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Huang S, Yang J, Li X, Tang X, Ji T. A novel non-invasive electromagnetic extendable intercalary endoprosthesis: a proof-of-concept study. Front Bioeng Biotechnol 2024; 12:1400428. [PMID: 39091970 PMCID: PMC11291365 DOI: 10.3389/fbioe.2024.1400428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 06/26/2024] [Indexed: 08/04/2024] Open
Abstract
Introduction: Femur and tibia are the most commonly affected sites for primary malignant bone tumors in children. The wide resection of the tumor frequently requires the physis to be resected. The normal growth of the unaffected limb will result in a significant limb length discrepancy at skeletal maturity. To compensate for this resulting LLD, different generations of extendible endoprostheses have been developed. Non-invasive extendable prostheses eliminate the need for surgical procedures and general anesthesia, enabling gradual and painless lengthening. Currently available non-invasive extendable prostheses focus on joint reconstruction, and no case series analysis of intercalary non-invasive extendable prosthesis has been reported. Therefore, we have designed a novel non-invasive electromagnetic extendable intercalary endoprosthesis. Methods: In vitro mechanical experiments and in vivo animal experiments were conducted. Results: In vitro experiments have confirmed that the prosthetics can extend at a constant rate, increasing by 4.4 mm every 10 min. The average maximum extension force during prosthetic elongation can reach 1306N. In animal in vivo experiments, the extension process is smooth and non-invasive, and the sheep is in a comfortable state. Discussion: The in vitro and in vivo animal studies provide evidence to support the extension reliability, laying the foundation for future large-scale validation experiments.
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Affiliation(s)
- Siyi Huang
- Musculoskeletal Tumor Center, Peking University People’s Hospital, Beijing, China
- Beijing Key Laboratory of Musculoskeletal Tumor, Beijing, China
| | - Jiake Yang
- Musculoskeletal Tumor Center, Peking University People’s Hospital, Beijing, China
- Beijing Key Laboratory of Musculoskeletal Tumor, Beijing, China
| | - Xinyu Li
- Beijing AK Medical Co., Ltd., Beijing, China
| | - Xiaodong Tang
- Musculoskeletal Tumor Center, Peking University People’s Hospital, Beijing, China
- Beijing Key Laboratory of Musculoskeletal Tumor, Beijing, China
| | - Tao Ji
- Musculoskeletal Tumor Center, Peking University People’s Hospital, Beijing, China
- Beijing Key Laboratory of Musculoskeletal Tumor, Beijing, China
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Li Z, Lu M, Zhang Y, You Q, Wang Y, Li L, Ye Q, Wang Y, Luo Y, Min L, Zhou Y, Tu C. Three-dimensional printed customized uncemented unipolar prosthesis combined with ligament reconstruction for tumorous defect of the distal femur in children. BMC Musculoskelet Disord 2022; 23:1100. [PMID: 36527043 PMCID: PMC9756496 DOI: 10.1186/s12891-022-06053-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Hemiarthroplasty following tumor resection of the distal femur in children provides a chance to preserve the proximal tibial physis for limb elongation. Based on three-dimensional (3D) printing technology, the uncemented unipolar prosthesis with joint stability reinforced structures (JSRSs) was custom-designed for our cases. This study aimed to describe the design and assess the short-term outcomes of this refined prosthetic hemiarthroplasty. METHODS Seven patients (four females and three males) received 3D-printed customized uncemented unipolar prosthesis for hemiarthroplasty after removal of the distal femur, from September 2019 to October 2020 at our Orthopedics department. The limb function, growth of the preserved proximal tibial physis, joint stability, and limb length discrepancy (LLD) were assessed. Complications were recorded. RESULTS Six patients survived with no evidence of metastasis or local recurrence at the last follow-up, and one patient died of lung metastasis at 19 months postoperatively. Follow-up ranged from 19 to 32 months, with an average of 26 months. Elongation of the tibia was observed in all cases. At the last follow-up, four patients exhibited equal growth length compared with the healthy contralateral tibia. LLD ranged from 0.8 to 1.6 cm with a mean of 1.3 cm. The average knee range of motion was 95.3° of flexion and 4.5° of extension. All patients achieved satisfactory postoperative limb function with a mean MSTS score of 25.8. The results of the drawer, Lachman, and pivot shift tests were negative in all patients. During follow-up, painless joint space narrowing was observed in two patients. The screw for ligament fixation loosened in one of the seven patients at 17 months postoperatively. No subluxation of the joint, angular deformity, or breakage of the implant was detected in the remaining patients. CONCLUSIONS 3D-printed customized uncemented unipolar prosthesis with JSRS would be a good choice for reconstructing tumorous defect in the distal femur in children.
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Affiliation(s)
- Zhuangzhuang Li
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 People’s Republic of China ,grid.412901.f0000 0004 1770 1022Model Worker and Craftsman Talent Innovation Workshop of Sichuan province , West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Minxun Lu
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 People’s Republic of China ,grid.412901.f0000 0004 1770 1022Model Worker and Craftsman Talent Innovation Workshop of Sichuan province , West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Yuqi Zhang
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 People’s Republic of China ,grid.412901.f0000 0004 1770 1022Model Worker and Craftsman Talent Innovation Workshop of Sichuan province , West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Qi You
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 People’s Republic of China ,grid.412901.f0000 0004 1770 1022Model Worker and Craftsman Talent Innovation Workshop of Sichuan province , West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Yitian Wang
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 People’s Republic of China ,grid.412901.f0000 0004 1770 1022Model Worker and Craftsman Talent Innovation Workshop of Sichuan province , West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Longqing Li
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 People’s Republic of China ,grid.412901.f0000 0004 1770 1022Model Worker and Craftsman Talent Innovation Workshop of Sichuan province , West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Qiang Ye
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 People’s Republic of China ,grid.412901.f0000 0004 1770 1022Model Worker and Craftsman Talent Innovation Workshop of Sichuan province , West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Yang Wang
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 People’s Republic of China ,grid.412901.f0000 0004 1770 1022Model Worker and Craftsman Talent Innovation Workshop of Sichuan province , West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Yi Luo
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 People’s Republic of China ,grid.412901.f0000 0004 1770 1022Model Worker and Craftsman Talent Innovation Workshop of Sichuan province , West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Li Min
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 People’s Republic of China ,grid.412901.f0000 0004 1770 1022Model Worker and Craftsman Talent Innovation Workshop of Sichuan province , West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Yong Zhou
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 People’s Republic of China ,grid.412901.f0000 0004 1770 1022Model Worker and Craftsman Talent Innovation Workshop of Sichuan province , West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Chongqi Tu
- grid.412901.f0000 0004 1770 1022Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041 People’s Republic of China ,grid.412901.f0000 0004 1770 1022Model Worker and Craftsman Talent Innovation Workshop of Sichuan province , West China Hospital, Sichuan University, Chengdu, People’s Republic of China
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Tibia Multiplanar Deformities and Growth Disturbance Following Expandable Endoprosthetic Distal Femur Replacement. J Clin Med 2022; 11:jcm11226734. [PMID: 36431210 PMCID: PMC9699560 DOI: 10.3390/jcm11226734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/29/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Expandable distal femur endoprosthesis (EDFE) is commonly used to compensate for the loss of the distal femoral epiphyseal plate in skeletally immature children who have undergone surgical resection of bone malignancies. However, the effect of the passive tibial component of the EDFE on tibial growth has not been extensively studied in the literature. This study aims to delineate the type, frequency, and associated risk factors of multiplanar proximal tibial deformities in skeletally immature children following the use of the expandable distal femur endoprosthesis (EDFE). Moreover, we plan to detect how these deformities influence the long-term functionality of the endoprosthesis in defining the need for subsequent implant revision or further surgical management. Patients and Methods: A total of 20 patients aged (7−12) years underwent expandable distal femur replacement. Two types of implants were used: Juvenile Tumor System (JTS) non-invasive prosthesis in 14 patients, and Modular Universal Tumor and Revision System (MUTARS)® Xpand Growing Prostheses in six patients. A scanogram and CT scan documented the measurements of longitudinal and multiplanar growth as leg length discrepancy (LLD), femur length discrepancy (FLD), tibia length discrepancy (TLD), and the yield values of rotational, sagittal, and coronal deformities of the tibia. The patients were followed up to assess the need for further management. Sex, age, size of tibial plate perforation, and type of implant used were studied for possible correlation with deformities or growth disturbance. Results: The patients were followed up for a mean of 3 (2−7) years. A total of 14 patients, (10 JTS, 4 implant cast) had a tibial deformity and/or growth disturbance. A single patient was found to have all deformities (growth, rotational, coronal, and sagittal). Fourteen patients were found to have an LLD ranging from 5.3 to 59 mm (median 21 mm), 12 had a TLD from 3 to 30 mm, (median 10 mm), and 11 patients showed evidence of malrotation from 6 to 32 degrees (median 11 degrees). TLD was found to contribute entirely to LLD in three patients, and >50% of LLDs in seven patients. All LLDs were treated conservatively, except in three patients; two received contralateral tibia epiphysiodesis and one received revision with a new implant. A single patient had a posterior tibia slope angle (PTSA) of −2.8 degrees, and three patients had a coronal deformity with a mean medial proximal tibia angle (MPTA) of 80.3 (77−83 degrees). Conclusions: Tibial growth disturbance and multiplanar deformities occur in the majority of patients following EDFE replacement, exacerbating LLD. Yet, these disturbances may be well tolerated, managed conservatively, and rarely mandate endoprosthetic revision or subsequent corrective surgery. Age at the time of surgery was found to be the only significant contributor to the development of tibia growth disturbance.
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Li D, Ji T, Guo W, Qu H, Liang H, Yang Y, Tang X, Yang R, Wang J. Outcomes of Semiknee Replacement in Skeletally Immature Bone Sarcoma Patients. J Knee Surg 2022. [PMID: 35817056 DOI: 10.1055/s-0042-1748823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION A semiknee mega endoprosthesis (SKMEP) was used to replace the resected distal femur or proximal tibia in skeletally immature bone sarcoma patients. This study investigated the surgical technique, endoprosthesis survival rate, functional outcome, complications, and approaches to resolve limb-length discrepancy (LLD) following this procedure. PATIENTS AND METHODS In total, 15 girls and 16 boys with a mean age of 9.1 years (range, 4-12) and 8.9 years (range, 5-13), respectively, were included in this study. The mean length of the resected distal femur (15 cases) and proximal tibia (16) was 145.0 and 122.8 mm, respectively. Altogether, 19 custom-made SKMEPs and 12 modular units were used to reconstruct the bone and joint defects. RESULTS The average follow-up was 82.8 months (range, 4-225 months). Five patients died of disease. Seven SKMEPs were revised to total knee endoprosthesis after a mean of 40.3 months. Nineteen patients retained the original SKMEP, and the mean LLD was 4.3 cm (range, 0-10 cm). One case each of Henderson type 1B, type 2A, type 2B, and type 5B failures was observed. Knee subluxation occurred in two cases. Although a slight laxity of the knee was identified on physical examination, the average Musculoskeletal Tumor Society 93(MSTS93) functional score was 84.5% (range, 57-97%). The estimated implant survival was 70.5% at 5 years. CONCLUSION This was the largest retrospective study reporting the application of SKMEP in bone sarcoma patients. For selected skeletally immature bone sarcoma patients, SKMEP is an option with satisfactory functional outcomes and survival rates. However, heightening pads or shoes to compensate the LLD were indispensable before subsequent LLD was adjusted by further operation(s).
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Affiliation(s)
- Dasen Li
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Tao Ji
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Huayi Qu
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Haijie Liang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Yi Yang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Xiaodong Tang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Rongli Yang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Jichuan Wang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China
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Long-term outcomes of non-invasive expandable endoprostheses for primary malignant tumors around the knee in skeletally-immature patients. Arch Orthop Trauma Surg 2022; 142:927-936. [PMID: 33417027 DOI: 10.1007/s00402-020-03712-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 12/06/2020] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Expandable endoprostheses are used to restore limb function and compensate for the sacrifice physis involved in carcinologic resection. Long-term outcomes of the last generation of knee "non-invasive" expandable endoprostheses are required. Objectives were to report on oncologic results of bone sarcoma resection around the knee with expandable endoprosthesis reconstruction and to compare the surgical outcomes of the "non-invasive" expandable endoprostheses used in our department. MATERIALS AND METHODS Retrospective study that included all children with bone sarcoma around the knee that underwent tumor resection reconstructed with non-invasive expandable prosthesis. Phenix-Repiphysis was used from 1994 to 2008 followed by Stanmore JTS non-invasive from 2008 to 2016. Survival and complications were recorded. Functional outcomes included Musculoskeletal Tumor Society (MSTS) score, knee range of motion, lower limb discrepancy (LLD). RESULTS Forty children (Sex Ratio = 1) aged a mean 8.8 years (range, 5.6-13.8) at surgery were included in the study. There were 36 osteosarcoma and 4 Ewing sarcoma that involved 33 distal femur and 7 proximal tibia. Cohort (n = 40) consisted of 28 Phenix-Repiphysis and 12 Stanmore with a mean follow-up of 9.8 ± 5.8 years and 6.1 ± 3.1 years, respectively. Postoperative infection rate was 7.5% in the cohort (3 Repiphysis). Functional results were significantly better in the Stanmore group with a mean MSTS of 87.6 ± 5.4% and knee flexion of 112 ± 38°. At last follow-up, implant survival was 100% in Stanmore group, whereas all living Phenix-Repiphysis were explanted. Mechanical failure was the primary cause for revision of Phenix-Repiphysis. Limb length equality was noted in 79% patients with Phenix-Repiphysis and 84% with Stanmore at last follow-up. CONCLUSION Chemotherapy and limb-salvage surgery yield good oncologic outcomes. Expandable endoprostheses are effective in maintaining satisfactory function and lower limb equality. With improvements made in the last generation of "non-invasive" prostheses, implants' survival has been substantially lengthened.
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Masrouha K, Abboud M, Saab R, Muwakkit SA, Khoury N, Haidar R, Saghieh S. Long-term follow-up of children treated with the Repiphysis expandable prosthesis for lower extremity bone sarcoma. J Pediatr Orthop B 2022; 31:e258-e263. [PMID: 34101677 DOI: 10.1097/bpb.0000000000000891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Expandable endoprostheses provide a limb salvage option for skeletally immature patients with bone sarcoma of the lower extremities. Initial reports of the Repiphysis prosthesis were encouraging; however, medium-term follow-up revealed high complication rates. We report on the long-term follow-up of a cohort of patients treated with the Repiphysis prosthesis. Eleven patients were included in the study. Data collected included sex, age at surgery, duration of follow-up, site of disease, histologic diagnosis, number of lengthening sessions, amount lengthened, postoperative complications, endoprosthetic failure, mode of endoprosthetic failure, duration from index surgery to failure and to revision, type of revision surgery and final limb-length discrepancy. The average duration of follow-up from the time of surgery was 180 months (range, 144-215 months). Fifteen Repiphysis implants were used in 11 patients. All implants failed with an average time from surgery to failure of 36 months (range, 3-72 months). Twenty-four complications were observed: one wound dehiscence, two deep infections, 18 mechanical failures, implant collapse with destruction of proximal tibia epiphysis in two and one periprosthetic proximal femur fracture with dislodgement of the stem. Despite being an option for limb salvage, the Repiphysis prosthesis has a high rate of mechanical failure and need for revision, similar to other expandable implants. The authors, therefore, recommend full disclosure of the potential short- and long-term complications and need for revision, as well as alternative treatment options if their use is considered. Level of evidence: IV (Therapeutic).
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Affiliation(s)
- Karim Masrouha
- Divisions of Pediatric Orthopedic Surgery and Orthopedic Oncology, Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Miguel Abboud
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Children's Cancer Institute
| | - Raya Saab
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Children's Cancer Institute
| | - Samar A Muwakkit
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Children's Cancer Institute
| | | | - Rachid Haidar
- Division of Orthopedic surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Said Saghieh
- Division of Orthopedic surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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Noninvasive Expandable Endoprostheses From Reconstruction to Skeletal Maturity: A Surgical Technique and Lengthening Guide. J Am Acad Orthop Surg 2021; 29:998-1007. [PMID: 34543240 DOI: 10.5435/jaaos-d-21-00183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 08/10/2021] [Indexed: 02/01/2023] Open
Abstract
Limb salvage is the benchmark for pediatric extremity bone sarcomas. However, reconstructive strategies must account for any anticipated remaining growth potential and the resultant limb inequality. Expandable endoprostheses offer the theoretical advantage of immediate weight-bearing, predictable function, and reliable maintenance of leg-length equality. The evolution of the lengthening mechanism now permits noninvasive lengthening, opposed to the multiple open procedures of the past. These design improvements have contributed to their growing popularity. Experience has indicated that these noninvasive implants more reliably achieve leg-length equality, have longer failure-free survival, and decreased complications, although some have noted gearbox and lengthening failures. Currently, no standardize technique exists for managing patients with noninvasive expandable implants from the time of reconstruction to final lengthening at skeletal maturity. This blueprint aims to provide a detailed surgical technique, lengthening schedule, and recommendations for the mitigation and management of complications to achieve successful limb salvage with noninvasive expandable endoprostheses.
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Raciborska A, Bilska K, Malesza I, Rodriguez-Galindo C, Pachuta B. Distal Tibial Reconstruction in the Management of Primary Bone Tumors in Children and Adolescents. Foot Ankle Int 2021; 42:1447-1453. [PMID: 34116600 DOI: 10.1177/10711007211012690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Distal tibial primary bone tumors are rare, and options for limb salvage surgery are limited and challenging. Importantly, local control has shown to be crucial and necessary for cure, and radical surgery is one of the most important components of therapy for some bone sarcomas. We investigated the feasibility and functional and oncological outcomes of distal tibial reconstruction using endoprosthesis in children with malignant bone tumors. METHODS Fourteen patients (median age 13.6 years) with primary bone tumors (4 Ewing sarcoma [ES], 10 osteosarcoma) of the distal tibiae were treated during 2013-2019. All patients had reconstruction using a modular (13 patients) or expandable custom-made titanium bone replacement system (1 patient). All patients received chemotherapy before and after surgery. RESULTS Twelve patients (85.7%) are alive with a median follow-up 20 months from diagnosis. Five-year estimates of event-free survival and overall survival were 60.6% and 76.4%, respectively. Three patients had postoperative complications requiring second surgery. Maximum dorsiflexion and plantar flexion of the foot were 20 degrees (range 0-20 degrees) and 20 degrees (range 5-20 degrees), respectively. CONCLUSION For select distal tibial sarcomas, after neoadjuvant chemotherapy pretreatment and radical resection, reconstruction using an endoprosthesis as a radical surgery provides an option was associated with a low rate of short-term local complications and relatively good early function. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Anna Raciborska
- Department of Oncology and Surgical Oncology for Children and Youth, Institute of Mother and Child, Warsaw, Poland
| | - Katarzyna Bilska
- Department of Oncology and Surgical Oncology for Children and Youth, Institute of Mother and Child, Warsaw, Poland
| | - Iwona Malesza
- Department of Oncology and Surgical Oncology for Children and Youth, Institute of Mother and Child, Warsaw, Poland
| | | | - Bartosz Pachuta
- Department of Oncology and Surgical Oncology for Children and Youth, Institute of Mother and Child, Warsaw, Poland
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Lex JR, Adlan A, Tsoi K, Evans S, Stevenson JD. Frequency and reason for reoperation following non-invasive expandable endoprostheses: A systematic review. J Bone Oncol 2021; 31:100397. [PMID: 34712555 PMCID: PMC8529098 DOI: 10.1016/j.jbo.2021.100397] [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: 05/27/2021] [Revised: 09/08/2021] [Accepted: 10/03/2021] [Indexed: 11/25/2022] Open
Abstract
Implant failure is the most common reason for revision of growing prostheses. Maximum prosthesis growth with a residual LLD is the most common mode of failure. Functional outcomes are good, but 1/ 5 patients have a persistent LLD over 2 cm.
Background Non-invasive expandable endoprostheses (NIEPR) utilize an external electromagnetic field to drive an innate mechanical gearbox. This lengthens the extremity following oncological resections in children with a predicted limb length discrepancy (LLD), facilitating limb-salvage. This review was conducted to assess NIEPR implant survival rates and identify modes of implant failure unique to these prostheses. Methods Medline, EMBASE and the Cochrane Library databases were searched for all manuscripts evaluating implant survival of NIEPRs implanted into skeletally immature patients following resection of extremity sarcomas. Minimum follow-up of 12 months or implant failure was required for inclusion. Failures were classified using the latest ISOLS classification and exact implant-specific failure modality was also identified. Results 19 studies met inclusion criteria. Mean age was 10.0 years (7.7 – 11.4 years). The most common locations for NIEPR implantation were the distal femur (343, 76.7%) and proximal tibia (53, 119%). Mean follow-up was 65.3 months (19.4 – 163 months). The overall implant revision rate was 46.2% (0 – 100%); implant specific revisions included maximal prosthesis lengthening with persistent LLD (10.4%), failed extension mechanism (6.1%), implant fracture (7.7%), hinge fracture (1.4%) and bushing wear (0.9%). Persistent clinically significant (>20 mm) LLD at final follow-up was present in 19.2% (0 – 50%) of patients. The mean MSTS score was 85.1% (66.7–96.3%) at final follow-up. Conclusion Implant-related failures are the most common reason for NIEPR revision. Implant reliability appears to be improved with current designs. A sub-classification to the current classification system based on implant-specific failures for NIEPRs is proposed.
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Affiliation(s)
- Johnathan R Lex
- The Royal Orthopaedic Hospital, Oncology Department, Birmingham, West Midlands B31 2AP, UK.,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Amirul Adlan
- The Royal Orthopaedic Hospital, Oncology Department, Birmingham, West Midlands B31 2AP, UK
| | - Kim Tsoi
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada.,University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada
| | - Scott Evans
- The Royal Orthopaedic Hospital, Oncology Department, Birmingham, West Midlands B31 2AP, UK
| | - Jonathan D Stevenson
- The Royal Orthopaedic Hospital, Oncology Department, Birmingham, West Midlands B31 2AP, UK.,Aston University Medical School, Aston University, Birmingham, UK
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El Beaino M, Wang WL, Alaraj SF, Gugala Z, Lin PP. Osteofibrous dysplasia and adamantinoma: A summary of diagnostic challenges and surgical techniques. Surg Oncol 2021; 38:101626. [PMID: 34280695 DOI: 10.1016/j.suronc.2021.101626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 12/11/2022]
Abstract
Osteofibrous dysplasia is an indolent benign fibro-osseous tumor, while adamantinoma is a locally aggressive biphasic malignancy with epithelial and fibro-osseous components. Predominantly arising in the tibial diaphysis of children and young adults, both tumors are resistant to chemotherapy and radiation. Wide surgical resection is regarded as the mainstay of therapy for adamantinoma, and limb-salvage reconstructive procedures can achieve good functional outcomes, albeit with non-negligible rates of complications. This review discusses emerging advances in the pathogenesis, histogenesis, and diagnosis of these entities and presents advantages and limitations of the most common surgical techniques used for their management.
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Affiliation(s)
- Marc El Beaino
- Department of Orthopaedic Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA; School of Public Health, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA.
| | - Wei-Lien Wang
- Department of Pathology and Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sami F Alaraj
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX, USA
| | - Zbigniew Gugala
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX, USA
| | - Patrick P Lin
- Department of Orthopaedic Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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11
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How should we lengthen post-traumatic limb defects? a systematic review and comparison of motorized lengthening systems, combined internal and external fixation and external fixation alone. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2020. [PMID: 33222112 DOI: 10.1007/s00590-020-02831-y)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Various external fixation systems for lower extremity long bone deformities have been used to various degrees of success, while newer mechanical lengthening nail (MLN) systems offer the potential for improved patient outcomes. Proponents of MLNs argue that they reduce the number of operations, infectious complications, and improve quality of life; however, the evidence to support these claims is scant. This systematic review aims to evaluate the optimal lengthening system for treating post-traumatic long bone deformity. METHODS The systematic review was conducted in accordance with PRISMA guidelines. PUBMED, EMBASE, CINAHL, and the Cochrane Library were searched for comparative studies of lengthening techniques among adult patients with axial deformities. Studies were screened and data extracted in duplicate. Treatment groups were pooled into external fixation (EF) alone, combined internal and external fixation (CIF), and mechanical lengthening nail (MLN). Outcomes were mean lengthening achieved, lengthening index, and reported complications. RESULTS Thirteen studies with 725 patients (mean age: 29.6 years, 74% male) were included. Nearly all of the studies were either prospective or retrospective cohort studies (n = 12), with one randomized controlled trial of moderate study quality. The mean limb lengthening achieved, lengthening index, and rate of reoperation were similar among the MLN, EF, and CIF groups. CONCLUSION The purported decreased the duration of lengthening and the risk of reoperation associated with MLNs was not demonstrated in this review. Patients with post-traumatic leg length deformities remain a challenging patient population to treat, with intervention being associated with high rates of infectious complications and need for revision operations.
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12
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How should we lengthen post-traumatic limb defects? a systematic review and comparison of motorized lengthening systems, combined internal and external fixation and external fixation alone. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:1015-1022. [PMID: 33222112 DOI: 10.1007/s00590-020-02831-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 11/10/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Various external fixation systems for lower extremity long bone deformities have been used to various degrees of success, while newer mechanical lengthening nail (MLN) systems offer the potential for improved patient outcomes. Proponents of MLNs argue that they reduce the number of operations, infectious complications, and improve quality of life; however, the evidence to support these claims is scant. This systematic review aims to evaluate the optimal lengthening system for treating post-traumatic long bone deformity. METHODS The systematic review was conducted in accordance with PRISMA guidelines. PUBMED, EMBASE, CINAHL, and the Cochrane Library were searched for comparative studies of lengthening techniques among adult patients with axial deformities. Studies were screened and data extracted in duplicate. Treatment groups were pooled into external fixation (EF) alone, combined internal and external fixation (CIF), and mechanical lengthening nail (MLN). Outcomes were mean lengthening achieved, lengthening index, and reported complications. RESULTS Thirteen studies with 725 patients (mean age: 29.6 years, 74% male) were included. Nearly all of the studies were either prospective or retrospective cohort studies (n = 12), with one randomized controlled trial of moderate study quality. The mean limb lengthening achieved, lengthening index, and rate of reoperation were similar among the MLN, EF, and CIF groups. CONCLUSION The purported decreased the duration of lengthening and the risk of reoperation associated with MLNs was not demonstrated in this review. Patients with post-traumatic leg length deformities remain a challenging patient population to treat, with intervention being associated with high rates of infectious complications and need for revision operations.
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13
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Axelrod D, Rubinger L, Shah A, Guy P, Johal H. How should we lengthen post-traumatic limb defects? a systematic review and comparison of motorized lengthening systems, combined internal and external fixation and external fixation alone. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2020. [PMID: 33222112 DOI: 10.1007/s00590-020-02831-y).] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
PURPOSE Various external fixation systems for lower extremity long bone deformities have been used to various degrees of success, while newer mechanical lengthening nail (MLN) systems offer the potential for improved patient outcomes. Proponents of MLNs argue that they reduce the number of operations, infectious complications, and improve quality of life; however, the evidence to support these claims is scant. This systematic review aims to evaluate the optimal lengthening system for treating post-traumatic long bone deformity. METHODS The systematic review was conducted in accordance with PRISMA guidelines. PUBMED, EMBASE, CINAHL, and the Cochrane Library were searched for comparative studies of lengthening techniques among adult patients with axial deformities. Studies were screened and data extracted in duplicate. Treatment groups were pooled into external fixation (EF) alone, combined internal and external fixation (CIF), and mechanical lengthening nail (MLN). Outcomes were mean lengthening achieved, lengthening index, and reported complications. RESULTS Thirteen studies with 725 patients (mean age: 29.6 years, 74% male) were included. Nearly all of the studies were either prospective or retrospective cohort studies (n = 12), with one randomized controlled trial of moderate study quality. The mean limb lengthening achieved, lengthening index, and rate of reoperation were similar among the MLN, EF, and CIF groups. CONCLUSION The purported decreased the duration of lengthening and the risk of reoperation associated with MLNs was not demonstrated in this review. Patients with post-traumatic leg length deformities remain a challenging patient population to treat, with intervention being associated with high rates of infectious complications and need for revision operations.
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Affiliation(s)
- Daniel Axelrod
- Division of Orthopedic Surgery, McMaster University, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada.
| | - Luc Rubinger
- Division of Orthopedic Surgery, McMaster University, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada
| | - Ajay Shah
- McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada
| | - Pierre Guy
- Division of Orthopedic Surgery, University of British Columbia, 2775 Laurel St Vancouver, British Columbia, Canada
| | - Herman Johal
- Division of Orthopedic Surgery, McMaster University, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada.,McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada
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14
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Staals EL, Sambri A, Campanacci DA, Muratori F, Leithner A, Gilg MM, Gortzak Y, Van De Sande M, Dierselhuis E, Mascard E, Windhager R, Funovics P, Schinhan M, Vyrva O, Sys G, Bolshakov N, Aston W, Gikas P, Schubert T, Jeys L, Abudu A, Manfrini M, Donati DM. Expandable distal femur megaprosthesis: A European Musculoskeletal Oncology Society study on 299 cases. J Surg Oncol 2020; 122:760-765. [PMID: 32506533 DOI: 10.1002/jso.26060] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 04/25/2020] [Accepted: 05/19/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES Expandable distal femur prostheses have become more popular over the last decades, but scientific data is limited. METHODS A retrospective study was performed, including cases treated between 1986 and 2019 in 15 European referral centers for bone sarcomas. RESULTS A total of 299 cases were included. Average follow-up was 80 months (range, 8-287 months). Mean patient age was 10 years. Most (80%) of the implants were noninvasive growers and a fixed hinge knee was used more often (64%) than a rotating hinge. Most prosthetic designs showed good (>80%) implant survival at 10 years, but repeat surgery was required for 63% of the patients. The most frequent reason for revision procedure was the completion of lengthening potential. Noninvasive expandable implants showed less risk of infection compared to invasive growers (11.8% vs 22.9% at 10 years). No difference in aseptic loosening was found between cemented and uncemented stems. CONCLUSIONS This study shows the increasing popularity of expandable distal femur prostheses, with overall good results for function and implant survival. However, repeat surgery is frequently required, especially in patients under the age of 10 years old. Infection is less frequent in noninvasive growers compared to implants that require invasive lengthening procedures.
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Affiliation(s)
| | - Andrea Sambri
- Orthopedic Surgery, AOSP Sant'Orsola-Malpighi, Bologna, Italy
| | | | - Francesco Muratori
- Orthopedic Surgery, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | | | | | - Yair Gortzak
- Orthopedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | | | | | - Eric Mascard
- Orthopedic Surgery, hôpital-Necker, Paris, France
| | | | | | | | - Oleg Vyrva
- Orthopedic Surgery, Sytenko Institute of Spine and Joint Pathology, Kharkiv, Ukraine
| | - Gwen Sys
- Orthopedic Surgery, Universitai Ziekenhuis Gent, Gent, Belgium
| | - Nikolay Bolshakov
- Orthopedic Surgery, National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Will Aston
- Orthopedic Surgery, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Panagiotas Gikas
- Orthopedic Surgery, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Thomas Schubert
- Orthopedic Surgery, Clinic Universitaires Saint-Luc, Brussels, Belgium
| | - Lee Jeys
- Orthopedic Surgery, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - Adesegun Abudu
- Orthopedic Surgery, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - Marco Manfrini
- Orthopedic Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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15
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Nezwek TA, Rothy AC, Chapman RM, Van Citters DW, Koenig K. Bilateral Femoral Component Fractures After Primary Total Knee Arthroplasty With Cruciate-Retaining Femoral Component. Arthroplast Today 2020; 6:496-501. [PMID: 32695866 PMCID: PMC7363632 DOI: 10.1016/j.artd.2020.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/18/2020] [Accepted: 06/01/2020] [Indexed: 11/25/2022] Open
Abstract
A 69-year-old male presented with atraumatic bilateral femoral component fractures at different time intervals after simultaneous bilateral total knee arthroplasty using the cemented Biomet Ascent Knee System. The right and left knee implant fractures occurred 12 and 17 years after primary arthroplasty, respectively. This patient was notably tall (190.5 cm, 98th percentile) and maintained an active lifestyle before implant fractures. Sequential, bilateral knee implant fractures in a system with a previously acceptable track record suggest that biomechanics, patient characteristics, and surgical factors can significantly influence the risks for fracture of an implant.
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Affiliation(s)
| | - Alexander C Rothy
- Department of Surgery and Perioperative Care, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Ryan M Chapman
- Dartmouth College Thayer School of Engineering, Hanover, NH, USA
| | | | - Karl Koenig
- Department of Surgery and Perioperative Care, The University of Texas at Austin Dell Medical School, Austin, TX, USA
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16
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Coathup MJ, Ahmad S, Maempel JF, Briggs TW, Aston WJ, Skinner JA, Blunn GW. Non-invasive massive growing prostheses reduce infection in paediatric cancer patients. J Orthop Surg (Hong Kong) 2020; 27:2309499019833403. [PMID: 30827180 DOI: 10.1177/2309499019833403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE In this study, we asked the question of whether non-invasive (NI) extendible bone tumour implants are as reliable and reduce infection when compared with patients who received a minimally invasive (MI) extendible implant. METHODS Forty-two NI extendible bone tumour implants were investigated at a mean follow-up of 22 months (range, 1-87 months) and 63 MI implants at a mean follow-up of 49 months (range, 1-156 months). RESULTS Kaplan-Meier analysis showed that the probability of MI implant survival was 58.8% compared with 78.6% in NI patients. No significant difference between these two patient groups was found. Infection was the main reason for failure in the MI implant group where nine (35%) implants were revised. However, only one (11%) NI implant was revised for infection ( p = 0.042). None of the NI implants failed due to aseptic loosening; however, six (23%) MI implants were revised for aseptic loosening of the intramedullary stem. Four (15%) of the failed MI implants were revised due to full extension and five (56%) of failed NI implants were replaced as the implant had been fully extended where the patient still required growth. CONCLUSION Where possible, an NI massive prosthesis should be used in this patient group. Our results suggest that MI prostheses should be infrequently used due to the high incidence of infection. Lengthening of NI prostheses is painless, can be carried out in the clinic and is more cost-effective. However, further work is required to increase the amount of growth potential available in these implants.
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Affiliation(s)
- Melanie Jean Coathup
- 1 Institute of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, The Royal National Orthopaedic Hospital, Middlesex, UK
| | - Samee Ahmad
- 1 Institute of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, The Royal National Orthopaedic Hospital, Middlesex, UK
| | - Julian F Maempel
- 2 Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | | | | | - Gordon W Blunn
- 1 Institute of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, The Royal National Orthopaedic Hospital, Middlesex, UK
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17
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Tsuda Y, Tsoi K, Stevenson JD, Fujiwara T, Tillman R, Abudu A. Extendable Endoprostheses in Skeletally Immature Patients: A Study of 124 Children Surviving More Than 10 Years After Resection of Bone Sarcomas. J Bone Joint Surg Am 2020; 102:151-162. [PMID: 31714469 DOI: 10.2106/jbjs.19.00621] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Extendable endoprostheses are used to reconstruct segmental defects following resection of bone sarcomas in skeletally immature patients. However, there remains a paucity of studies with regard to long-term outcomes. METHODS We retrospectively reviewed 124 skeletally immature children who underwent an extendable endoprosthetic replacement and survived more than 10 years after the surgical procedures. Anatomical sites included the distal part of the femur (n = 66), the proximal part of the femur (n = 13), the proximal part of the tibia (n = 29), and the proximal part of the humerus (n = 16). Complications and implant survival were classified according to the modified Henderson criteria. RESULTS The mean follow-up was 24 years (range, 10 to 36 years). The mean age at the time of the extendable endoprosthetic replacement was 9 years (range, 2 to 16 years). All patients had reached skeletal maturity at the last follow-up. The 10-year endoprosthetic failure-free survival rate was 28%. A total of 243 complications occurred in 90% of patients; these complications were most frequently related to soft-tissue problems (27% of complications). The incidence of and cumulative survival with respect to each failure mode varied between anatomical sites. Soft-tissue failures occurred most frequently in the proximal part of the femur (77%; p = 0.003), and the distal part of the femur was the most frequent site of aseptic loosening (52%; p = 0.014) and structural failure (55%; p = 0.001). Excluding lengthening procedures, 105 patients (85%) underwent an additional surgical procedure, with a mean of 2.7 surgical procedures per patient (range, 0 to 7 surgical procedures per patient). The mean limb-length discrepancy at the final follow-up was 1 cm (range, 0 to 9 cm). Limb salvage was achieved in 113 patients (91%). The mean Musculoskeletal Tumor Society functional score (the percentage of a total score of 30 points) was 82% (range, 40% to 100%) in 115 patients with available data at the last follow-up. CONCLUSIONS Extendable endoprostheses are associated with a high complication rate and a need for additional surgical procedures over time. Despite this, successful limb salvage with reasonable function and small limb-length discrepancy is achievable in the long term. Our study provides benchmark data for individual anatomical sites for further improvements of outcomes. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Yusuke Tsuda
- Royal Orthopaedic Hospital, Birmingham, United Kingdom
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18
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Ji T, Yang Y, Li DS, Tang XD, Guo W. Limb Salvage Using Non-hinged Endoprosthesis and Staged Correction of Leg-length Discrepancy for Children with Distal Femoral Malignant Tumors. Orthop Surg 2019; 11:819-825. [PMID: 31489784 PMCID: PMC6819186 DOI: 10.1111/os.12525] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 07/05/2019] [Accepted: 07/21/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Limb salvage in pediatric patients remains a challenge. We describe a staged strategy. The procedure includes: (i) tumor removal and non-hinged static endoprosthesis reconstruction; (ii) leg length discrepancy (LLD) correction by shoe lift or distraction osteogenesis; and (iii) maturity reconstruction by regular endoprosthesis. The aim of the study was to investigate the results of non-hinged static megaprosthesis reconstruction and staged LLD correction in the treatment of malignant tumors in the distal femur in children. METHODS Non-hinged megaprostheses were implanted in 12 pediatric patients with osteosarcoma in the distal femur. The prosthesis consists of a femoral component with constrained condylar knee (CCK) design, and a tibial component with a small-diameter press-fit stem and derotation fins. A posterior stabilizing polyethylene component is fixed on the tibial component. The cases were prospectively followed up with focus on the growth rate of adjacent uninvolved bone in the salvaged limb, joint stability, knee stability, function outcome, length discrepancy, and surgery-related complications. RESULTS There were five girls and seven boys included in the study, with an average age at the time of primary surgery of 10.0 years (range, 8-12 years). All the tumors were located in the distal femur. The average follow up was 76.3 months (range, 24-139 months). The Ligament Augmentation and Reconstruction System (LARS) ligament was used in two patients to enhance the soft tissue reattachment and reconstruct medial collateral ligament (MCL). Ten patients were alive at the final follow-up and two had died of lung metastases. Expected LLD was 6.7 cm (range, 3.0-13.2 cm) at initial surgery. At the final follow-up, nine patients reached skeletal maturity and the actual LLD at the femur was 5.3 cm (range, 3.0-10.1 cm), excluding 1 cm correction at initial surgery by endoprosthesis. The proximal tibia physis showed an average of 86.7% (range, 56.5%-100%) growth of the contralateral side. The mean reduction in tibial length was 1.2 cm (range, 0.5-4.7 cm). Six patients received distraction osteogenesis at a mean length of 5.4 cm (range, 3.0-9.1 cm). Range of knee movement was between 85° and 125°, with an average of 102.5°. The Musculoskeletal Tumor Society 93 score of patients alive was 80.6 (range, 60-90). CONCLUSION Non-hinged static megaprosthesis followed by LLD correction with shoe lift or staged distraction osteogenesis appears to be an alternative option to treat children with malignant bone tumors around the knee.
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Affiliation(s)
- Tao Ji
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing, China
| | - Yi Yang
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing, China
| | - Da-Sen Li
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing, China
| | - Xiao-Dong Tang
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing, China
| | - Wei Guo
- Musculoskeletal Tumor Center, People's Hospital, Peking University, Beijing, China
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19
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Sambri A, Staals E, Medellin MR, Abudu A, Gikas P, Pollock R, Briggs TWR, Donati DM, Manfrini M. Stanmore noninvasive extendible endoprosthesis in the treatment of bone sarcoma in the preadolescent. J Surg Oncol 2019; 120:176-182. [DOI: 10.1002/jso.25501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/03/2019] [Accepted: 04/26/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Andrea Sambri
- Orthopedic OncologyIRCCS Istituto Ortopedico RizzoliBologna Italy
| | - Eric Staals
- Orthopedic OncologyIRCCS Istituto Ortopedico RizzoliBologna Italy
| | - Manuel Ricardo Medellin
- Orthopedic OncologyRoyal Orthopaedic Hospital NHS TrustBirmingham UK
- Orthopedic OncologyInstituto Nacional de CancerologiaBogotà Colombia
| | - Adesegun Abudu
- Orthopedic OncologyRoyal Orthopaedic Hospital NHS TrustBirmingham UK
| | - Panagiotis Gikas
- Orthopedic OncologyRoyal National Orthopaedic Hospital NHS TrustLondon UK
| | - Rob Pollock
- Orthopedic OncologyRoyal National Orthopaedic Hospital NHS TrustLondon UK
| | - Tim WR Briggs
- Orthopedic OncologyRoyal National Orthopaedic Hospital NHS TrustLondon UK
| | | | - Marco Manfrini
- Orthopedic OncologyIRCCS Istituto Ortopedico RizzoliBologna Italy
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20
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Medellin MR, Fujiwara T, Clark R, Jeys LM. Comparison of minimally invasive and non-invasive systems in lengthening total femoral prostheses. Bone Joint J 2018; 100-B:1640-1646. [DOI: 10.1302/0301-620x.100b12.bjj-2018-0135.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aim of this study was to describe, analyze, and compare the survival, functional outcome, and complications of minimally invasive (MI) and non-invasive (NI) lengthening total femoral prostheses. Patients and Methods A total of 24 lengthening total femoral prostheses, 11 MI and 13 NI, were implanted between 1991 and 2016. The characteristics, complications, and functional results were recorded. There were ten female patients and ten male patients. Their mean age at the time of surgery was 11 years (2 to 41). The mean follow-up was 13.2 years (seven months to 29.25 years). A survival analysis was performed, and the failures were classified according to the Modified Henderson System. Results The overall implant survival was 79% at five, ten, and 20 years for MI prostheses, and 84% at five years and 70% at ten years for NI prostheses. At the final follow-up, 13 prostheses did not require further surgery. The overall complication rate was 46%. The mean revision-free implant survival for MI and NI prostheses was 59 months and 49 months, respectively. There were no statistically significant differences in the overall implant survival, revision-free survival, or the distribution of complications between the two types of prosthesis. Infection rates were also comparable in the groups (9% vs 7%; p = 0.902). The rate of leg-length discrepancy was 54% in MI prostheses and 23% in NI prostheses. In those with a MI prosthesis, there was a smaller mean range of movement of the knee (0° to 62° vs 0° to 83°; p = 0.047), the flexion contracture took a longer mean time to resolve after lengthening (3.3 months vs 1.07 months; p < 0.001) and there was a lower mean Musculoskeletal Tumor Society (MSTS) score (24.7 vs 27; p = 0.295). Conclusion The survival and complications of MI and NI lengthening total femoral prostheses are comparable. However, patients with NI prosthesis have more accurate correction of leg-length discrepancy, a better range of movement of the knee and an improved overall function.
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Affiliation(s)
- M. R. Medellin
- Consultant in Orthopaedic Oncology and Reconstructive Surgery, Royal Orthopaedic Hospital, Birmingham, UK
| | - T. Fujiwara
- Consultant in Orthopaedic Oncology and Reconstructive Surgery, Royal Orthopaedic Hospital, Birmingham, UK
| | - R. Clark
- Consultant in Orthopaedic Oncology and Reconstructive Surgery, Royal Orthopaedic Hospital, Birmingham, UK
| | - L. M. Jeys
- Consultant in Orthopaedic Oncology and Reconstructive Surgery, Royal Orthopaedic Hospital, Birmingham, UK
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21
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22
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Gilg MM, Gaston CL, Jeys L, Abudu A, Tillman RM, Stevenson JD, Grimer RJ, Parry MC. The use of a non-invasive extendable prosthesis at the time of revision arthroplasty. Bone Joint J 2018; 100-B:370-377. [PMID: 29589498 DOI: 10.1302/0301-620x.100b3.bjj-2017-0651.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The use of a noninvasive growing endoprosthesis in the management of primary bone tumours in children is well established. However, the efficacy of such a prosthesis in those requiring a revision procedure has yet to be established. The aim of this series was to present our results using extendable prostheses for the revision of previous endoprostheses. Patients and Methods All patients who had a noninvasive growing endoprosthesis inserted at the time of a revision procedure were identified from our database. A total of 21 patients (seven female patients, 14 male) with a mean age of 20.4 years (10 to 41) at the time of revision were included. The indications for revision were mechanical failure, trauma or infection with a residual leg-length discrepancy. The mean follow-up was 70 months (17 to 128). The mean shortening prior to revision was 44 mm (10 to 100). Lengthening was performed in all but one patient with a mean lengthening of 51 mm (5 to 140). Results The mean residual leg length discrepancy at final follow-up of 15 mm (1 to 35). Two patients developed a deep periprosthetic infection, of whom one required amputation to eradicate the infection; the other required two-stage revision. Implant survival according to Henderson criteria was 86% at two years and 72% at five years. When considering revision for any cause (including revision of the growing prosthesis to a non-growing prosthesis), revision-free implant survival was 75% at two years, but reduced to 55% at five years. Conclusion Our experience indicates that revision surgery using a noninvasive growing endoprosthesis is a successful option for improving leg length discrepancy and should be considered in patients with significant leg-length discrepancy requiring a revision procedure. Cite this article: Bone Joint J 2018;100-B:370-7.
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Affiliation(s)
- M M Gilg
- Department of Orthopedic Surgery and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - C L Gaston
- Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK and The Department of Orthopedics, Philippine General Hospital, Manila Taft Avenue, Manila, 1000, Philippines
| | - L Jeys
- Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, United Kingdom
| | - A Abudu
- Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, United Kingdom
| | - R M Tillman
- Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, United Kingdom
| | - J D Stevenson
- Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, United Kingdom
| | - R J Grimer
- Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, United Kingdom
| | - M C Parry
- Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, United Kingdom
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23
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When Do Orthopaedic Oncologists Consider the Implantation of Expandable Prostheses in Bone Sarcoma Patients? Sarcoma 2018; 2018:3504075. [PMID: 29681761 PMCID: PMC5845529 DOI: 10.1155/2018/3504075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 12/13/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction Indications discussed for the implantation of expandable prostheses in bone sarcoma patients are unclear. This survey aimed to analyse common practice with this implant type in orthopaedic oncology. Methods A web-based survey was sent to 98 orthopaedic oncology surgeons. Factors reported in literature to influence the decision on the implantation of a growing prosthesis were covered in individual questions and three case scenarios. Results The completion rate of the survey was 45% (n = 44). Twenty-seven of 44 surgeons (61%) had implanted between 1 and 15 expandable prostheses within three years. The minimum median patient age was 6.5 years, and 3–5 cm of predicted growth deficit was the minimum before implanting a growing prosthesis. One-third of surgeons do not use growth calculation methods. Two out of three surgeons would rather not implant a growing prosthesis in children with metastatic disease. Conclusions Our survey confirmed the literature with 3-4 cm as the minimum estimated growth deficit. The minimum age for the implantation of a growing prosthesis is approx. 6.6 years, and therefore the patients are younger than those reported in previous publications. One-quarter of orthopaedic surgeons do not use growing prostheses at all. It remains unclear whether growing prostheses are indicated in patients with metastatic disease.
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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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Abstract
Reconstruction options in children after bone tumor resection are as varied as they are challenging. Advances in biologic and endoprosthetic design have led to many choices, all of which must be considered in the context of prognosis, treatment limitations, and patient/family expectations. The current experience and results of limb-sparing surgery following bone sarcoma resection in growing children are discussed, including allograft, autograft, and metallic prostheses alone and in combination, especially as they pertain to the knee. In some cases, the ablative options of amputation and rotationplasty must be seen as equal and, at times, superior choices to limb salvage.
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Gilg MM, Gaston CL, Parry MC, Jeys L, Abudu A, Tillman RM, Carter SR, Grimer RJ. What is the morbidity of a non-invasive growing prosthesis? Bone Joint J 2017; 98-B:1697-1703. [PMID: 27909134 DOI: 10.1302/0301-620x.98b12.bjj-2016-0467] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 07/12/2016] [Indexed: 11/05/2022]
Abstract
AIMS Extendible endoprostheses have been available for more than 30 years and have become more sophisticated with time. The latest generation is 'non-invasive' and can be lengthened with an external magnetic force. Early results have shown a worryingly high rate of complications such as infection. This study investigates the incidence of complications and the need for further surgery in a cohort of patients with a non-invasive growing endoprosthesis. PATIENTS AND METHODS Between 2003 and June 2014, 50 children (51 prostheses) had a non-invasive growing prosthesis implanted for a primary bone sarcoma. The minimum follow-up was 24 months for those who survived. Their mean age was 10.4 years (6 to 14). The incidence of complications and further surgery was documented. RESULTS The mean follow-up was 64 months (20 to 145). The overall survivorship of the patients was 84% at three years and 70% at five years. Revision-free survival was 81.7% at three years and 61.6% at five years with competing risk analysis. Deep infection occurred in 19.6% of implants at a mean of 12.5 months (0 to 55). Other complications were a failure of the lengthening mechanism in five prostheses (9.8%) and breakage of the implant in two (3.9%). Overall, there were 53 additional operations (0 to 5 per patient). A total of seven patients (14%) underwent amputation, three for local recurrence and four for infection. Their mean limb length discrepancy was 4.3 mm (0 to 25) and mean Musculoskeletal Tumor Society Score functional score was 26.5 (18 to 30) at the final follow-up. CONCLUSIONS When compared with previously published early results, this mid-term series has shown continued good functional outcomes and compensation for leg-length discrepancy. Infection is still the most common complication: post-operative wound healing problems, central line infection and proximal tibial location are the main risk factors. Cite this article: Bone Joint J 2016;98-B:1697-1703.
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Affiliation(s)
- M M Gilg
- Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - C L Gaston
- The Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
| | - M C Parry
- The Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
| | - L Jeys
- The Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
| | - A Abudu
- The Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
| | - R M Tillman
- The Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
| | - S R Carter
- The Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
| | - R J Grimer
- The Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, UK
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Gilg MM, Zeller CW, Leitner L, Leithner A, Labek G, Sadoghi P. The incidence of implant fractures after knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2016; 24:3272-3279. [PMID: 27154281 DOI: 10.1007/s00167-016-4160-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/27/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE This study aimed to evaluate the incidence of "implant" fractures after knee arthroplasty using clinical literature and worldwide arthroplasty registers. The hypothesis was that register datasets report higher rates of these rare complications than clinical studies. METHODS Calculations were based on the pooled incidence of revision operations after fractures of knee arthroplasties, comparing clinical studies published in MEDLINE-listed journals and annual reports from worldwide arthroplasty registers in a structured literature analysis based on a standardized methodology. RESULTS Twelve clinical studies and datasets from six worldwide registers were included. Rates of fractures of knee arthroplasties were reported from 0.2 to 2.5 % in clinical studies versus 0.02-0.17 % in worldwide arthroplasty registers. CONCLUSIONS Fractures of knee arthroplasty systems are rare complications, with clinical studies showing higher incidence rates than worldwide arthroplasty registries. Unicompartmental knee arthroplasty (UKA) implanted before 2000, constrained primary or revision constrained total knee arthroplasties, and patellar replacements showed the highest incidence of implant fracture. The results of this analysis can help clinicians to counsel patients on potential complications following knee arthroplasty. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Magdalena M Gilg
- Department of Orthopedic Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Christian W Zeller
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93042, Regensburg, Germany
| | - Lukas Leitner
- Department of Orthopedic Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Andreas Leithner
- Department of Orthopedic Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Gerold Labek
- Department of Orthopedic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Patrick Sadoghi
- Department of Orthopedic Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
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Benevenia J, Patterson F, Beebe K, Tucker K, Moore J, Ippolito J, Rivero S. Results of 20 consecutive patients treated with the Repiphysis expandable prosthesis for primary malignant bone. SPRINGERPLUS 2015; 4:793. [PMID: 26702382 PMCID: PMC4688289 DOI: 10.1186/s40064-015-1582-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 12/02/2015] [Indexed: 02/06/2023]
Abstract
Limb-salvage for primary malignant bone tumors in pediatric patients presents a unique challenge when resection includes an active physis. Early expandable prostheses required open surgical procedures to achieve lengthening. Newer prostheses are capable of achieving expansion without open procedures through the use of an electromagnetic field. This study reports our results with 90 consecutive expansion procedures using the Repiphysis® prosthesis. We retrospectively reviewed the records of 20 patients (22 limbs) who underwent limb-salvage using the Repiphysis® prosthesis from 2003 to 2015. There were 9 males and 11 females with a mean age of 9 years and 9 months (6–16 years). Reconstruction included the distal femur in 11 cases, total femur in four, proximal tibia in three, proximal humerus in three, and total humerus in one. Complications were reviewed and functional scores were recorded using the MSTS/ISOLS system. Five patients had a second prosthesis implanted during the course of the study for a total of 27 prostheses. The mean follow-up was 57 (6–148) months. Four patients have not been expanded: three due to death prior to lengthening, and one patient who has not yet developed a leg length discrepancy. Ninety consecutive expansion procedures were performed in 18 limbs in 16 patients. A mean of 9 (5–20) mm was gained per expansion and 4.8 cm per patient who has undergone expansion to date. Seven patients have reached skeletal maturity and have been converted to an adult endoprosthesis. These patients averaged 8 expansions per patient and a mean of 7.4 (1.8–12.9) cm in length gained. There were 15 complications in 11 patients including one dislocation, one contracture, four cases of aseptic loosening, five structural failures (three expansion mechanism failures and two tibial fractures), three deep infections, and one case of local recurrence. The mean MSTS score was 80 % (37–97 %) and the limb retention rate was 95 %. The results of this study are comparable to previous studies involving non-invasive prostheses. This study hopefully provides additional data for clinicians to consider when faced with limb threatening sarcomas in the immature skeleton.
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Affiliation(s)
- Joseph Benevenia
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, ACC Building, Suite D-1610, Newark, NJ 07103 USA
| | - Francis Patterson
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, ACC Building, Suite D-1610, Newark, NJ 07103 USA
| | - Kathleen Beebe
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, ACC Building, Suite D-1610, Newark, NJ 07103 USA
| | - Kimberly Tucker
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, ACC Building, Suite D-1610, Newark, NJ 07103 USA
| | - Jeffrey Moore
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, ACC Building, Suite D-1610, Newark, NJ 07103 USA
| | - Joseph Ippolito
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, ACC Building, Suite D-1610, Newark, NJ 07103 USA
| | - Steven Rivero
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, 140 Bergen Street, ACC Building, Suite D-1610, Newark, NJ 07103 USA
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Arteau A, Lewis VO, Moon BS, Satcher RL, Bird JE, Lin PP. Tibial Growth Disturbance Following Distal Femoral Resection and Expandable Endoprosthetic Reconstruction. J Bone Joint Surg Am 2015; 97:e72. [PMID: 26582624 PMCID: PMC4642228 DOI: 10.2106/jbjs.o.00060] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In growing children, an expandable endoprosthesis is commonly used after distal femoral resection to compensate for loss of the distal femoral physis. Our hypothesis was that such prostheses can affect proximal tibial growth, which would contribute to an overall leg-length discrepancy and cause angular deformity. METHODS Twenty-three skeletally immature patients underwent the placement of a distal femoral expandable endoprosthesis between 1994 and 2012. Tibial length, femoral length, and mechanical axis were measured radiographically to determine the growth rate. RESULTS No patient had radiographic evidence of injury to the proximal tibial physis at the time of surgery other than insertion of the tibial stem. Fifteen (65%) of the patients experienced less proximal tibial growth in the operative compared with the contralateral limb. In ten (43%) of the patients, the discrepancy progressively worsened, whereas in five (22%) of the patients, the discrepancy stabilized. Seven patients did not develop tibial length discrepancy, and one patient had overgrowth of the tibia. For the ten patients with progressive shortening, the proximal tibial physis grew an average of 4.0 mm less per year in the operative limb. Five (22%) of the patients had ≥ 20 mm of tibial length discrepancy at last follow-up. Three of these patients underwent contralateral tibial epiphysiodesis. Three patients required corrective surgery for angular deformity. CONCLUSIONS The tibial growth plate may not resume normal growth after implantation of a distal femoral prosthesis. Physeal bar resection, prosthesis revision, and contralateral tibial epiphysiodesis may be needed to address tibial growth abnormalities.
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Affiliation(s)
- Annie Arteau
- CHU de Québec, Pavillon Hôtel Dieu, 11 Côte du palais, Québec G1R2J6, Canada
| | - Valerae O. Lewis
- Department of Orthopaedic Oncology, MD Anderson Cancer Center, Unit 1448, P.O. Box 301402, Houston, Texas 77230. E-mail address for P.P. Lin:
| | - Bryan S. Moon
- Department of Orthopaedic Oncology, MD Anderson Cancer Center, Unit 1448, P.O. Box 301402, Houston, Texas 77230. E-mail address for P.P. Lin:
| | - Robert L. Satcher
- Department of Orthopaedic Oncology, MD Anderson Cancer Center, Unit 1448, P.O. Box 301402, Houston, Texas 77230. E-mail address for P.P. Lin:
| | - Justin E. Bird
- Department of Orthopaedic Oncology, MD Anderson Cancer Center, Unit 1448, P.O. Box 301402, Houston, Texas 77230. E-mail address for P.P. Lin:
| | - Patrick P. Lin
- Department of Orthopaedic Oncology, MD Anderson Cancer Center, Unit 1448, P.O. Box 301402, Houston, Texas 77230. E-mail address for P.P. Lin:
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Guder W, Hardes J, Gosheger G, Nottrott M, Streitbürger A. Osteo- und Chondrosarkome des Beckens und der unteren Extremitäten. Chirurg 2015; 86:993-1003; quiz 1004. [DOI: 10.1007/s00104-015-0082-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chung SH, Jeon DG, Cho WH, Song WS, Kong CB, Cho SH, Kim BS, Lee SY. Temporary hemiarthroplasty with a synthetic device in children with osteosarcoma around the knee as a bridging procedure until skeletal maturity. J Surg Oncol 2015; 112:107-14. [PMID: 26179818 DOI: 10.1002/jso.23964] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 06/10/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND We hypothesized that hemiarthroplasty with a synthetic device in skeletally immature patients with osteosarcoma around the knee would be functional due to high adaptability in the pediatric age group, and may decrease the number of surgeries until limb equalization by preserving the nearby physis. METHODS We analyzed the outcomes of 25 hemiarthroplasties (12 distal femur, 13 proximal tibia). Average patient age was 11.8 years. We assessed (1) whether hemiarthroplasty could be considered as a viable option and could preserve growth of the nearby physis, and (2) whether these patients could reach the final goal of adult-type tumor prosthesis implantation within a preplanned number of surgeries. RESULTS Three (12%) of 25 hemiarthroplasties showed failure. Average Musculoskeletal Tumor Society functional score of 23 patients was 25.1. Average tibial and femoral shortening for the corresponding reconstruction was 0.3 cm and 0.5 cm, respectively. In terms of number of surgeries for limb equalization, 19 patients (76%) had less, four (16%) had equal, and two (8%) had more surgeries than planned. CONCLUSIONS Hemiarthroplasty is a sound option until skeletal maturity, allowing surgeons to choose the appropriate procedure based on the patient's growth status, and may reduce the amount of shortening by preserving nearby physis.
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Affiliation(s)
- So Hak Chung
- Department of Orthopedic Surgery, Kosin University Gospel Hospital, Busan, Korea
| | - Dae-Geun Jeon
- Department of Orthopedic Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Wan Hyeong Cho
- Department of Orthopedic Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Won Seok Song
- Department of Orthopedic Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Chang-Bae Kong
- Department of Orthopedic Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Sang Hyun Cho
- Department of Orthopedic Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Bum Suk Kim
- Department of Orthopedic Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Soo-Yong Lee
- Department of Orthopedic Surgery, Korea Cancer Center Hospital, Seoul, Korea
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Total Femur Replacement After Tumor Resection: Limb Salvage Usually Achieved But Complications and Failures are Common. Clin Orthop Relat Res 2015; 473:2079-87. [PMID: 25832007 PMCID: PMC4419011 DOI: 10.1007/s11999-015-4282-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 03/24/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Primary bone or soft tissue tumors of the femur sometimes present with severe and extensive bone destruction, leaving few limb-salvage options other than total femur replacement. However, there are few data available regarding total femur replacement and, in particular, regarding implant failures. QUESTIONS/PURPOSES We asked: (1) What are the revision-free and overall implant survival rates of conventional total femur replacements in patients treated for sarcoma of the femur or soft tissues? (2) What are the revision-free and overall implant survival rates of expandable total femur replacements in skeletally immature patients? (3) Using the comprehensive International Society of Limb Salvage failure-mode classification, what types of complications occur with conventional and expandable total femur replacements? PATIENTS AND METHODS Our retrospective, single-center cohort study was based on data prospectively collected for 50 patients who received a total femur replacement after tumor resection for indications other than carcinoma or metastatic disease. Of the 50 patients, six (12%) were lost to followup before 6 months. Ten of the remaining 44 patients received expandable implants. The mean followup was 57 months (range, 1-280 months) and 172 months (range, 43-289 months) for patients who underwent conventional and expandable total femur replacements, respectively. For implant survival, competing risk analyses were used. RESULTS At 5 years, revision-free implant survival of conventional total femur replacements was 48% (95% CI, 0.37-0.73), and overall implant survival was 97% (95% CI, 0.004-0.20). Five-year revision-free implant survival of expandable total femur replacements was 30% (95% CI, 0.47-1.00) and overall implant survival was 100%. With conventional total femur replacements soft tissue failures occurred in 13 of 34 patients, structural failures in three, infection in six, and local tumor progression in one. No patient had aseptic loosening with conventional total femur replacements, but hip disarticulation occurred in two patients owing to extensive wound-healing problems and infection. With expandable total femur replacements soft tissue failure, aseptic loosening, and infection occurred in one patient each of 10, and structural failures in three of 10 (two periprosthetic fractures, one loosening of an enhanced tendon anchor). No hip disarticulations were performed. Additionally expandable total femur replacement-related failures included hip instability in eight of 10 patients, contractures attributable to massive scar tissue in six, and defect of the implant's expansion mechanism in four patients. CONCLUSIONS Although the indications for total femoral resection are rare, we think that total femur replacement is a reasonable treatment option for reconstruction of massive femoral bone defects after tumor resection in adults and skeletally immature patients, and results in limb salvage in most patients. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Frequent complications and severe bone loss associated with the repiphysis expandable distal femoral prosthesis. Clin Orthop Relat Res 2015; 473:831-8. [PMID: 24664193 PMCID: PMC4317465 DOI: 10.1007/s11999-014-3564-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The treatment of choice for distal femur malignancies in skeletally immature patients remains controversial. An expandable endoprosthesis device (Repiphysis Limb Salvage System; Wright Medical Technology, Arlington, TN, USA) allows for limb preservation and noninvasive lengthening but has been associated with significant complications; however, the extent and implications of bone loss associated with this implant have not been reported. QUESTIONS/PURPOSES Our goals were to report (1) the 2-year minimum clinical outcomes after placement of the Repiphysis expandable prosthesis for pediatric distal femur malignancies; (2) the complications associated with this prosthesis; (3) the failure rate of this prosthesis; and (4) the revision alternatives available for salvage procedures. METHODS Between 2002 and 2010, one surgeon (SG) treated all skeletally immature patients (mean age, 10.1 years; range, 4.7-13.6 years) with distal femoral osteosarcoma using a Repiphysis expandable prosthesis. Of the 12 patients who met these criteria, two were excluded for death from disease before 2 years, and mean followup for the remaining 10 was 72 months (range, 26-119 months). Medical records were retrospectively reviewed for complications and clinical outcomes, as assessed by the Musculoskeletal Tumor Society (MSTS) scoring system. Radiographs at final followup were reviewed for bone loss and analyzed by the two senior authors (SG, WWV) to determine reconstruction options available for future revisions. RESULTS MSTS scores averaged 67%, and we observed 37 implant-related complications requiring a total of 15 reoperations. Six patients underwent implant revisions with aseptic loosening being the predominant mode of failure; ultimately, four of these were converted to adult modular oncology prostheses, and two underwent total femoral replacements. Bone loss in this series was severe in terms of femoral length, cortical thinning, and metadiaphyseal compromise, and most patients will not have sufficient bone stock to permit future revision using standard stem fixation. CONCLUSIONS The bone loss around the stem of this prosthesis limits subsequent revision options, often resulting in a total femoral prosthesis. Although the decision to use the Repiphysis device must be made on an individual basis, surgeons should recognize the potential for significant bone compromise limiting revision options and consider other options. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Gilg MM, Wibmer C, Andreou D, Avian A, Sovinz P, Maurer-Ertl W, Tunn PU, Leithner A. Paley's multiplier method does not accurately predict adult height in children with bone sarcoma. Clin Orthop Relat Res 2014; 472:2506-13. [PMID: 24777720 PMCID: PMC4079875 DOI: 10.1007/s11999-014-3636-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 04/07/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND The majority of patients with osteosarcoma and Ewing's sarcoma are diagnosed before skeletal maturity. Paley's multiplier is used for height prediction in healthy children, and has been suggested as a method to make growth predictions for children with osteosarcoma and Ewing's sarcoma when considering limb salvage options. To our knowledge, no evaluation of this method in this particular patient group has been performed, but a temporary growth deficit has been observed in children undergoing chemotherapy. QUESTIONS/PURPOSES We asked whether (1) Paley's formula reliably predicts growth in children who received polychemotherapy; (2) chemotherapy impairs growth velocity; and (3) final adult height is impaired in these patients. METHODS Retrospectively, data for 94 patients with osteosarcoma and Ewing's sarcoma were retrieved from databases of two sarcoma centers. Onset before 14 years of age in girls and 16 years in boys and a minimum followup until 18 years were required (mean, 67 months; range, 31-124 months) criteria. Exclusion criteria were the intake of growth hormones or no chemotherapy. Thirty-three patients (35%) fulfilled all inclusion criteria. Predicted adult heights were compared with actual adult height. The development of a growth deficit was evaluated for 23 children (without chemotherapy for recurrence) using age- and gender-specific standard deviation scores for height (WHO Z-scores). RESULTS Height prediction using Paley's method showed a high percentage of false predictions (outside ± 1 SD, 70%; outside ± 2 SD, 61%). On average, the mean total height of the patients was overestimated (2.3 cm). The median absolute error of prediction was 5.0 cm (range, -17 to 8). Patients with osteosarcoma and Ewing's sarcoma showed a significant growth impairment during polychemotherapy. A catchup phase in growth before skeletal maturity was observed in patients with osteosarcoma but not with Ewing's sarcoma. CONCLUSIONS Owing to its lack of reliability in this patient group, methods other than Paley's should be evaluated to predict adult height. Although limited by a small number of patients, our study results indicate a decreased adult height in patients with bone sarcoma after chemotherapy. LEVEL OF EVIDENCE Level III, therapeutic study. See the Instructions for Authors for complete description of levels of evidence.
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Affiliation(s)
- Magdalena Maria Gilg
- />Department of Orthopaedic Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Christine Wibmer
- />Department of Orthopaedic Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Dimosthenis Andreou
- />Department of General Orthopaedics and Tumororthopaedics, University Hospital of Muenster, Münster, Germany
| | - Alexander Avian
- />Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Petra Sovinz
- />Division of Paediatric Haemato-Oncology, Department of Paediatrics, Medical University of Graz, Graz, Austria
| | - Werner Maurer-Ertl
- />Department of Orthopaedic Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Per-Ulf Tunn
- />Department of Orthopaedic Oncology, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - Andreas Leithner
- />Department of Orthopaedic Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
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Outcomes and Options for Prosthetic Reconstruction After Tumour Resection About the Knee. CURRENT SURGERY REPORTS 2014. [DOI: 10.1007/s40137-013-0042-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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