinic with complaints of gradually swelling left calf and palpable painless mass for five months. Imageological exam indicated a lesion spanning the entire length of the tibia and surrounding the vascular plexus. Diagnosis of chondrosarcoma was confirmed by biopsy. Amputation was initially recommended but rejected, thus a novel one-step limb-salvage procedure was performed. After en-bloc tumor resection and blood supply rebuilding, a customized, three-dimensional printed prosthesis with porous interface was fixed that connected the tumor knee prosthesis and distal ultra-small bone segment. During a 16-month follow-up, no soft tissue or prosthesis-related complications occurred. The patient was alive with no sign of recurrence or metastasis. Walking ability and full tibiotalar range of motion were preserved. Conclusions Custom-made, three-dimensional printed prosthesis manifested excellent mechanical stability during the follow-up in this joint-preserving surgery. Further investigation of the durability and rate of long-term complications is needed to introduce to routine clinical practice.
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Affiliation(s)
| | | | | | | | | | - Yong Hu
- Correspondence: Shenglin Xu Yong Hu
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Wong KC, Sze LKY, Kumta SM. Complex joint-preserving bone tumor resection and reconstruction using computer navigation and 3D-printed patient-specific guides: A technical note of three cases. J Orthop Translat 2021; 29:152-162. [PMID: 34249613 PMCID: PMC8241897 DOI: 10.1016/j.jot.2021.05.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/30/2021] [Accepted: 05/31/2021] [Indexed: 02/07/2023] Open
Abstract
In selected extremity bone sarcomas, joint-preserving surgery retains the natural joints and nearby ligaments with a better function than in traditional joint-sacrificing surgery. Geometric multiplanar osteotomies around bone sarcomas were reported with the advantage of preserving more host bone. However, the complex surgical planning translation to the operating room is challenging. Using both Computer Navigation and Patient-Specific Guide may combine each technique's key advantage in assisting complex bone tumor resections. Computer Navigation provides the visual image feedback of the pathological information and validates the correct placement of Patient-Specific Guide that enables accurate, guided bone resections. We first described the digital workflow and the use of both computer navigation and patient-specific guides (NAVIG) to assist the multiplanar osteotomies in three extremity bone sarcoma patients who underwent joint-preserving bone tumor resections and reconstruction with patient-specific implants. The NAVIG technique verified the correct placement of patient-specific guides that enabled precise osteotomies and well-fitted patient-specific implants. The mean maximum deviation errors of the nine achieved bone resections were 1.64 ± 0.35 mm (95% CI 1.29 to 1.99). The histological examination of the tumor specimens showed negative resection margin. At the mean follow-up of 55 months (40–67), no local recurrence was noted. There was no implant loosening that needed revision. The mean MSTS score was 29 (28–30) out of 30 with the mean knee flexion of 140° (130°–150°). The excellent surgical accuracy and limb function suggested that the NAVIG technique might replicate the surgical planning of complex bone sarcoma resections by combining the strength of both Computer Navigation and Patient-Specific Guide. The patient-specific approach may translate into clinical benefits. The translational potential of this article: The newly described technique enhances surgeons’ capability in performing complex joint-preserving surgery in bone sarcoma that is difficult to be achieved by the traditional method. The high precision and accuracy may translate into superior clinical outcomes.
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Affiliation(s)
- Kwok Chuen Wong
- Orthopaedic Oncology, Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Louis Kwan Yik Sze
- Orthopaedic Oncology, Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shekhar Madhukar Kumta
- Orthopaedic Oncology, Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
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Zhao D, Tang F, Min L, Lu M, Wang J, Zhang Y, Zhao K, Zhou Y, Luo Y, Tu C. Intercalary Reconstruction of the "Ultra-Critical Sized Bone Defect" by 3D-Printed Porous Prosthesis After Resection of Tibial Malignant Tumor. Cancer Manag Res 2020; 12:2503-2512. [PMID: 32308487 PMCID: PMC7152541 DOI: 10.2147/cmar.s245949] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 03/13/2020] [Indexed: 02/05/2023] Open
Abstract
Purpose This study aimed to evaluate the early stability, limb function, and mechanical complications of 3D-printed porous prosthetic reconstruction for "ultra-critical sized bone defects" following intercalary tibial tumor resections. Methods This study defined an "ultra-critical sized bone defect" in the tibia when the length of segmental defect in the tibia was >15.0 cm or >60% of the full tibia and the length of the residual fragment in proximal or distal tibia was between 0.5 cm and 4.0 cm. Thus, five patients with "ultra-critical sized bone defects" following an intercalary tibial malignant tumor resection treated with 3D-printed porous prosthesis between June 2014 and June 2018 were retrospectively reviewed. Patient information, implants design and fabrication, surgical procedures, and early clinical outcome data were collected and evaluated. Results Among the five patients, three were male and two were female, with an average age of 30.2 years. Pathological diagnoses were two osteosarcomas, one Ewing sarcoma, one pseudo-myogenic hemangioendothelioma, and one undifferentiated pleomorphic sarcoma . The average length of the bone defects following tumor resection was 22.8cm, and the average length of ultra-short residual bone was 2.65cm (range=0.6cm-3.8cm). The mean follow-up time was 27.6 months (range=14.0-62.0 months). Early biological fixation was achieved in all five patients. The average time of clinical osseointegration at the bone-porous interface was 3.2 months. All patients were reported to be pain free and have no limitations in their walking distance. No prosthetic mechanical complications were observed. Conclusion Reconstruction of the "ultra-critical sized bone defect" after an intercalary tibial tumor resection using 3D-printed porous prosthesis achieved satisfactory overall early biological fixation and limb function. Excellent primary stability and the following rigid biological fixation were key factors for success. The outcomes of this study were supposed to support further clinical application and evaluation of 3D-printed porous prosthetic reconstruction for "ultra-critical sized bone defects" in the tibia.
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Affiliation(s)
- Dingyun Zhao
- Department of Orthopeadics, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Fan Tang
- Department of Orthopeadics, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Li Min
- Department of Orthopeadics, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Minxun Lu
- Department of Orthopeadics, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Jie Wang
- Department of Orthopeadics, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Yuqi Zhang
- Department of Orthopeadics, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Kun Zhao
- Department of Orthopeadics, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, People's Republic of China.,Department of Orthopeadics, Tianjin Fifth Central Hospital, Tianjin 300450, People's Republic of China
| | - Yong Zhou
- Department of Orthopeadics, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Yi Luo
- Department of Orthopeadics, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
| | - Chongqi Tu
- Department of Orthopeadics, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, People's Republic of China
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Takeuchi A, Yamamoto N, Hayashi K, Matsubara H, Miwa S, Igarashi K, Tsuchiya H. Joint-preservation surgery for pediatric osteosarcoma of the knee joint. Cancer Metastasis Rev 2020; 38:709-722. [PMID: 31807972 DOI: 10.1007/s10555-019-09835-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The multi-disciplinary approach involving imaging, multi-agent chemotherapy, meticulous surgical procedures, and careful postoperative care has facilitated an increase in the use of limb-sparing surgery for pediatric osteosarcoma. Osteosarcoma usually occurs around the metaphysis of the distal femur or proximal tibia and needs wide excision with the adjacent joint and replacement by a megaprosthesis. The recent advancement in imaging modalities and surgical techniques supports joint-preservation surgery (JPS), involving the preservation of the adjacent epiphysis, for select patients following careful assessment of the tumor margins and precise tumor excision. An advantage of this surgery is that it maintains the adjacent joint and preserves the growth of the residual epiphysis, which provides excellent limb function. Various reconstruction options are available, including allograft, tumor-devitalized autograft, vascularized fibula graft, distraction osteogenesis, and custom-made implants. However, several complications are inevitable with these options, such as loosening, non-union at the host-graft junction, infection, fracture, implant loosening, breakage, deformity, limb-length discrepancy related to the reconstruction methods, or patient growth in pediatric osteosarcoma. Surgeons should fully understand the advantages and disadvantages of this procedure. In this review, we discuss the concept of JPS, types of reconstruction methods, and current treatment outcomes. It is our opinion that the further analysis by multi-institutional setting is necessary to clarify long-term outcomes and establish global guidelines on the indications and surgical procedure for JPS.
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Affiliation(s)
- Akihiko Takeuchi
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
| | - Norio Yamamoto
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Katsuhiro Hayashi
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Hidenori Matsubara
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Shinji Miwa
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Kentaro Igarashi
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
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Surgical Technique and Outcome of Custom Joint-Sparing Endoprosthesis as a Reconstructive Modality in Juxta-Articular Bone Sarcoma. JOURNAL OF ONCOLOGY 2019; 2019:9417284. [PMID: 32082379 PMCID: PMC7012265 DOI: 10.1155/2019/9417284] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 09/13/2019] [Indexed: 11/17/2022]
Abstract
Background Joint-sparing limb salvage surgery (JSLSS) is an advancement in the techniques and concepts of limb salvage surgery, which makes it possible to save not only the limb affected by malignancy but also the adjacent joint and the epiphyseal plate. In the growing child, this procedure is technically demanding due to the availability of small length of bone for implant purchase. Reconstruction options can be biological reconstruction or endoprosthesis; however, the outcome of endoprosthetic reconstruction after joint-sparing resection is not well described in the literature. Purposes (1) To determine the prosthesis survival rates when using customized Joint-Sparing Endoprosthesis (JSE) after juxta-articular resection of bone tumors, (2) to investigate the rates of local recurrence, (3) to evaluate the need for revision surgery, and (4) to compare the outcome of customized JSE with that of joint-sacrificing techniques. Methods In our study, joint sparing is defined as any procedure where a custom-made JSE is used in lieu of sacrificing the adjacent joint whenever the length of the remaining bone segment is not enough to accommodate the stem of a modular implant. Twenty-eight patients received JSE, and 31 joints were spared. Their age ranged from 4 to 55 years with a median age of 13 years. Twenty-one patients received surgery for primary reconstruction and 7 patients for revision of failed bone allograft or modular implant. Twenty-four joints are spared in the lower limbs and 7 in the upper limbs. Osteosarcoma was the most common pathological diagnosis (n = 13). Flat surface HA-coated custom JSE was used to spare 15 joints, and short-stemmed custom JSE was used to spare 16 joints. The length of the remaining bone epiphysis for JSE anchorage from the knee and ankle joints was 25-75 mm, median = 45 mm, and the length of the cortical bone remaining for the proximal femur and distal humerus was 5-70 mm, median = 10 mm. Results Operative time was 2.5 to 4 hours (avg. 3 hr.) The bone resection surface fitted the prosthesis surface with <2 mm difference. Histological examination of all resected specimens shows clear bone resection margins; 2 patients had positive soft tissue margins. At mean follow-up period of 3 years (6 months-10 years), 6 patients developed local and systemic recurrences, three of them had a pathological fracture at the time of diagnosis (P=0.139), and 4 showed a poor response to chemotherapy (P=0.139), and 4 showed a poor response to chemotherapy (. Conclusions Whenever this kind of implant is affordable and can be utilized, particularly in younger age groups, JSE may be a good reconstruction option to avoid the use of expandable implants and to avoid the potentially higher revision and complication rates associated with biological reconstruction, as well as the complications of conventional joint-sacrificing implant, mainly dislocations and polyethylene wear and tear.
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Correa TA, Pal B, van Arkel RJ, Vanacore F, Amis AA. Reduced tibial strain-shielding with extraosseous total knee arthroplasty revision system. Med Eng Phys 2018; 62:22-28. [PMID: 30314902 PMCID: PMC6236098 DOI: 10.1016/j.medengphy.2018.09.006] [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: 06/25/2018] [Revised: 09/07/2018] [Accepted: 09/30/2018] [Indexed: 11/16/2022]
Abstract
A novel extracortical support system for revision of failed knee prostheses. Shown to reduce metaphyseal stress-shielding versus intramedullary stem fixation. Reduces bone loss and enables bone grafting of defects after implant loosening. Enables use of conventional prosthesis in a revision scenario.
Background Revision total knee arthroplasty (RTKA) has poorer results than primary total knee arthroplasty (TKA), and the prostheses are invasive and cause strain-shielding of the bones near the knee. This paper describes an RTKA system with extracortical fixation. It was hypothesised that this would reduce strain-shielding compared with intramedullary fixation. Methods Twelve replica tibiae were prepared for full-field optical surface strain analysis. They were either left intact, implanted with RTKA components with cemented intramedullary fixation stems, or implanted with a novel design with a tibial tray subframe supported by two extracortical fixation plates and screw fixation. They were loaded to simulate peak walking and stair climbing loads and the surface strains were measured using digital image correlation. The measurements were validated with strain gauge rosettes. Results Compared to the intact bone model, extracortical fixation reduced surface strain-shielding by half versus intramedullary fixation. For all load cases and bone regions examined, the extracortical implant shielded 8–27% of bone strain, whereas the intramedullary component shielded 37–56%. Conclusions The new fixation design, which offers less bone destruction than conventional RTKA, also reduced strain-shielding. Clinically, this design may allow greater rebuilding of bone loss, and should increase long-term fixation.
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Affiliation(s)
- Tomas A Correa
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London SW7 2AZ, UK.
| | - Bidyut Pal
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London SW7 2AZ, UK; School of Engineering, University of Portsmouth, Portsmouth PO1 3DJ, UK.
| | - Richard J van Arkel
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London SW7 2AZ, UK.
| | - Felice Vanacore
- Department of Orthopaedics and Traumatology, Marche Polytechnic University, Ancona, Italy.
| | - Andrew A Amis
- Biomechanics Group, Mechanical Engineering Department, Imperial College London, London SW7 2AZ, UK; Musculoskeletal Surgery Group, Department of Surgery and Cancer, Imperial College London School of Medicine, London W6 8RF, UK.
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7
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Stevenson JD, Wigley C, Burton H, Ghezelayagh S, Morris G, Evans S, Parry M, Jeys L. Minimising aseptic loosening in extreme bone resections: custom-made tumour endoprostheses with short medullary stems and extra-cortical plates. Bone Joint J 2017; 99-B:1689-1695. [PMID: 29212694 DOI: 10.1302/0301-620x.99b12.bjj-2017-0213.r1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 06/05/2017] [Indexed: 11/05/2022]
Abstract
AIMS Following the resection of an extensive amount of bone in the treatment of a tumour, the residual segment may be insufficient to accept a standard length intramedullary cemented stem. Short-stemmed endoprostheses conceivably have an increased risk of aseptic loosening. Extra-cortical plates have been added to minimise this risk by supplementing fixation. The aim of this study was to investigate the survivorship of short-stemmed endoprostheses and extra-cortical plates. PATIENTS AND METHODS The study involved 37 patients who underwent limb salvage surgery for a primary neoplasm of bone between 1998 and 2013. Endoprosthetic replacement involved the proximal humerus in nine, the proximal femur in nine, the distal femur in 13 and the proximal tibia in six patients. There were 12 primary (32%) and 25 revision procedures (68%). Implant survivorship was compared with matched controls. The amount of bone that was resected was > 70% of its length and statistically greater than the standard control group at each anatomical site. RESULTS The mean follow-up was seven years (one to 17). The mean length of the stem was 33 mm (20 to 60) in the humerus and 79 mm (34 to 100) in the lower limb. Kaplan-Meier analysis of survival of the implant according to anatomical site confirmed that there was no statistically significant difference between the short-stemmed endoprostheses and the standard stemmed controls at the proximal humeral (p = 0.84), proximal femoral (p = 0.57), distal femoral (p = 0.21) and proximal tibial (p = 0.61) sites. In the short-stemmed group, no implants with extra-cortical plate osseointegration suffered loosening at a mean of 8.5 years (range 2 to 16 years). Three of ten (30%) without osseointegration suffered aseptic loosening at a mean of 7.7 years (range 2 to 11.5 years). CONCLUSION When extensive resections of bone are required in the surgical management of tumours, and in revision cases, the addition of extra-cortical plates to short medullary stems has shown non-inferiority to standard length medullary stems and minimises aseptic failure. Cite this article: Bone Joint J 2017;99-B:1689-95.
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Affiliation(s)
- J D Stevenson
- The Royal Orthopaedic Hospital, Birmingham and Honorary Senior Clinical Lecturer, Aston University Medical School, Aston Expressway, Birmingham, B4 7ET, UK
| | - C Wigley
- University of Birmingham Medical School, Birmingham, UK
| | - H Burton
- University of Birmingham Medical School, Birmingham, UK
| | - S Ghezelayagh
- University of Birmingham Medical School, Birmingham, UK
| | - G Morris
- The Royal Orthopaedic Hospital, Birmingham, UK
| | - S Evans
- The Royal Orthopaedic Hospital, Birmingham, UK
| | - M Parry
- The Royal Orthopaedic Hospital, Birmingham and Honorary Senior Clinical Lecturer, Aston University Medical School, Aston Expressway, Birmingham, B4 7ET, UK
| | - L Jeys
- The Royal Orthopaedic Hospital, Birmingham, Professor of Life & Health Sciences at University of Aston, Aston Expressway, Birmingham, B4 7ET, UK
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Jeys L, Morris G, Evans S, Stevenson J, Parry M, Gregory J. Surgical Innovation in Sarcoma Surgery. Clin Oncol (R Coll Radiol) 2017; 29:489-499. [PMID: 28502707 DOI: 10.1016/j.clon.2017.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 03/30/2017] [Accepted: 04/05/2017] [Indexed: 12/24/2022]
Abstract
The field of orthopaedic oncology relies on innovative techniques to resect and reconstruct a bone or soft tissue tumour. This article reviews some of the most recent and important innovations in the field, including biological and implant reconstructions, together with computer-assisted surgery. It also looks at innovations in other fields of oncology to assess the impact and change that has been required by surgeons; topics including surgical margins, preoperative radiotherapy and future advances are discussed.
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Affiliation(s)
- L Jeys
- Royal Orthopaedic Hospital, Birmingham, UK; School of Health and Life Sciences, Aston University, Birmingham, UK.
| | - G Morris
- Royal Orthopaedic Hospital, Birmingham, UK
| | - S Evans
- Royal Orthopaedic Hospital, Birmingham, UK
| | | | - M Parry
- Royal Orthopaedic Hospital, Birmingham, UK
| | - J Gregory
- Royal Orthopaedic Hospital, Birmingham, UK
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Qu H, Guo W, Yang R, Tang X, Yan T, Li D, Yang Y, Zang J. Cortical strut bone grafting and long-stem endoprosthetic reconstruction following massive bone tumour resection in the lower limb. Bone Joint J 2015; 97-B:544-9. [PMID: 25820896 DOI: 10.1302/0301-620x.97b4.34695] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We determined the efficacy of a devitalised autograft (n = 13) and allograft (n = 16) cortical strut bone graft combined with long-stem endoprosthetic reconstruction in the treatment of massive tumours of the lower limb. A total of 29 patients (18 men:11 women, mean age 20.1 years (12 to 45) with a ratio of length of resection to that of the whole prosthesis of > 50% were treated between May 2003 and May 2012. The mean follow-up was 47 months (15 to 132). The stem of the prosthesis was introduced through bone graft struts filled with cement, then cemented into the residual bone. Bone healing was achieved in 23 patients (86%). The mean Musculoskeletal Tumour Society functional score was 85% (57 to 97). The five-year survival rate of the endoprostheses was 81% (95% confidence intervals 67.3 to 92.3). The mean length of devitalised autografts and allografts was 8.6 cm (5 to 15), which increased the ratio of the the length of the stem of the prosthesis to that of the whole length of the prosthesis from a theoretical 35% to an actual 55%. Cortical strut bone grafting and long-stem endoprosthetic reconstruction is an option for treating massive segmental defects following resection of a tumour in the lower limb. Patients can regain good function with a low incidence of aseptic loosening. The strut graft and the residual bone together serve as a satisfactory bony environment for a revision prosthesis, if required, once union is achieved.
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Affiliation(s)
- H Qu
- People's Hospital, Peking University, Xizhimen Nan 11, Xicheng District, Beijing, 100044, China
| | - W Guo
- People's Hospital, Peking University, Xizhimen Nan 11, Xicheng District, Beijing, 100044, China
| | - R Yang
- People's Hospital, Peking University, Xizhimen Nan 11, Xicheng District, Beijing, 100044, China
| | - X Tang
- People's Hospital, Peking University, Xizhimen Nan 11, Xicheng District, Beijing, 100044, China
| | - T Yan
- People's Hospital, Peking University, Xizhimen Nan 11, Xicheng District, Beijing, 100044, China
| | - D Li
- People's Hospital, Peking University, Xizhimen Nan 11, Xicheng District, Beijing, 100044, China
| | - Y Yang
- People's Hospital, Peking University, Xizhimen Nan 11, Xicheng District, Beijing, 100044, China
| | - J Zang
- People's Hospital, Peking University, Xizhimen Nan 11, Xicheng District, Beijing, 100044, China
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Construction and biomechanical properties of polyaxial self-locking anatomical plate based on the geometry of distal tibia. BIOMED RESEARCH INTERNATIONAL 2014; 2014:436325. [PMID: 25025051 PMCID: PMC4082832 DOI: 10.1155/2014/436325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 05/24/2014] [Indexed: 11/18/2022]
Abstract
In order to provide scientific and empirical evidence for the clinical application of the polyaxial self-locking anatomical plate, 80 human tibias from healthy adults were scanned by spiral CT and their three-dimensional images were reconstructed using the surface shaded display (SSD) method. Firstly, based on the geometric data of distal tibia, a polyaxial self-locking anatomical plate for distal tibia was designed and constructed. Biomechanical tests were then performed by applying axial loading, 4-point bending, and axial torsion loading on the fracture fixation models of fresh cadaver tibias. Our results showed that variation in twisting angles of lateral tibia surface was found in various segments of the distal tibia. The polyaxial self-locking anatomical plate was constructed based on the geometry of the distal tibia. Compared to the conventional anatomical locking plate, the polyaxial self-locking anatomical plate of the distal tibia provides a better fit to the geometry of the distal tibia of the domestic population, and the insertion angle of locking screws can be regulated up to 30°. Collectively, this study assesses the geometry of the distal tibia and provides variable locking screw trajectory to improve screw-plate stability through the design of a polyaxial self-locking anatomical plate.
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11
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Mangat KS, Jeys LM, Carter SR. Latest developments in limb-salvage surgery in osteosarcoma. Expert Rev Anticancer Ther 2014; 11:205-15. [DOI: 10.1586/era.10.225] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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12
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Sewell MD, Hanna SA, McGrath A, Aston WJS, Blunn GW, Pollock RC, Skinner JA, Cannon SR, Briggs TWR. Intercalary diaphyseal endoprosthetic reconstruction for malignant tibial bone tumours. ACTA ACUST UNITED AC 2011; 93:1111-7. [DOI: 10.1302/0301-620x.93b8.25750] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The best method of reconstruction after resection of malignant tumours of the tibial diaphysis is unknown. In the absence of any long-term studies analysing the results of intercalary endoprosthetic replacement, we present a retrospective review of 18 patients who underwent limb salvage using a tibial diaphyseal endoprosthetic replacement following excision of a malignant bone tumour. There were ten men and eight women with a mean age of 42.5 years (16 to 76). Mean follow-up was 58.5 months (20 to 141) for all patients and 69.3 months (20 to 141) for the 12 patients still alive. Cumulative patient survival was 59% (95% confidence interval (CI) 32 to 84) at five years. Implant survival was 63% (95% CI 35 to 90) at ten years. Four patients required revision to a proximal tibial replacement at a mean follow-up of 29 months (10 to 54). Complications included metastases in five patients, aseptic loosening in four, peri-prosthetic fracture in two, infection in one and local recurrence in one. The mean Musculoskeletal Tumor Society score and the mean Toronto Extremity Salvage Score were 23 (17 to 28) and 74% (53 to 91), respectively. Although rates of complication and revision were high, custom-made tibial diaphyseal replacement following resection of malignant bone tumours enables early return to function and provides an attractive alternative to other surgical options, without apparent compromise of patient survival.
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Affiliation(s)
- M. D. Sewell
- Sarcoma Unit, London Bone and Soft Tissue Tumour Service
| | - S. A. Hanna
- Sarcoma Unit, London Bone and Soft Tissue Tumour Service
| | - A. McGrath
- Sarcoma Unit, London Bone and Soft Tissue Tumour Service
| | - W. J. S. Aston
- Sarcoma Unit, London Bone and Soft Tissue Tumour Service
| | - G. W. Blunn
- The John Scales Centre for Biomedical Engineering, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP, UK
| | - R. C. Pollock
- Sarcoma Unit, London Bone and Soft Tissue Tumour Service
| | - J. A. Skinner
- Sarcoma Unit, London Bone and Soft Tissue Tumour Service
| | - S. R. Cannon
- Sarcoma Unit, London Bone and Soft Tissue Tumour Service
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Smith JO, Aarvold A, Tayton ER, Dunlop DG, Oreffo ROC. Skeletal tissue regeneration: current approaches, challenges, and novel reconstructive strategies for an aging population. TISSUE ENGINEERING PART B-REVIEWS 2011; 17:307-20. [PMID: 21615329 DOI: 10.1089/ten.teb.2011.0143] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Loss of skeletal tissue as a consequence of trauma, injury, or disease is a significant cause of morbidity with often wide-ranging socioeconomic impacts. Current approaches to replace or restore significant quantities of lost bone come with substantial limitations and inherent disadvantages that may in themselves cause further disability. In addition, the spontaneous repair capacity of articular cartilage is limited; thus, investigation into new cartilage replacement and regeneration techniques are warranted. Along with the challenges of an increasingly aging demographic, changing clinical scenarios and rising functional expectations provide the imperative for new, more reliable skeletal regeneration strategies. The science of tissue engineering has expanded dramatically in recent years, notably in orthopedic applications, and it is clear that new approaches for de novo skeletal tissue formation offer exciting opportunities to improve the quality of life for many, particularly in the face of increasing patient expectations. However, significant scientific, financial, industrial, and regulatory challenges should be overcome before the successful development of an emergent tissue engineering strategy can be realized. We outline current practice for replacement of lost skeletal tissue and the innovative approaches in tissue regeneration that have so far been translated to clinical use, along with a discussion of the significant hurdles that are presented in the process of translating research strategies to the clinic.
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Affiliation(s)
- James Oliver Smith
- Bone and Joint Research Group, Centre for Human Development, Stem Cells and Regeneration, Human Development and Health, Institute of Developmental Sciences, Southampton, United Kingdom
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Agarwal M, Puri A, Gulia A, Reddy K. Joint-sparing or physeal-sparing diaphyseal resections: the challenge of holding small fragments. Clin Orthop Relat Res 2010; 468:2924-32. [PMID: 20607464 PMCID: PMC2947679 DOI: 10.1007/s11999-010-1458-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Joint-sparing or physeal-sparing diaphyseal resections are technically challenging when only a small length of bone is available for implant purchase. QUESTIONS/PURPOSES We describe a series of cases with the aim of generating some guidelines as to the choice of reconstruction method and the implant used. METHODS We retrospectively reviewed 25 patients with diaphyseal resections in which the remaining epiphyseal or metaphyseal segment provided 3 cm or less of purchase. Reconstruction was performed with bone (allograft, extracorporeally radiated autograft, or vascularized fibula) in 19 cases or a custom diaphyseal implant (CDI) in six. The implants used for holding the bone construct varied from standard plates to custom plates. The presence of union, function, complications, and disease status at last followup was recorded. RESULTS Sixteen of the 25 patients are disease-free and alive with the original construct at a median followup of 34 months (range, 12-66 months). Implant-related complications such as plate breakage (four) and angulation (three) happened more frequently when weak plates such as reconstruction plates were used. Local recurrence with pulmonary metastases occurred in two cases. The two deep infections required an amputation or rotationplasty for control. Custom plates were successful in three of four patients. CONCLUSIONS Weak plates such as reconstruction plates are best avoided for these reconstructions. Custom plates allow secure fixation with technical ease. CDIs allow immediate weightbearing and ability to lengthen with predictable good functional short-term outcome.
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Affiliation(s)
- Manish Agarwal
- Tata Memorial Centre, Bone & Soft Tissue Service, Mumbai, India ,Hinduja Hospital and Medical Research Centre, Room 1417, Veer savarkar Marg, Mahim, Mumbai, 400016 India
| | - Ajay Puri
- Tata Memorial Centre, Bone & Soft Tissue Service, Mumbai, India
| | - Ashish Gulia
- Tata Memorial Centre, Bone & Soft Tissue Service, Mumbai, India
| | - Kishore Reddy
- Tata Memorial Centre, Bone & Soft Tissue Service, Mumbai, India
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