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Pesare E, Meschini C, Caredda M, Messina F, Rovere G, Solarino G, Ziranu A. Carbon vs. Titanium Nails in the Treatment of Impending and Pathological Fractures: A Literature Review. J Clin Med 2024; 13:2940. [PMID: 38792483 PMCID: PMC11121808 DOI: 10.3390/jcm13102940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/30/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Long bones are commonly affected by musculoskeletal tumors, but they also represent one of the most frequent locations for metastases. The treatment is based on pain management and the prevention or stabilization of pathological fractures by intramedullary nailing. While titanium nails are probably the most used, carbon-fiber-reinforced (CFR) nails have emerged as a new option for oncological patients. The aim of this review is to compare titanium and CFR nails according to current findings. Methods: Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standards were followed: a total of 1004 articles were identified and 10 were included. Results: Traditionally, titanium implants are highly valued for their optimal biomechanical properties and ease of insertion, facilitated by their radiopacity. However, the use of titanium poses challenges in radiotherapy due to interference with radiation dosage and the creation of ferromagnetic artifacts. Conversely, CFR implants have emerged as a recommended option for intramedullary fixation, due to their biomechanical and structural properties and their benefits during radiotherapy and follow-up monitoring X-ray. Conclusions: CFR nailing represents a promising advancement in the surgical management of oncological patients with long bone metastases. However, further studies are needed to increase surgeons' confidence in their use.
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Affiliation(s)
- Elisa Pesare
- Orthopaedics Unit, Policlinico Universitario di Bari, Department of Translational Biomedicine and Neuroscience ‘DiBraiN’, University of Bari “Aldo Moro”, Piazza G. Cesare 11, 70124 Bari, Italy;
| | - Cesare Meschini
- Department of Orthopedics Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy (F.M.); (A.Z.)
| | - Matteo Caredda
- Department of Orthopedics Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy (F.M.); (A.Z.)
| | - Federica Messina
- Department of Orthopedics Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy (F.M.); (A.Z.)
| | - Giuseppe Rovere
- Department of Orthopedics Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy (F.M.); (A.Z.)
| | - Giuseppe Solarino
- Orthopaedics Unit, Policlinico Universitario di Bari, Department of Translational Biomedicine and Neuroscience ‘DiBraiN’, University of Bari “Aldo Moro”, Piazza G. Cesare 11, 70124 Bari, Italy;
| | - Antonio Ziranu
- Department of Orthopedics Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy (F.M.); (A.Z.)
- Department of Orthopedics, Ospedale Isola Tiberina-Gemelli Isola, 00186 Rome, Italy
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Liu L, Deng XQ, Zhao YJ, Ma RX, Yang L, Song KX, Zhang JY, Hu YC. Modular intercalary prosthetic reconstruction for malignant and metastatic tumours of the proximal femur. Sci Rep 2024; 14:5867. [PMID: 38467756 PMCID: PMC10928187 DOI: 10.1038/s41598-024-56645-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/08/2024] [Indexed: 03/13/2024] Open
Abstract
To illustrate the surgical technique and explore clinical outcomes of the reconstruction for the malignant and metastatic bone tumour of proximal femur with metallic modular intercalary prosthesis. Sixteen patients who underwent modular intercalary prosthetic reconstruction after tumour resection were included from April 2012 and October 2020. Prosthesis and screws parameters, resected bone length and residual bone length, clinical outcomes and survivorship were analyzed. All patients were followed up for an average of 19 months (range 1-74). In our series, 12 patients died of the progression of the primary disease at the final follow-up. The cumulative survivorship since the treatment of proximal femoral metastasis was 78.6% (11 patients) at 6 months and 38.5% (5 patients) at 1 year. The mean MSTS score was 22.25 ± 4.55 among all patients. There were no cases of loosening or breakage of the prostheses, plates or screws, despite the various measurements of prostheses and residual bones. Modular intercalary prosthetic reconstruction was an effective method for malignant tumour of the proximal femur, including the advantages of providing early pain relief, quickly restoring postoperative function, required a short operation time, and preserving the adjacent joints.
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Affiliation(s)
- Lu Liu
- Graduate School, Tianjin Medical University, 22 Qixiangtai Road, Tianjin, China
- Xing'anmeng People's Hospital, 66 Hanshan West Street, Ulanhot, Inner Mongolia, China
| | - Xiao-Qiang Deng
- Xing'anmeng People's Hospital, 66 Hanshan West Street, Ulanhot, Inner Mongolia, China
| | - Yong-Jie Zhao
- Binzhou Medical University Hospital, 661 Huanghe 2 Road, Binzhou, China
| | - Rong-Xing Ma
- Graduate School, Tianjin Medical University, 22 Qixiangtai Road, Tianjin, China
| | - Li Yang
- Beijing Jishuitan Hospital Guizhou Hospital, 206 Sixian Street, Guiyang, Yunnan, China
| | - Kun-Xiu Song
- Binzhou Medical University Hospital, 661 Huanghe 2 Road, Binzhou, China
| | - Jing-Yu Zhang
- Department of Bone Tumor and Soft Tissue Oncology, Tianjin Hospital, 406 Jiefang Southern Road, Tianjin, China.
| | - Yong-Cheng Hu
- Department of Bone Tumor and Soft Tissue Oncology, Tianjin Hospital, 406 Jiefang Southern Road, Tianjin, China.
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Leporace M, Lancellotta V, Baccolini V, Calabria F, Castrovillari F, Filippiadis DK, Tagliaferri L, Iezzi R. Magnetic resonance-guided focused ultrasound versus percutaneous thermal ablation in local control of bone oligometastases: a systematic review and meta-analysis. LA RADIOLOGIA MEDICA 2024; 129:291-306. [PMID: 38302831 DOI: 10.1007/s11547-024-01780-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 01/03/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND The percutaneous thermal ablation techniques (pTA) are radiofrequency ablation, cryoablation, and microwave ablation, suitable for the treatment of bone oligometastases. Magnetic resonance-guided focused ultrasound (MRgFUS) is a noninvasive ablation technique. OBJECTIVES To compare the effectiveness and safety of MRgFUS and pTA for treating bone oligometastases and their complications. METHODS Studies were selected with a PICO/PRISMA protocol: pTA or MRgFUS in patients with bone oligometastases; non-exclusive curative treatment. Exclusion criteria were: primary bone tumor; concurrent radiation therapy; palliative therapy; and absence of imaging at follow-up. PubMed, BioMed Central, and Scopus were searched. The modified Newcastle-Ottawa Scale assessed articles quality. For each treatment (pTA and MRgFUS), we conducted two separate random-effects meta-analyses to estimate the pooled effectiveness and safety. The effectiveness was assessed by combining the proportions of treated lesions achieving local tumor control (LTC); the safety by combining the complications rates of treated patients. Meta-regression analyses were performed to identify any outcome predictor. RESULTS A total of 24 articles were included. Pooled LTC rate for MRgFUS was 84% (N = 7, 95% CI 66-97%, I2 = 74.7%) compared to 65% of pTA (N = 17, 95% CI 51-78%, I2 = 89.3%). Pooled complications rate was similar, respectively, 13% (95% CI 1-32%, I2 = 81.0%) for MRgFUS and 12% (95% CI 8-18%, I2 = 39.9%) for pTA, but major complications were recorded with pTA only. The meta-regression analyses, including technique type, study design, tumor, and follow-up, found no significant predictors. DISCUSSION The effectiveness and safety of the two techniques were found comparable, even though MRgFUS is a noninvasive treatment that did not cause any major complication. Limited data availability on MRgFUS and the lack of direct comparisons with pTA may affect these findings. CONCLUSIONS MRgFUS can be a valid, safe, and noninvasive treatment for bone oligometastases. Direct comparison studies are needed to confirm its promising benefits.
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Affiliation(s)
- Mario Leporace
- Department of Nuclear Medicine and Theragnostics, "Mariano Santo" Cosenza Hospital, Cosenza, Italy.
| | - Valentina Lancellotta
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Valentina Baccolini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Ferdinando Calabria
- Department of Nuclear Medicine and Theragnostics, "Mariano Santo" Cosenza Hospital, Cosenza, Italy
| | | | - Dimitrios K Filippiadis
- Second Department of Radiology, University General Hospital "ATTIKON" - Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Luca Tagliaferri
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Roberto Iezzi
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica Ed Ematologia - Istituto Di Radiologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A Gemelli 8, 00168, Rome, Italy
- Institute of Radiology - Università Cattolica del Sacro Cuore, Rome, Italy
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Soares do Brito J, Esperança Martins M, Goes R, Spranger A, Almeida P, Fernandes I, Portela J. Closed-incision negative-pressure wound therapy (ciNPWT) to minimize wound-related complications in lower limb reconstruction after bone tumor resection: preliminary proof-of-concept study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:2895-2902. [PMID: 36897409 DOI: 10.1007/s00590-023-03501-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/26/2023] [Indexed: 03/11/2023]
Abstract
AIMS The purpose of this study was to compare the impact of postoperative closed-incision negative-pressure wound therapy (ciNPWT) and conventional dressings in wound-related complications after bone tumor resection and reconstruction. PATIENTS AND METHODS A total of 50 patients with bone tumors and clinical indication for wide resection and reconstruction were included and divided into two groups (A and B). Bone defect reconstructions were achieved with modular endoprosthesis or biologic techniques, mainly involving allografts with free vascularized fibula. Group A received ciNPWT, and Group B conventional dressings. Wound-related complications, including wound dehiscence, persistent wound leakage, surgical site infections (SSIs), and causes for surgical revision, were assessed. RESULTS Nineteen patients were included in Group A and 31 in Group B. No significant differences were found between groups regarding epidemiologic and clinical presentation features, contrarily to reconstructive options, which were significantly different between both (Fisher = 10,100; p = 0.005). Additionally, Group A presented lower wound dehiscence rate (0 vs. 19.4%; χ2(1) = 4.179; p = 0.041), SSI rate (0 vs. 19.4%; χ2(1) = 4.179; p = 0.041), and surgical revision rate (5.3% vs. 32.3%; χ2(1) = 5.003; p = 0.025) compared to Group B. CONCLUSIONS This is the first study reporting the impact of ciNPWT after bone tumor resection and reconstruction, and its results support a potential role for this technique in diminishing postoperative wound complications and SSIs. A multicentric randomized controlled trial may help clarify the role and impact of ciNPWT after bone tumor resection and reconstruction.
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Affiliation(s)
- Joaquim Soares do Brito
- Department of Orthopedics and Trauma, Centro Hospitalar Universitário Lisboa Norte, 1649-028, Lisbon, Portugal.
| | - Miguel Esperança Martins
- Department of Medical Oncology, Centro Hospitalar Universitário Lisboa Norte, 1649-028, Lisbon, Portugal
- Translational Oncobiology Laboratory, Instituto de Medicina Molecular - João Lobo Antunes, Faculdade de Medicina de Lisboa, 1649-028, Lisbon, Portugal
| | - Rodrigo Goes
- Department of Orthopedics and Trauma, Centro Hospitalar Universitário Lisboa Norte, 1649-028, Lisbon, Portugal
| | - André Spranger
- Department of Orthopedics and Trauma, Centro Hospitalar Universitário Lisboa Norte, 1649-028, Lisbon, Portugal
| | - Paulo Almeida
- Department of Orthopedics and Trauma, Centro Hospitalar Universitário Lisboa Norte, 1649-028, Lisbon, Portugal
| | - Isabel Fernandes
- Department of Medical Oncology, Centro Hospitalar Universitário Lisboa Norte, 1649-028, Lisbon, Portugal
- Translational Oncobiology Laboratory, Instituto de Medicina Molecular - João Lobo Antunes, Faculdade de Medicina de Lisboa, 1649-028, Lisbon, Portugal
| | - José Portela
- Department of Orthopedics and Trauma, Centro Hospitalar Universitário Lisboa Norte, 1649-028, Lisbon, Portugal
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El Motassime A, Meschini C, Di Costa D, Rovere G, Matrangolo MR, De Maio F, Farsetti P, Ziranu A, Maccauro G, Vitiello R. Functional Outcomes and Shoulder Instability in Reconstruction of Proximal Humerus Metastases. Curr Oncol 2023; 30:3571-3579. [PMID: 37185385 PMCID: PMC10136526 DOI: 10.3390/curroncol30040272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 05/17/2023] Open
Abstract
(1) Background: Some of the goals of orthopedic surgical oncology are saving limbs and function. The humerus is the third most frequent site in primary tumors and one of the most involved sites for metastases. Prosthetic replacement with modular megaprosthesis is one of the treatment choices, but there are several types of complications, such as problems with function and pain. The aim of our study is to assess functional outcomes and shoulder instability in the reconstruction of proximal humerus metastases. (2) Methods: This is a retrospective observational study. Twenty-eight patients, with proximal humerus metastases, admitted to the department of Orthopaedics and Traumatology of our University Hospital between 2014 and 2022 were recruited. Each patient underwent resection and prosthetic replacement surgery with modular megaprosthesis. Clinical evaluation was assessed through MSTS score, WOSI index, and DASH score. (3) Results: Twenty patients were included in the study. Fairly good results, especially regarding pain, function, and emotional acceptance, were obtained in all three tests: DASH, MSTS, and WOSI. Patients who reported shoulder instability actually have worse outcomes than those who report having stable shoulders. In addition, patients with a resection >10 cm have worse outcomes than those who had a resection of 10 cm. No significant differences were found between the deltopectoral approach group and the lateral approach group. (4) Conclusions: Reconstructive surgery with megaprosthesis of the proximal humerus in patients with metastases can be considered a treatment option, especially in patients with pathological fractures or injuries with a high risk of fracture and good life expectancy. This study shows how this type of surgery affects instability, but in terms of functionality, pain, and patient satisfaction, it gives satisfactory results.
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Affiliation(s)
- Alessandro El Motassime
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Cesare Meschini
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, University Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Doriana Di Costa
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Giuseppe Rovere
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, University Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Maria Rosaria Matrangolo
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Fernando De Maio
- Department of Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology, University of Rome "Tor Vergata", 00133 Rome, Italy
| | - Pasquale Farsetti
- Department of Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology, University of Rome "Tor Vergata", 00133 Rome, Italy
| | - Antonio Ziranu
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, University Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giulio Maccauro
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, University Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Raffaele Vitiello
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, University Cattolica del Sacro Cuore, 00168 Rome, Italy
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Vitiello R, Perisano C, Greco T, Cianni L, Polichetti C, Comodo RM, De Martino I, La Vergata V, Maccauro G. Intramedullary nailing vs modular megaprosthesis in extracapsular metastases of proximal femur: clinical outcomes and complication in a retrospective study. BMC Musculoskelet Disord 2022; 22:1069. [PMID: 36100879 PMCID: PMC9472329 DOI: 10.1186/s12891-022-05728-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Extracapsular proximal femur metastasis could be treated by synthesis or resection and megaprosthesis. No universal accepted guidelines are present in the literature. The aim of our study is to analyze of patients with metastases in the trochanteric region of the femur treated by a single type of intramedullary nailing or hip megaprosthesis. METHODS We retrospectively reviewed all patients affected by extracapsular metastases of proximal femur. Anthropometric and anamnestic data, routine blood exams and complications were collected. VAS score and MSTS score was administered before the surgery, ad 1-6-12 months after surgery. An un-paired T test and Chi-square were used. Multiple linear regression and logistic regression was performed. Significance was set for p < 0.05. RESULT Twenty patients were assigned in intramedullary Group, twenty-five in megaprostheses Group. The mean operative time is shorter in intramedullary group. Differential shows a higher anemization in megaprostheses group (2 ± 2 vs 3.6 ± 1.3; p = 0.02). The patients of intramedullary group showed malnutrition (Albumin: 30.5 ± 6.5 vs 37.6 ± 6 g/L; p = 0.03) and pro-inflammatory state (NLR: 7.1 ± 6.7 vs 3.8 ± 2.4; p = 0.05) (PLR: 312 ± 203 vs 194 ± 99; p = 0.04) greater than megaprostheses group. The patients in intramedullary groups shows a higher functional performance score than megaprostheses group at 1 month follow-up (MSTS: 16.4 ± 6.3 vs 12.2 ± 3.7; p = 0.004). A multivariate analysis confirms the role of type of surgery (p = 0.001), surgery duration (p = 0.005) and NLR (p = 0.02) in affecting the MSTS. Globally eight complications were recorded, no statistical difference was noticed between the two groups (p = 0.7), no predictor was found at logistic analysis. CONCLUSION Intramedullary nailing guarantees a rapid functional recovery, compared to patients undergoing hip megaprosthesis who instead improve gradually over time. The selection of patients with poor prognosis allows the correct surgical indication of nailing, while in the case of a more favorable prognosis, the intervention of hip megaprosthesis is to be preferred.
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Affiliation(s)
- Raffaele Vitiello
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
- Università Cattolica Del Sacro Cuore, Rome, Italy.
| | - Carlo Perisano
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Tommaso Greco
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Luigi Cianni
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Chiara Polichetti
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica Del Sacro Cuore, Rome, Italy
| | | | - Ivan De Martino
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Vincenzo La Vergata
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Giulio Maccauro
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica Del Sacro Cuore, Rome, Italy
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7
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Oliva MS, Muratori F, Vitiello R, Ziranu A, Foschi L, Rovere G, Meschini C, Campanacci DA, Maccauro G. Cemented vs uncemented megaprostheses in proximal femur metastases: a multicentric comparative study. BMC Musculoskelet Disord 2022; 22:1068. [PMID: 36068628 PMCID: PMC9450228 DOI: 10.1186/s12891-022-05726-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/04/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Hip megaprostheses are a long known reconstructive method in the treatment of proximal femur metastases. The use of cemented or uncemented stems is still matter of debate. The aim of this study to compare cemented and uncemented megaprostheses on functional outcomes and complications, in order to establish the role of cementation. METHODS We retrospectively analysed 51 metastatic patients with proximal femur metastases treated with endoprosthetic reconstruction by megaprostheses, 25 with cementless stems and 26 with cemented ones with different megaprosthetic implants. The primary endpoint was MSTS score, and the secondary endpoint was to state the incidence of surgical and clinical complications in the two groups. An un-paired T test was used to compare anthropometric, anamnestic data, and MSTS. Chi-square test was performed for evaluation of complication in the two group. Multiple linear regression was used to match the functional outcomes and complications' incidence in the population study. Logistic regression was performed to analyse the odds ratio of different parameters and their role in the incidence of complications. RESULTS The mean follow-up was 50.1 months (+ 12.5). In thirty case right side was involved. No statistical differences were noticed between Group A and B regard the age, gender, active fracture/impending fracture. Comparing the MSTS results within the two groups at last follow-up, the score cemented group was higher than cementless one (17.9 + 7.8 vs 24.2 + 5.3; statistical significance p = 0.001). Regarding surgical complications a logistic regression was performed to analyse the odds ratio of age, cementation and length of resection; cementation confirm and odds ratio of 11 times in the incidence of surgical complications. CONCLUSIONS Cementation seems to be more liable to complications onset, while improves functional score in metastatic patients compared to uncemented megaprostheses. More studies have to be conducted in order to create a protocol and establish criteria to use cemented or uncemented stems in a frail population like metastatic patients.
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Affiliation(s)
- Maria Serena Oliva
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Francesco Muratori
- Ortopedia Oncologica e Ricostruttiva Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Raffaele Vitiello
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Antonio Ziranu
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
- Università Cattolica Del Sacro Cuore, Rome, Italy.
| | - Lorenzo Foschi
- Ortopedia Oncologica e Ricostruttiva Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Giuseppe Rovere
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Cesare Meschini
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica Del Sacro Cuore, Rome, Italy
| | | | - Giulio Maccauro
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica Del Sacro Cuore, Rome, Italy
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8
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Pala E, Procura A, Trovarelli G, Berizzi A, Ruggieri P. Intramedullary nailing for impending or pathologic fracture of the long bone: titanium vs carbon fiber peek nailing. EFORT Open Rev 2022; 7:611-617. [PMID: 35924657 PMCID: PMC9458939 DOI: 10.1530/eor-22-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Methods Results Conclusions
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Affiliation(s)
- Elisa Pala
- 1Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy
| | - Alberto Procura
- 1Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy
| | - Giulia Trovarelli
- 1Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy
| | - Antonio Berizzi
- 1Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy
| | - Pietro Ruggieri
- 1Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy
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9
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Trends in Diagnosis and Surgical Treatment of Bone Metastases among Orthopedic Surgeons. J Clin Med 2022; 11:jcm11154284. [PMID: 35893375 PMCID: PMC9341391 DOI: 10.3390/jcm11154284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/27/2022] [Accepted: 07/22/2022] [Indexed: 12/10/2022] Open
Abstract
Background: The proper diagnosis and treatment of bone metastases are essential for patient survival. However, several strategies for the treatment are practiced. Therefore, the aim of the study was to analyze what factors influence the choice of a method of treatment. Methods: An online survey was conducted within the Polish Society of Orthopedics and Traumatology. It consisted of 45 questions and was divided into four main parts: Participant Characteristics, Diagnosis and Qualification, Treatment, and Clinical Cases. Results: A total number of 104 responses were collected. The most frequently chosen methods were: Intramedullary nail (IMN) + Resection + Polymethyl methacrylate (PMMA) (30.47%) and IMN without tumor resection (42.13%), and in third place, modular endoprosthesis (17.25%). The less experienced group of orthopedic surgeons more often (47.5% vs. 39.5%) decided to perform IMN without tumor resection than the more experienced group (p = 0.046). Surgeons from district hospitals less frequently (13.7% vs. 23.1%) would decide to use modular endoprosthesis than surgeons from university hospitals (p = 0.000076). Orthopedists who performed ≥ 11 bone metastases surgeries per year would more often use modular endoprosthesis (34.8% vs. 13.2%) than those who performed ≤ 10 operations per year (p = 0.000114). Conclusion: Experience, place of work, and the number of metastasis surgeries performed during a year may influence the choice of treatment method in patients with bone metastases.
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Vitiello R, Matrangolo MR, El Motassime A, Perna A, Cianni L, Maccauro G, Ziranu A. Three-Dimension-Printed Custom-Made Prosthetic Reconstructions in Bone Tumors: A Single Center Experience. Curr Oncol 2022; 29:4566-4577. [PMID: 35877221 PMCID: PMC9322169 DOI: 10.3390/curroncol29070361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/19/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022] Open
Abstract
Bone can be affected by different neoplastic conditions. Limb salvage surgery has become the preferred treatment strategy for most malignant tumors of the extremities. Advanced 3D printing technology has transformed the conventional view of oncological surgery. These types of implants are produced by electron beam melting (EBM) technology by sintering titanium powder in a scaffold shape designed following a project designed from HRCT and MRI. The aim of our study was to evaluate the outcomes and the mid-term follow-up of a population treated with 3D-printed custom-made prosthesis implantation in major oncological bone resection or after failure of primary implants. The primary outcome was the general patient satisfaction one year after surgery. The secondary outcomes were: mortality rate, treatment related complication rate, functional and clinical outcomes (KPS, ADL and IADL). Eight patients were included, five females and two males, with a mean age of 50.3 (±23.72) years at the surgery. The enrolled patients reported a mean satisfaction rate after surgery of 7.38 (±2) where 10 was the maximum value. There were no changes between pre- and postoperative mean KPS (81.43 +/−10.69). Mean preoperative ADL and IADL score was in both cases 4.86 (±1.07), while postoperative was 5 (±0.82), with a delta of 0.13 (p > 0.05). Custom-made prosthesis permits reconstructing bone defects caused by large tumor resection, especially in anatomically complex areas, restoring articular function.
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Affiliation(s)
- Raffaele Vitiello
- Orthopedics & Traumatology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Roma, Italy; (R.V.); (M.R.M.); (A.P.); (L.C.); (G.M.); (A.Z.)
- Orthopedics and Traumatology, Università Cattolica Del Sacro Cuore, 00168 Roma, Italy
| | - Maria Rosaria Matrangolo
- Orthopedics & Traumatology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Roma, Italy; (R.V.); (M.R.M.); (A.P.); (L.C.); (G.M.); (A.Z.)
- Orthopedics and Traumatology, Università Cattolica Del Sacro Cuore, 00168 Roma, Italy
| | - Alessandro El Motassime
- Orthopedics & Traumatology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Roma, Italy; (R.V.); (M.R.M.); (A.P.); (L.C.); (G.M.); (A.Z.)
- Orthopedics and Traumatology, Università Cattolica Del Sacro Cuore, 00168 Roma, Italy
- Correspondence: ; Fax: +39-06-305-1161
| | - Andrea Perna
- Orthopedics & Traumatology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Roma, Italy; (R.V.); (M.R.M.); (A.P.); (L.C.); (G.M.); (A.Z.)
- Orthopedics and Traumatology, Università Cattolica Del Sacro Cuore, 00168 Roma, Italy
| | - Luigi Cianni
- Orthopedics & Traumatology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Roma, Italy; (R.V.); (M.R.M.); (A.P.); (L.C.); (G.M.); (A.Z.)
- Orthopedics and Traumatology, Università Cattolica Del Sacro Cuore, 00168 Roma, Italy
| | - Giulio Maccauro
- Orthopedics & Traumatology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Roma, Italy; (R.V.); (M.R.M.); (A.P.); (L.C.); (G.M.); (A.Z.)
- Orthopedics and Traumatology, Università Cattolica Del Sacro Cuore, 00168 Roma, Italy
| | - Antonio Ziranu
- Orthopedics & Traumatology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00168 Roma, Italy; (R.V.); (M.R.M.); (A.P.); (L.C.); (G.M.); (A.Z.)
- Orthopedics and Traumatology, Università Cattolica Del Sacro Cuore, 00168 Roma, Italy
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11
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Sofulu O, Sirin E, Saglam F, Tokyay A, Igrek S, Erol B. Implant survival and functional results of endoprosthetic reconstruction for proximal femoral metastases with pathological fractures. Hip Int 2022; 32:174-184. [PMID: 33934620 DOI: 10.1177/11207000211014813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study aimed to evaluate the patient and implant survival, clinical and functional outcomes, and the rate of complications resulting in reconstruction failure following endoprosthetic reconstruction (EPR) of extensive proximal femoral metastases associated with actual or impending pathological fractures. METHODS A total of 111 patients with actual or impending pathological fractures due to metastatic disease of the proximal femur were treated with EPR between 2003 and 2018. Staged surgery, bilateral EPR, was performed in 3 cases. The patients comprised 51 females and 60 males with a mean age of 52.1 ± 12.3 years. The patient and implant survival were recorded. Clinical and functional outcomes were assessed by using the visual analogue scale (VAS), Musculoskeletal Tumour Society (MSTS) functional scoring, and Karnofsky Performance Scale (KPS). The different types of abductor mechanism repair were evaluated by functional tests and existence of Trendelenburg gait at postoperative follow-ups. The complications resulting in reconstruction failure were investigated. RESULTS The mean follow-up was 23.1 ± 17.9 months. The overall survival of patients after EPR was 89% at 6 months, 72% at 1 year and 10% at 5 years. The estimated 1- and 5-year overall implant survival was 100% and 97.3% (95% CI, 0.95-0.98), respectively, as the endpoint was defined as complete removal of the prosthesis. Median VAS score before endoprosthetic replacement was 8 and after 3 months 4. Before surgery, the median MSTS score was 40 (30-56.6%) and the median KPS score was 40 (30-50). Postoperative third month, the median MSTS score was 56.6 (53.3-86.6%) and the median KPS score was 60 (40-70). Functional scores were superior in trochanter major split osteotomized group compared to trochanter major removed group. Trendelenburg gait was seen in 20 (17.5%) patients postoperatively. There were 10 (8.7%) complications resulting in reconstruction failure. CONCLUSION Endoprosthetic replacement can provide a durable fixation with high implant survival rate and good clinical and functional results in extensive proximal femoral metastases associated with a pathological fracture.
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Affiliation(s)
- Omer Sofulu
- Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Evrim Sirin
- Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Fevzi Saglam
- Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey
| | | | - Servet Igrek
- Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Bulent Erol
- Department of Orthopaedic Surgery and Traumatology, Marmara University School of Medicine, Istanbul, Turkey
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12
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A Tailored Approach for Appendicular Impending and Pathologic Fractures in Solid Cancer Metastases. Cancers (Basel) 2022; 14:cancers14040893. [PMID: 35205641 PMCID: PMC8870648 DOI: 10.3390/cancers14040893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/05/2022] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Patients with bone metastases often suffer with complications, such as bone fractures, which have a substantial negative impact on clinical outcomes. To optimize clinical results, a tailored approach should be defined for managing impending or pathologic fractures in each individual case. The ability to control systemic disease, the extent, location and nature of bone metastases, and the biology of the underlying tumor, are the main factors that will define the strategy to follow. Abstract Advances in medical and surgical treatment have played a major role in increasing the survival rates of cancer patients with metastatic bone disease. The clinical course of patients with bone metastases is often impaired by bone complications, such as bone fractures, which have a substantial negative impact on clinical outcomes. To optimize clinical results and prevent a detrimental impact on patients’ health, a tailored approach should be defined for any given patient. The optimal management of impending or pathologic fractures is unknown and relies on a multidisciplinary approach to tailor clinical decisions to each individual patient. The ability to control systemic disease, the extent, location and nature of bone metastases, and the biology of the underlying tumor, are the main factors that will define the strategy to follow. The present review covers the most recent data regarding impending and pathologic fractures in patients with bone metastases, and discusses the medical and surgical management of patients presenting with metastatic bone disease in different clinical settings.
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13
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Cazzato RL, Garnon J, Dalili D, Autrusseau PA, Auloge P, De Marini P, Buy X, Palussiere J, Gangi A. Percutaneous Osteoplasty in long bones: current status and assessment of outcomes. Tech Vasc Interv Radiol 2022; 25:100803. [DOI: 10.1016/j.tvir.2022.100803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Long-term outcome of patients with primary or secondary tumors of the proximal femur treated by bipolar modular tumor prosthesis. Arch Orthop Trauma Surg 2022; 142:33-39. [PMID: 32851502 DOI: 10.1007/s00402-020-03581-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 08/16/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The proximal femur is a common area for primary and also metastatic bone tumors. The objective of this study was to assess the long-term functional and oncological outcomes of patients with malignant primary or secondary tumors of the proximal femur, who underwent proximal femoral resection then reconstruction using bipolar modular tumor prosthesis. METHODS Sixty patients with proximal femoral malignant tumors underwent resection and bipolar modular prosthesis between 2000 and 2016, were retrospectively reviewed. Based on diagnosis and presence or absence of pathological fracture, patients were divided into groups. The functional outcome of the patients was evaluated using the Musculoskeletal Tumor Society (MSTS) functional scoring system for the lower extremities. RESULTS The mean age was 38 (9-80) years at the time of primary surgery. Pathological fracture was the presentation in 28 patients. The study included 44 patients with primary bone tumor and 16 patients with a secondary bone tumor. The mean MSTS functional score of the patients was 24.3 (range, 18-30) points with no significant difference in patients with primary or secondary tumors. The rate of complications in the present series was 45%. The most frequent complication was an infection in 10 patients (16.7%), followed by aseptic loosening in 7 patients (11.7%). Local recurrence of primary bone tumors occurred in three out of 44 patients (6.8%). CONCLUSION Modular bipolar tumor prosthesis has a good long-term functional result in both primary and secondary tumors of the proximal femur, with no significant effect of age, presence or absence of pathological fracture or femoral resection length on the functional outcome. It was found that the only statistically significant variable regarding the risk of infection is previous surgeries. LEVEL OF EVIDENCE Level IV, retrospective case series.
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15
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Mou H, Wang Z, Zhang W, Li G, Zhou H, Yinwang E, Wang F, Sun H, Xue Y, Wang Z, Chen T, Chai X, Qu H, Lin P, Teng W, Li B, Ye Z. Clinical Features and Serological Markers Risk Model Predicts Overall Survival in Patients Undergoing Breast Cancer and Bone Metastasis Surgeries. Front Oncol 2021; 11:693689. [PMID: 34604031 PMCID: PMC8484887 DOI: 10.3389/fonc.2021.693689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 08/13/2021] [Indexed: 12/23/2022] Open
Abstract
Background Surgical therapy of breast cancer and bone metastasis can effectively improve the prognosis of breast cancer. However, after the first operation, the relationship between preoperative indicators and outcomes in patients who underwent metastatic bone surgery remained to be studied. Purpose 1. Recognize clinical and laboratory prognosis factors available to clinical doctors before the operation for bone metastatic breast cancer patients. 2. Develop a risk prediction model for 3-year postoperative survival in patients with breast cancer bone metastasis. Methods From 2014 to 2020, patients who suffered from breast cancer bone metastasis and received therapeutic procedures in our institution were included for analyses (n=145). For patients who underwent both breast cancer radical surgery and bone metastasis surgery, comprehensive datasets of the parameters of interest (clinical features, laboratory factors, and patient prognoses) were collected (n=69). We performed Multivariate Cox regression to identify factors that were associated with postoperative outcome. 3-year survival prediction model and nomograms were established by 100 bootstrapping. Its benefit was evaluated by calibration plot, C-index, and decision curve analysis. The Surveillance, Epidemiology, and End Results database was also used for external validation. Results Radiotherapy for primary cancer, pathological type of metastatic breast cancer, lymph node metastasis, elevated serum alkaline phosphatase, lactate dehydrogenase were associated with postoperative prognosis. Pathological types of metastatic breast cancer, multiple bone metastasis, organ metastases, and elevated serum lactate dehydrogenase were associated with 3-year survival. Then those significant variables and serum alkaline phosphatase counts were integrated to construct nomograms for 3-year survival. The C-statistic of the established predictive model was 0.83. The calibration plot presents a graphical representation of calibration. In the decision curve analysis, the benefits are higher than those of the extreme curve. The receiver operating characteristic of the external validation of the model was 0.82, indicating a favored fitting degree of the two models. Conclusion Our study suggests that several clinical features and serological markers can predict the overall survival among the patients who are about to receive bone metastasis surgery after breast cancer surgery. The model can guide the preoperative evaluation and clinical decision-making for patients. Level of evidence Level III, prognostic study.
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Affiliation(s)
- Haochen Mou
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Zhan Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Wenkan Zhang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Guoqi Li
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Hao Zhou
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Eloy Yinwang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Fangqian Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Hangxiang Sun
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Yucheng Xue
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Zenan Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Tao Chen
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Xupeng Chai
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Hao Qu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Peng Lin
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Wangsiyuan Teng
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Binghao Li
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Zhaoming Ye
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
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Omar M, Graulich T, von Falck C, Bruns N, Krettek C, Ettinger M. [Treatment strategies for tumor-related pathological fractures of the extremities]. Unfallchirurg 2021; 124:704-719. [PMID: 34427698 DOI: 10.1007/s00113-021-01056-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2021] [Indexed: 11/30/2022]
Abstract
Pathological fractures of the extremities frequently lead to uncertainty with respect to the treatment strategy and timing. The origin of metastases is typically breast, bronchial, renal and prostate cancer and myelomas. Primary bone tumors play a subordinate role. The majority affect the femur, humerus and occasionally the tibia. Surgery is typically the first line treatment as healing under conservative treatment is unlikely. The most important goal is to relieve pain and the preservation or restoration of function. For correct assessment of indications, analysis of the fracture pattern and oncological aspects including dignity, entity, prognosis, metastatic status and the general condition of the patient need to be taken into consideration. Based on all these aspects the surgical approach can be chosen. Treatment options range from osteosynthetic stabilization and augmentation osteosynthesis up to endoprosthesis replacement. The treatment is carried out in an interdisciplinary procedure as additional measures need to be addressed in addition to the surgical treatment.
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Affiliation(s)
- Mohamed Omar
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - Tilman Graulich
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Christian von Falck
- Institut für Diagnostische und Interventionelle Radiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Nico Bruns
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Christian Krettek
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Max Ettinger
- Orthopädische Klinik, Medizinischen Hochschule Hannover, Hannover, Deutschland
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Wang Z, Sun J, Sun Y, Gu Y, Xu Y, Zhao B, Yang M, Yao G, Zhou Y, Li Y, Du D, Zhao H. Machine Learning Algorithm Guiding Local Treatment Decisions to Reduce Pain for Lung Cancer Patients with Bone Metastases, a Prospective Cohort Study. Pain Ther 2021; 10:619-633. [PMID: 33740239 PMCID: PMC8119531 DOI: 10.1007/s40122-021-00251-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 02/23/2021] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION As life expectancy increases for lung cancer patients with bone metastases, the need for personalized local treatment to reduce pain is expanding. METHODS Patients were treated by a multidisciplinary team (MDT), and local treatment including surgery, percutaneous osteoplasty, or radiation. Visual analog scale (VAS) and quality of life (QoL) scores were analyzed. VAS at 12 weeks after treatment was the main outcome. We developed and tested machine learning models to predict which patients should receive local treatment. Model discrimination was evaluated by the area under curve (AUC), and the best model was used for prospective decision-making accuracy validation. RESULTS Under the direction of MDT, 161 patients in the training set, 32 patients in the test set, and 36 patients in the validation set underwent local treatment. VAS in surgery, percutaneous osteoplasty, and radiation groups decreased significantly to 4.78 ± 1.28, 4.37 ± 1.36, and 5.39 ± 1.31 at 12 weeks, respectively (p < 0.05), with no significant differences among the three datasets, and improved QoL was also observed (p < 0.05). A decision tree (DT) model that included VAS, bone metastases character, Frankel classification, Mirels score, age, driver gene, aldehyde dehydrogenase 2, and enolase 1 expression had a best AUC in predicting whether patients would receive local treatment of 0.92 (95% CI 0.89-0.94) in the training set, 0.85 (95% CI 0.77-0.94) in the test set, and 0.88 (95% CI 0.81-0.96) in the validation set. CONCLUSION Local treatment provided significant pain relief and improved QoL. There were no significant differences in reducing pain and improving QoL among training, test, and validation sets. The DT model was best at determining whether patients should receive local treatment. Our machine learning model can help guide clinicians to make local treatment decisions to reduce pain. TRIAL REGISTRATION Trial registration number ChiCRT-ROC-16009501.
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Affiliation(s)
- Zhiyu Wang
- Department of Internal Oncology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Jing Sun
- Department of Internal Oncology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Yi Sun
- Department of Radiation, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Yifeng Gu
- Department of Intervention, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Yongming Xu
- Department of Pain, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Bizeng Zhao
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Mengdi Yang
- Department of Internal Oncology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Guangyu Yao
- Department of Internal Oncology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Yiyi Zhou
- Department of Internal Oncology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Yuehua Li
- Department of Intervention, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Dongping Du
- Department of Pain, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, People's Republic of China.
| | - Hui Zhao
- Department of Internal Oncology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, People's Republic of China.
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Bonnevialle P, Sailhan F. Spinal and peripheral bone metastases: Time to structure medico-surgical management! Orthop Traumatol Surg Res 2020; 106:995-996. [PMID: 32891548 DOI: 10.1016/j.otsr.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Paul Bonnevialle
- Département d'Orthopédie Traumatologie du CHU de Toulouse, Hôpital P.P. Riquet, Place Baylac, 31052 Toulouse Cedex, France.
| | - Frédéric Sailhan
- Service d'Orthopédie, Hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
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19
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Meynard P, Seguineau A, Laumonerie P, Fabre T, Foltran D, Niglis L, Descamps J, Bouthors C, Lebaron M, Szymanski C, Sailhan F, Bonnevialle P. Surgical management of proximal femoral metastasis: Fixation or hip replacement? A 309 case series. Orthop Traumatol Surg Res 2020; 106:1013-1023. [PMID: 32778439 DOI: 10.1016/j.otsr.2020.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/04/2020] [Accepted: 05/13/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The proximal femur is the most frequent operative site for metastasis, but there is no consensus between internal fixation and hip replacement. The present multicenter retrospective observational study sought: (1) to compare early clinical results between internal fixation and hip replacement for proximal femoral metastasis (PFM), and (2) to assess events affecting survival. HYPOTHESIS The study hypothesis was that internal fixation and hip replacement give comparable clinical results, operative site complications rates and survival. MATERIAL AND METHODS The series comprised 309 cases, 10 of which were bilateral, in 182 females and 117 males, with a mean age of 67.2±11.5 years and 62.5±13.2 years, respectively. Primaries were mainly breast (118; 38.2%), lung (85; 25.5%) or kidney (40; 12.9%). PFM was revelatory in 114 cases (36.9%). There was visceral involvement in 142 patients (46%), multiple peripheral bone involvement in 212 (68.6%), and spinal involvement in 134 (43.4%). There were 124 pathologic fractures (40%), 51 of which were revelatory. Metastases were cervicocephalic in 135 cases (43.7%), metaphyseal in 166 (53.7%) and both in 8 (2.6%). PFM was osteolytic in 90% of cases, managed by hip replacement in 161 cases and internal fixation in 148 (12 screwed plates, 136 nails). Seventy-seven patients had postoperative radiation therapy. RESULTS After hip replacement (n=144), walking was normal in 35 cases (24.3%), impaired but unassisted in 53 (36.8%), with 1 forearm crutch in 24 (16.6%), 2 crutches or a frame in 26 (18%), and impossible in 6 (4.1%). After nailing (n=125), results were respectively 38 (30.4%), 47 (37.6%), 15 (12%), 18 (14.4) and 7 (5.6%). Recovery of normal walking capacity did not significantly differ according to technique (p=0.162); nor did pain or function. Recovery of normal walking capacity was better after preventive surgery (p<0.001). Perioperative complications comprised: 10 cases of severe blood loss, 7 pulmonary embolisms, 6 digestive hemorrhages, and 5 lung infections. Secondarily, there were 11 infections (7 after hip replacement, 2 after nailing, 2 after plate fixation), 7 progressive osteolyses and 5 fractures. Complications rates were significantly higher with plate fixation, with no difference between nailing and hip replacement. Survival did not significantly differ between hip replacement (12 months [95% CI: 7-19]), nailing (7 months [95% CI: 6-11]) and plate fixation (16 months [95% CI: 6-not calculable]). CONCLUSIONS Clinical results and survival were comparable between hip replacement and nailing, confirming the study hypothesis, in agreement with the literature. Each technique has its indications. Patients with severely impaired walking capacity benefited greatly from surgery. The importance of preventive surgery was highlighted. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- Pierre Meynard
- Centre hospitalier universitaire de Bordeaux, place Amélie Raba-Léon, 33076 Bordeaux cedex, France.
| | - Arthur Seguineau
- Centre hospitalier universitaire de Bordeaux, place Amélie Raba-Léon, 33076 Bordeaux cedex, France
| | - Pierre Laumonerie
- Département universitaire d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, place Baylac, 31052 Toulouse cedex, France
| | - Thierry Fabre
- Centre hospitalier universitaire de Bordeaux, place Amélie Raba-Léon, 33076 Bordeaux cedex, France
| | - Deborah Foltran
- Département universitaire d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, place Baylac, 31052 Toulouse cedex, France
| | - Lucas Niglis
- Service d'orthopédie traumatologie, hôpital de Hautepierre, avenue Molière, 67200 Strasbourg, France
| | - Jules Descamps
- Service d'orthopédie, hôpital Cochin, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Charlie Bouthors
- Service de chirurgie orthopédique et traumatologie et du Rachis, hôpital Kremlin-Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Marie Lebaron
- Service de chirurgie orthopédique et traumatologie, hôpital Nord, chemin des Bourrely, 13015 Marseille, France
| | - Christophe Szymanski
- Service de chirurgie orthopédique et traumatologie, hôpital Salengro, avenue du Professeur-Emile-Laine, 59037 Lille, France
| | - Fréderic Sailhan
- Service d'orthopédie, hôpital Cochin, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Paul Bonnevialle
- Département universitaire d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, place Baylac, 31052 Toulouse cedex, France
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- Société française de chirurgie orthopédique et traumatologique (SoFCOT), 56, rue Boissonade, 75014 Paris, France
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Lavignac P, Prieur J, Fabre T, Descamps J, Niglis L, Carlier C, Bouthors C, Baron-Trocellier T, Sailhan F, Bonnevialle P. Surgical treatment of peri-acetabular metastatic disease: Retrospective, multicentre study of 91 THA cases. Orthop Traumatol Surg Res 2020; 106:1025-1032. [PMID: 32763011 DOI: 10.1016/j.otsr.2020.03.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 03/07/2020] [Accepted: 03/24/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The occurrence of peri-acetabular metastasis (PAM) is a turning point in the progression of cancer because the disabling pain prevents the patient from walking or makes it difficult. Recent progress in controlling cancers that spread to the bone and controlling local bone destruction justify this national study. Since the data in France is incomplete or based on small studies, we analysed a multicentre retrospective cohort of patients with PAM who underwent total hip arthroplasty (THA) to evaluate 1) the clinical and radiological outcomes and 2) the factors impacting patient survival. HYPOTHESIS The clinical outcomes, complication rate and survivorship are comparable to that of recent published studies. METHODS Ninety-one patients (27 men, 64 women) with a mean age of 62.7±10.5 years (extremes 38 and 88) with PAM secondary to breast cancer [42 patients (46%)] or lung cancer [20 patients (22%)] underwent THA. The metastasis was the first sign of cancer in 33 cases (36%). Concurrent visceral metastases were present in 30 patients (33%), multiple peripheral bone metastasis in 48 patients (53%) and synchronous spine metastasis in 39 patients (43%). The most common construct was a cemented stem with metal reinforcement cage and cemented dual mobility cup [71 times (78%), while 85/91 had a dual mobility cup (93%)]. RESULTS Elimination or reduction of pain was reported in 81 patients (91%). Overall walking ability was deemed normal or acceptable in 74 patients (83%). Six patients died (7%) before the end of the 3rd month. There were seven general complications (8%) including five thromboembolic events. There were 22 complications related to the surgical procedure in 20 patients (22%) that required surgical revision, including 10 surgical site infections (11%) and 3 dislocations (3%) (one concerning a dual mobility cup and 2 after single mobility cup). The median survivorship all causes combined was 19.5 months; it was 23.7 months for patients with breast cancer and 8.9 months for those with lung cancer. CONCLUSION Despite different endpoints being used, the clinical outcomes in our study are like those in other published studies, as were the incidence of surgery-related complications and the survivorship. The recommended surgical technique is the implantation of an acetabular reinforcement cage, curettage with cement filling of osteolytic areas, dual mobility cup and cemented stem followed by radiation therapy. The role of THA versus interventional radiology procedures must still be determined. LEVEL OF EVIDENCE IV, retrospective study without control group.
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Affiliation(s)
- Pierre Lavignac
- Service de chirurgie orthopédique et traumatologique, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon 33076 Bordeaux cedex, France
| | - Jules Prieur
- Service de chirurgie orthopédique et traumatologique, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon 33076 Bordeaux cedex, France
| | - Thierry Fabre
- Service de chirurgie orthopédique et traumatologique, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon 33076 Bordeaux cedex, France.
| | - Jules Descamps
- Service d'orthopédie, hôpital Cochin, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Lucas Niglis
- Service d'orthopédie traumatologie, hôpital de Hautepierre, avenue Molière, 67200 Strasbourg, France
| | - Christophe Carlier
- Clinique chirurgicale orthopédique et traumatologique, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - Charlie Bouthors
- Service de chirurgie orthopédique et traumatologie et du rachis, hôpital Kremlin-Bicêtre, 78, rue du Général-Leclerc 94270 Le Kremlin-Bicêtre, France
| | - Thomas Baron-Trocellier
- Département universitaire d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, place Baylac, 31052 Toulouse Cedex, France
| | - Fréderic Sailhan
- Service d'orthopédie, hôpital Cochin, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France; Clinique Arago, groupe Almaviva, 187, rue Raymond-Losserand, 75014 Paris, France
| | - Paul Bonnevialle
- Département universitaire d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, place Baylac, 31052 Toulouse Cedex, France
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- SOFCOT, 56, rue Boissonade, 75014 Paris, France
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Surgical treatment of tibial metastases: Retrospective, multicenter, observational study of 25 patients. Orthop Traumatol Surg Res 2020; 106:1039-1045. [PMID: 31624032 DOI: 10.1016/j.otsr.2019.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/02/2019] [Accepted: 07/15/2019] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Long bone metastasis to the tibia is somewhat rare and has only been studied in a few publications with a limited number of cases. This led us to carry out a large multicenter, observational, retrospective study to 1) evaluate the clinical and radiological outcomes of surgical treatment at this location and 2) highlight the specific risks associated with this condition. HYPOTHESIS We hypothesized that the clinical outcomes and survivorship were comparable to those reported in the literature. MATERIAL AND METHODS The case series included 15 men and 10 women with a mean age of 66±11.7 years. The most common primary cancers were kidney (10 patients) and lung (4 patients). Thirteen patients had a concurrent visceral metastasis and sixteen had metastasis in another bone. The tibial metastasis was the initial sign of cancer in seven patients. The surgical procedure was done to prevent an impending fracture in 19 patients and to treat a pathological fracture in 6 patients (initial sign of cancer in 4 patients). Osteolysis occurred in the proximal epiphysis/metaphysis in 12 patients, diaphysis in 9 patients and distal epiphysis/metaphysis in 4 patients. We performed fixation with a lateral cortex plate and cementoplasty in 14 patients, locked intramedullary nailing in 8 patients, cementoplasty only in 2 patients and knee arthroplasty in 1 patient. RESULTS Three surgical site infections, one pulmonary embolism and one cardiac rhythm disturbance occurred. Four patients died before the 3rd month postoperative. At their best clinical status, 2 patients had not resumed walking, 10 could walk short distances with two canes or a walker, 3 had altered gait but could walk without aids and 6 could walk normally. The mean survival was 14±11.7 months (95% CI: 8.1-19.8) for all patients, 4±4 months (95% CI: 3-14) for those with a lung primary and 32±14 months (95% CI: 20-47) for those with a kidney primary. The survival was 15 months (95% CI: 4-29) after preventative treatment and 5 months (95% CI: 4-26) after fracture treatment. CONCLUSION Our clinical outcomes are comparable overall to the three main published articles on this topic. The risk of infection and benefits of preventative fixation were apparent in our cohort. LEVEL OF EVIDENCE IV, retrospective study.
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Retrospective, multicenter, observational study of 112 surgically treated cases of humerus metastasis. Orthop Traumatol Surg Res 2020; 106:1047-1057. [PMID: 32768275 DOI: 10.1016/j.otsr.2020.02.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/18/2020] [Accepted: 02/27/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The humerus is the second most common site for metastasis in the peripheral skeleton. These humeral metastases (HM) occur in the midshaft in 42% to 61% of cases and theproximal humerus in 32% to 45% of cases. They are often secondary to primary breast (17-31%), kidney (13-15%) or lung (11-24%) cancer. The optimal surgical treatment between intramedullary (IM) procedures, fixation or arthroplasty is still being debated. HYPOTHESIS We hypothesized that fixation and/or arthroplasty are safe and effective options for controlling pain and improving the patients' function. MATERIALS AND METHODS Between 2004 and 2016, 11 French hospitals included 112 continuous cases of HM in 54 men (49%) and 57 women (51%). The average age was 63.7±13.4 years (30-94). The HM occurred in the context of primary breast (30%), lung (23%) or kidney (21%) cancers. The HM was proximal in 35% of cases, midshaft in 59% and distal in 7% of cases. Surgery was required in 69% of patients because of a pathological fracture. The surgical procedure consisted of bundle pinning, plate fixation, arthroplasty or locked IM nailing in 6%, 11%, 14% and 69% of patients, respectively. RESULTS Seven patients (6%) had to be reoperated due to surgical site complications including two infections and four fractures (periprosthetic or away from implant). Twelve patients (11%) experienced a general complication. The overall survival was 16.7 months, which was negatively and significantly impacted by the occurrence of a fracture, a diaphyseal location and the type of primary cancer. At the final assessment, 75% had normal or subnormal function and more than 90% were pain-free or had less pain. The final function was not related to the occurrence of a fracture or etiology of the metastasis. In epiphyseal and metaphyseal HM, there was a trend to better function after shoulder arthroplasty than after plate fixation or IM nailing. CONCLUSIONS Our initial hypothesis was confirmed. Our findings were consistent with those of other published studies. Based on our findings, we recommend using static locked IM nailing with cementoplasty for mid-shaft lesions and modular arthroplasty for destructive epiphyseal or metaphyso-epiphyseal lesions. The criteria for assessing humeral fracture risk should be updated to allow the introduction of a preventative procedure, which contributes to better survival. LEVEL OF EVIDENCE IV, retrospective study.
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Crenn V, Carlier C, Gouin F, Sailhan F, Bonnevialle P. High rate of fracture in long-bone metastasis: Proposal for an improved Mirels predictive score. Orthop Traumatol Surg Res 2020; 106:1005-1011. [PMID: 32782175 DOI: 10.1016/j.otsr.2020.03.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 03/03/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Pathologic fracture is the most feared complication in long-bone metastasis. Various radiographic tools are available for identifying at-risk patients and guide preventive treatment. The Mirels score is the most frequently studied and widely used, but has been criticized, many patients not being operated on until the actual fracture stage. We therefore conducted a French national multicenter prospective study: (1) to determine the proportion of patients operated on at fracture stage versus preventively; (2) to compare Mirels score between the two; and (3) to identify factors for operation at fracture stage according to Mirels score and other epidemiological, clinical and biological criteria. HYPOTHESIS Simple discriminatory items can be identified to as to complete the Mirels score and enhance its predictive capacity. MATERIAL AND METHODS A non-controlled multicenter prospective study included 245 patients operated on for non-revelatory long-bone metastasis, comparing patients operated on for fracture versus preventively according to body-mass index (BMI), ASA score, Katagiri score items and the 4 Mirels items. RESULTS One hundred and twenty-six patients (51.4%) were operated on at fracture stage: 106 (84.1%) showed high risk on Mirels score (score>8), and 15 (11.9%) moderate risk (score=8). On multivariate analysis, 4 independent factors emerged: in increasing order, advanced age (OR=1.03; 95%CI 1.01-1.06), VAS pain score>6 (OR=1.47; 95%CI 1.02-2.11), WHO grade>2 (OR=2.74; 95%CI 1.22-6.15), and upper-limb location (OR=5.26; 95%CI 2.13-12.84). DISCUSSION The present study confirmed that more than half of patients with long-bone metastasis are operated on at actual fracture stage, in agreement with the literature. Several studies highlighted the weakness of the Mirels score as a predictive instrument. Comparison between preventive and fracture-stage surgery showed that upper-limb location, intense pain, advanced age and impaired functional status were associated with fracture-stage surgery, and should be taken into account alongside the original Mirels criteria. This improved scoring instrument remains to be validated in a prospective study. LEVEL OF EVIDENCE IV, prospective cohort study without control group.
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Affiliation(s)
- Vincent Crenn
- Clinique Chirurgicale Orthopédique et Traumatologique, CHU de Nantes, Hôtel-Dieu, Place A. Ricordeau, 44093 Nantes Cedex, France; Physos, Inserm UMR 1238, Faculté de Médecine de Nantes, Rue G. Veil, 44000 Nantes, France.
| | - Christophe Carlier
- Clinique Chirurgicale Orthopédique et Traumatologique, CHU de Nantes, Hôtel-Dieu, Place A. Ricordeau, 44093 Nantes Cedex, France
| | - François Gouin
- Clinique Chirurgicale Orthopédique et Traumatologique, CHU de Nantes, Hôtel-Dieu, Place A. Ricordeau, 44093 Nantes Cedex, France; Physos, Inserm UMR 1238, Faculté de Médecine de Nantes, Rue G. Veil, 44000 Nantes, France; Département de Chirurgie, Centre Léon Bérard, 28, Rue Laennec, 69008 Lyon, France
| | - Fréderic Sailhan
- Hôpital Cochin, 27, Rue du Faubourg-Saint-Jacques, 75014 Paris, France; Clinique Arago, Groupe Almaviva, 187a, Rue Raymond Losserand, 75014 Paris, France
| | - Paul Bonnevialle
- Département Universitaire d'Orthopédie Traumatologie de Toulouse, Hôpital P.P. Riquet, Place Baylac, 31052 Toulouse Cedex, France
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- Société Française de Chirurgie Orthopédique et de Traulatologie (So.F.C.O.T.), 56, rue Boissonnade, 75014 Paris, France
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Functional results and survival after surgery for peripheral skeletal metastasis: A 434-case multicenter retrospective series. Orthop Traumatol Surg Res 2020; 106:997-1003. [PMID: 32273249 DOI: 10.1016/j.otsr.2019.10.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 10/23/2019] [Accepted: 10/23/2019] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Peripheral skeletal metastasis (PSM) has a negative impact on quality of life. New treatments for the primary tumor or the osteolysis hold out hope of improved survival. The few published French series were small, and we therefore undertook a multicenter retrospective analysis of PSM surgery between 2005 and December 2016, with the aim of assessing: 1) rate and type of complications, 2) functional results, and 3) overall survival and corresponding risk factors. HYPOTHESIS The French data for clinical results, survival and complications are in agreement with the international literature. MATERIALS AND METHOD The series comprised 391 patients with 434 metastatic locations. There was female predominance: 247 women (63%). Two sites were treated in 46 patients (12%), and three in 5. The main etiologies were breast cancer (151/391: 39%), lung cancer (103/391: 26%) and kidney cancer (52/391: 13%). There was synchronous visceral metastasis in 166 patients (42.5%), other peripheral locations in 137 (35%) and spinal location in 142 (39%). One hundred (27%) had ASA score>3; 61 (16%) had WHO score>3. The reason for surgery was pathologic fracture (n=137: 35%). Locations were femoral (274: 70%), acetabular (58: 15%), humeral (40: 0%), tibial (12: 3%) or other (7: 2%). RESULTS There were surgery site complications in 41 patients (9.4%), including 13 surgery site infections, and general complications in 47 patients (11%), including 11 cases of thromboembolism, 6 of blood loss, 9 pulmonary complications and 6 perioperative deaths. Overall survival, taking all etiologies and sites together, was 10 months (range, 5 days to 9 years; 95% CI, 8-13 months), and significantly better in females (14 versus 6 months; p=0.01), under-65 year-olds (p=0.001), and in preventive surgery versus fractured PSM (p=0.001). Median survival was 22 months (95% CI, 17-28 months) after breast cancer, 3 months (95% CI, 2-5 months) after lung cancer, and 17 months (95% CI, 8-58 months) after kidney cancer. Preoperatively, walking was impossible for 143 patients (38%), versus 23 (6.5%) postoperatively; 229 patients (63.5%) could walk normally or nearly normally after surgery, versus 110 (28%) before. After surgery, 3 patients (6%) were not using their operated upper limb, versus 27 (45%) before; 30 patients (54%) had normal upper limb use after surgery, versus 8 (5%) before. CONCLUSION The study hypothesis was on the whole confirmed in terms of survival according to type of primary and whether surgery was indicated preventively or for fracture. LEVEL OF EVIDENCE IV, retrospective study without control group.
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Vitiello R, Bellieni A, Oliva MS, Di Capua B, Fusco D, Careri S, Colloca GF, Perisano C, Maccauro G, Lillo M. The importance of geriatric and surgical co-management of elderly in muscoloskeletal oncology: A literature review. Orthop Rev (Pavia) 2020; 12:8662. [PMID: 32913597 PMCID: PMC7459364 DOI: 10.4081/or.2020.8662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/17/2020] [Indexed: 12/16/2022] Open
Abstract
People over 65 years old are the fastestgrowing part of the population and also the most common population in oncological practice. The geriatric co-assessment when involved in the management of orthopedic elderly patients could improve the survival and clinical outcomes of the patients. The aim of this review is to understand the importance of comprehensive geriatric assessment in elderly cancer orthopaedic patients affected by bone and soft tissue sarcoma in order to apply it and identify the mean surgical prognostic factors of this population.
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Affiliation(s)
- Raffaele Vitiello
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - Andrea Bellieni
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - Maria Serena Oliva
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - Beatrice Di Capua
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - Domenico Fusco
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - Silvia Careri
- Department of Orthopaedics and Traumatology, Paediatric Hospital Bambino Gesù IRCCS, Rome
| | | | - Carlo Perisano
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - Giulio Maccauro
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - Marco Lillo
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
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Oliva MS, Vitiello R, Cauteruccio M, Pesare E, Rovere G, Meschini C, Liuzza F, Maccauro G, Ziranu A. Cemented versus cementless megaprosthesis in proximal femur metastatic disease: A systematic review. Orthop Rev (Pavia) 2020; 12:8689. [PMID: 32913616 PMCID: PMC7459367 DOI: 10.4081/or.2020.8689] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 12/19/2022] Open
Abstract
The proximal femur is the long bone most commonly affected by metastatic disease. There are many treatment options, such as hip megaprostheses. A topic still widely debated in literature is the use of cemented or uncemented megaprostheses in this kind of patients. The purpose of this review is to examine both these surgical options to understand which of them should be preferred in metastatic patients. Twelve articles were finally included in the review. Eight authors used cemented mega - prostheses, two cementless megaprostheses and two authors used both techniques. Better functional outcomes and lower infection rates were found in cementless mega - prostheses. More studies have to be performed to choose the better technique and improve patients’ quality of life.
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Affiliation(s)
- Maria Serena Oliva
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Catholic University of the Sacred Heart, Rome, Italy
| | - Raffaele Vitiello
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Catholic University of the Sacred Heart, Rome, Italy
| | - Michele Cauteruccio
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Catholic University of the Sacred Heart, Rome, Italy
| | - Elisa Pesare
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Rovere
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Catholic University of the Sacred Heart, Rome, Italy
| | - Cesare Meschini
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Liuzza
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - Giulio Maccauro
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio Ziranu
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
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Rossi B, Zoccali C, Baldi J, Scotto di Uccio A, Biagini R, De Luca A, Petrongari MG, Ferraresi V. Reorganization Tips from a Sarcoma Unit at Time of the COVID-19 Pandemic in Italy: Early Experience from a Regional Referral Oncologic Center. J Clin Med 2020; 9:jcm9061868. [PMID: 32549298 PMCID: PMC7357067 DOI: 10.3390/jcm9061868] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 12/30/2022] Open
Abstract
Since the World Health Organization declared the novel coronavirus outbreak a global health emergency, Italy's lockdown was declared on 9 March 2020. Elective orthopedic surgery was forced to stop to allow the healthcare system to face the emergency. However, many orthopedic oncology cases could not be postponed. The aim of this study was to report the experience in managing sarcoma patients and the reorganization of a cancer center in an attempt to maintain it free from COVID-19. A Coronavirus Crisis Unit was established by the health directorate coordination in order to adopt specific procedures. General rules of screening and social distancing were applied in different health settings (entrance check point, hospital inward, outpatient clinic, operative room). Regarding oncologic orthopedics, priority was given to bone and soft tissue sarcomas, metastases and aggressive benign tumors at risk of impending or pathologic fracture. Precise indications were followed to manage first outpatient visits, patients undergoing surgery and follow-up. Meticulous adherence to rules among patients and personnel and collaboration between leadership and medical staff in order to continue to perform multidisciplinary treatment protocols, maintain the availability of infrastructural spaces and source protective equipment, swabs and screening samples have been successful in the aim towards a safe cure for cancer patients.
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Affiliation(s)
- Barbara Rossi
- Oncological Orthopedic Unit, IRCCS-Regina Elena National Cancer Institute, 00144 Rome, Italy; (C.Z.); (J.B.); (R.B.)
- Correspondence: ; Tel.: +39-338-777-7872
| | - Carmine Zoccali
- Oncological Orthopedic Unit, IRCCS-Regina Elena National Cancer Institute, 00144 Rome, Italy; (C.Z.); (J.B.); (R.B.)
| | - Jacopo Baldi
- Oncological Orthopedic Unit, IRCCS-Regina Elena National Cancer Institute, 00144 Rome, Italy; (C.Z.); (J.B.); (R.B.)
| | - Alessandra Scotto di Uccio
- Hepato-Biliary and Organ Transplant Unit, School of General Surgery, Sapienza University, 00144 Rome, Italy;
| | - Roberto Biagini
- Oncological Orthopedic Unit, IRCCS-Regina Elena National Cancer Institute, 00144 Rome, Italy; (C.Z.); (J.B.); (R.B.)
| | - Assunta De Luca
- Department Risk Management Unit, IRCCS-Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Maria Grazia Petrongari
- Department of Radiation Oncology, IRCCS-Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Virginia Ferraresi
- Department of Medical Oncology, IRCCS-Regina Elena National Cancer Institute, 00144 Rome, Italy;
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Carbon Fiber/Polyether Ether Ketone (CF/PEEK) Implants Allow for More Effective Radiation in Long Bones. MATERIALS 2020; 13:ma13071754. [PMID: 32283675 PMCID: PMC7178689 DOI: 10.3390/ma13071754] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/03/2020] [Accepted: 04/07/2020] [Indexed: 11/22/2022]
Abstract
Background: Metallic implants show dose-modulating effects in radiotherapy and complicate its computed tomography (CT)-based planning. Dose deviations might not only affect the surrounding tissues due to backscattering and inadvertent dose increase but might also compromise the therapeutic effect to the target lesion due to beam attenuation. Later on, follow-up imaging is often obscured by metallic artefacts. Purposes: This study investigates the dosimetric impact of titanium and radiolucent carbon fiber/polyether ether ketone (CF/PEEK) implants during adjuvant radiation therapy in long bones. (1) Does the use of CF/PEEK implants allow for a more homogenous application of radiation? (2) Is the dose delivery to the target volume more efficient when using CF/PEEK implants? (3) Do CF/PEEK implants facilitate CT-based radiation therapy planning? Materials and methods: After CT-based planning, bone models of six ovine femora were irradiated within a water phantom in two immersion depths to simulate different soft-tissue envelopes. Plates and intramedullary nails of both titanium and CF/PEEK were investigated. Radiation dosage and distribution patterns were mapped using dosimetry films. Results: First, the planned implant-related beam attenuation was lower for the CF/PEEK plate (1% vs. 5%) and the CF/PEEK nail (2% vs. 9%) than for corresponding titanium implants. Secondly, the effective decrease of radiation dosage behind the implants was noticeably smaller when using CF/PEEK implants. The radiation dose was not significantly affected by the amount of surrounding soft tissues. A significant imaging artefact reduction was seen in all CF/PEEK models. Conclusion: CF/PEEK implants lead to a more reliable and more effective delivery of radiation dose to an osseous target volume. With regard to radiation therapy, the use of CF/PEEK implants appears to be particularly beneficial for intramedullary nails.
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Falcinelli C, Di Martino A, Gizzi A, Vairo G, Denaro V. Mechanical behavior of metastatic femurs through patient-specific computational models accounting for bone-metastasis interaction. J Mech Behav Biomed Mater 2019; 93:9-22. [PMID: 30738327 DOI: 10.1016/j.jmbbm.2019.01.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 01/23/2019] [Accepted: 01/27/2019] [Indexed: 12/21/2022]
Abstract
This paper proposes a computational model based on a finite-element formulation for describing the mechanical behavior of femurs affected by metastatic lesions. A novel geometric/constitutive description is introduced by modelling healthy bone and metastases via a linearly poroelastic constitutive approach. A Gaussian-shaped graded transition of material properties between healthy and metastatic tissues is prescribed, in order to account for the bone-metastasis interaction. Loading-induced failure processes are simulated by implementing a progressive damage procedure, formulated via a quasi-static displacement-driven incremental approach, and considering both a stress- and a strain-based failure criterion. By addressing a real clinical case, left and right patient-specific femur models are geometrically reconstructed via an ad-hoc imaging procedure and embedding multiple distributions of metastatic lesions along femurs. Significant differences in fracture loads, fracture mechanisms, and damage patterns, are highlighted by comparing the proposed constitutive description with a purely elastic formulation, where the metastasis is treated as a pseudo-healthy tissue or as a void region. Proposed constitutive description allows to capture stress/strain localization mechanisms within the metastatic tissue, revealing the model capability in describing possible strain-induced mechano-biological stimuli driving onset and evolution of the lesion. The proposed approach opens towards the definition of effective computational strategies for supporting clinical decision and treatments regarding metastatic femurs, contributing also to overcome some limitations of actual standards and procedures.
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Affiliation(s)
- Cristina Falcinelli
- Department of Engineering, Campus Bio-Medico University of Rome, Italy; Department of Civil Engineering & Computer Science, University of Rome "Tor Vergata", Italy
| | - Alberto Di Martino
- Department of Orthopaedics and Trauma Surgery, Campus Bio-Medico University of Rome, Italy; Sideny Kimmel Medical College, Thomas Jefferson University (SKMC), Philadelphia, USA
| | - Alessio Gizzi
- Department of Engineering, Campus Bio-Medico University of Rome, Italy
| | - Giuseppe Vairo
- Department of Civil Engineering & Computer Science, University of Rome "Tor Vergata", Italy.
| | - Vincenzo Denaro
- Department of Orthopaedics and Trauma Surgery, Campus Bio-Medico University of Rome, Italy
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Luigi Cazzato R, Auloge P, De Marini P, Rousseau C, Chiang JB, Koch G, Caudrelier J, Rao P, Garnon J, Gangi A. Percutaneous image-guided ablation of bone metastases: local tumor control in oligometastatic patients. Int J Hyperthermia 2018; 35:493-499. [PMID: 30307346 DOI: 10.1080/02656736.2018.1508760] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Percutaneous image-guided cryo- (CA) and radiofrequency- (RFA) ablations have been widely used in the treatment of painful bone metastases (BM). However, paucity of data is available for the performance of these treatments when used with a curative intent. The aim of this study is to investigate the local progression free-survival (LPFS) after radical percutaneous image-guided ablation of BM in oligometastatic patients, and to identify predictive factors associated with local tumor progression. MATERIALS AND METHODS This is a retrospective review of all patients who underwent percutaneous image-guided CA or RFA of BM with a radical intent between 2007 and 2018. RESULTS Forty-six patients with a total of forty-nine BM underwent percutaneous image-guided CA (N = 37; 75,5%) or RFA (N = 12; 24,5%). Primary malignancies included thyroid (N = 11, 22.5%), breast (N = 21; 42.9%), lung (N = 8; 16.3%) and other (N = 9; 18,3%) cancers. Additional consolidation was performed after ablation in 20.4% cases (N = 10). Mean follow-up was 34.1 ± 22 months. Local progression at the treated site was observed in 28.5% cases (N = 14); 1- and 2-year LPFS was 76.8% and 71.7%, respectively. Size of BM (>2 cm) predicted local tumor progression (p = .002). CONCLUSIONS Percutaneous image-guided locoregional therapies used in the radical treatment of BM in oligometastatic patients demonstrate significant rates of LPFS providing the size of BM ≤2 cm.
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Affiliation(s)
- Roberto Luigi Cazzato
- a Interventional Radiology , University Hospital of Strasbourg , Strasbourg , France
| | - Pierre Auloge
- a Interventional Radiology , University Hospital of Strasbourg , Strasbourg , France
| | - Pierre De Marini
- a Interventional Radiology , University Hospital of Strasbourg , Strasbourg , France
| | - Chloé Rousseau
- b Clinical Investigation, INSERM 1414 , University of Rennes , Rennes , France
| | - Jeanie Betsy Chiang
- c Interventional Radiology , Queen Elizabeth Hospital , Hong Kong , Hong Kong
| | - Guillaume Koch
- a Interventional Radiology , University Hospital of Strasbourg , Strasbourg , France
| | - Jean Caudrelier
- a Interventional Radiology , University Hospital of Strasbourg , Strasbourg , France
| | - Pramod Rao
- a Interventional Radiology , University Hospital of Strasbourg , Strasbourg , France
| | - Julien Garnon
- a Interventional Radiology , University Hospital of Strasbourg , Strasbourg , France
| | - Afshin Gangi
- a Interventional Radiology , University Hospital of Strasbourg , Strasbourg , France
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Is endoprosthesis safer than internal fixation for metastatic disease of the proximal femur? A systematic review. Injury 2017; 48 Suppl 3:S48-S54. [PMID: 29025610 DOI: 10.1016/s0020-1383(17)30658-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Metastases to the proximal femur are usually managed surgically by tumor resection and reconstruction with an endoprosthesis, or by fixation with osteosynthesis. Still controversy remains regarding the most appropriate surgical treatment. We posed the following questions: (1) Is the frequency of surgical revision greater in patients treated with internal fixation than endoprosthetic reconstruction, and (2) Do complications that do not require surgery occur more frequently in patients treated with internal fixation rather than in those with endoprosthetic reconstruction? MATERIALS AND METHODS A systematic review was performed of those studies reporting on surgical revision and complication rates comparing the two surgical methods. Ten studies including 1107 patients met the inclusion criteria, three with high methodological quality, three intermediate, and four with lowquality, according to the STROBE guidelines. RESULTS At present, prosthetic dislocation is the most common complication observed in patients managed by prosthesis replacement of the proximal femur, while loosening was the main cause of reoperation in the fixation group. Time to reintervention ranged from 3 to 11.6 months for the prosthetic replacement and from 7.8 to 22.3 months for the fixation group. Non surgical complications, (mainly dislocations and infections) were more commonly observed in patients operated on by prosthetic replacement. CONCLUSIONS Implant related complications and surgery-related morbidity should be taken into account in the decision-making process for the surgical management of these patients. These data can improve the surgeon-patient communication and guide further studies on patients' survival and complications with respect to surgery.
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Piccioli A, Piana R, Lisanti M, Di Martino A, Rossi B, Camnasio F, Gatti M, Maniscalco P, Gherlinzoni F, Spinelli MS, Donati DM, Biagini R, Capanna R, Denaro V. Carbon-fiber reinforced intramedullary nailing in musculoskeletal tumor surgery: a national multicentric experience of the Italian Orthopaedic Society (SIOT) Bone Metastasis Study Group. Injury 2017; 48 Suppl 3:S55-S59. [PMID: 29025611 DOI: 10.1016/s0020-1383(17)30659-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Carbon fiber reinforced (CFR) implants have been proposed for the treatment of fractures or impending fractures of the long bones in the oncology patient. Aim of this study is to present the largest cohort of oncology patients operated by CFR nailing by the Italian Orthopaedic Society (SIOT) Bone Metastasis Study Group. METHODS 53 adult oncology patients were operated on with a CFR-PEEK nail. All the data from adjuvants therapies were collected. Bone callus formation, response to radiotherapy, relapse or progression of the osteolysis were recorded. Hardware survival and failure, breakage and need for implant revision were also analysed. RESULTS Anatomical implantation of nails include humerus (n = 35), femur (n =11) and tibia (n = 7). The most frequent tumors affecting the bone were myeloma (n = 13), breast (n = 11), lung (n = 8), and renal cell cancer (n = 7). Acrylic cement reinforcement was used in 2 patients. One patient was subjected to electrochemotherapy after nail insertion. Intraoperative and early postoperative complications occurred in 13.2% and 7.54% of patients respectively. Eight patients had local progression and one developed a stress fracture proximally to the distal static screw. Radiographic union occurred in 14 patients; one screw loosening was recorded. DISCUSSION There is currently a lack of solid evidence on the clinical use of CFR nails in oncologic patients. This is the first and largest study of CFR nailing, with the longest available follow up. CONCLUSIONS Implant related complications and surgery-related morbidity should be taken into account in the decision-making process for the surgical management of these patients. These data can improve the surgeon-patient communication and guide further studies on patients' survival and complications with respect to surgery.
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Affiliation(s)
- Andrea Piccioli
- Centro Oncologico di Palazzo Baleani, Policlinico Umberto I, Roma
| | - Raimondo Piana
- SC Ortopedia Oncologica e Ricostruttiva, AOU Città della Salute e della Scienza di Torino
| | - Michele Lisanti
- Ortopedia, Dipartimento di ricerca traslazionale e delle nuove tecnologie in medicina e chirurgia, Università di Pisa
| | - Alberto Di Martino
- Department of Orthopaedics and Trauma Surgery, University Campus Bio-Medico of Rome.
| | - Barbara Rossi
- Ortopedia e Traumatologia, Presidio Ospedaliero Alto Chiascio, ASLUmbria1
| | | | | | - Pietro Maniscalco
- U.O.C. Traumatologia Provinciale dell'Azienda Unità Sanitaria Locale di Piacenza
| | | | | | - Davide Maria Donati
- Clinica Ortopedica e Traumatologica III a prevalente indirizzo Oncologico, Istituto Ortopedico Rizzoli ed Università di Bologna
| | | | - Rodolfo Capanna
- Orthopaedic and Traumatologic Clinic, University of Pisa, Italy
| | - Vincenzo Denaro
- Department of Orthopaedics and Trauma Surgery, University Campus Bio-Medico of Rome
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- The Italian Orthopaedic Society (SIOT), Rome, Italy
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Cazzato RL, Garnon J, Tsoumakidou G, Koch G, Palussière J, Gangi A, Buy X. Percutaneous image-guided screws meditated osteosynthesis of impeding and pathological/insufficiency fractures of the femoral neck in non-surgical cancer patients. Eur J Radiol 2017; 90:1-5. [PMID: 28583620 DOI: 10.1016/j.ejrad.2017.02.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/02/2017] [Accepted: 02/15/2017] [Indexed: 11/28/2022]
Abstract
AIM To present percutaneous image-guided screw-mediated osteosynthesis (PIGSMO) for fixation of impending fractures (ImF) and non-displaced/mildly displaced pathological/insufficient fractures (PF/InF) of the femoral neck in non-surgical cancer patients. MATERIALS AND METHODS This is a double-centre single-arm observational study. Retrospective review of electronic records identified all oncologic patients who had undergone femoral neck PIGSMO. Inclusion criteria were: non-displaced or mildly displaced PF/InF, and ImF (Mirels' score ≥8); life expectancy ≥1 month; unsuitability for surgical treatment due to sub-optimal clinical fitness, refusal of consent, or unacceptable delay to systemic therapy. RESULTS Eleven patients were treated (mean age 63.7±13.5 years) due to ImF (63.6%, mean Mirels' score 10.1), PF (27.3%) or post-radiation InF (9.1%) under CT/fluoroscopy- (36.4%) or CBCT- (63.6%) guidance. Thirty-two screws were implanted and cement injection was added in 36.4% cases. Technical success was 90.9%. No procedure related complications were noted. At 1-month clinical follow-up (pain/walking impairment), 63.6% and 27.3% patients reported significant and mild improvement, respectively. Imaging follow-up (available in 63.6% cases) showed no signs of secondary fractures, neither of screws loosening at mean 2.8 months. Five patients (45.5%) died after PIGSMO (mean time interval 3.6 months). CONCLUSIONS PIGSMO is technically feasible and safe in cancer patients with limited life expectancy; it offers good short-term results. Further prospective studies are required to corroborate mid- and to prove long-term efficacy of the technique.
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Affiliation(s)
- Roberto Luigi Cazzato
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg (HUS), 1, place de l'Hopital, 67000 Strasbourg, France.
| | - Julien Garnon
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg (HUS), 1, place de l'Hopital, 67000 Strasbourg, France.
| | - Georgia Tsoumakidou
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg (HUS), 1, place de l'Hopital, 67000 Strasbourg, France.
| | - Guillaume Koch
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg (HUS), 1, place de l'Hopital, 67000 Strasbourg, France.
| | - Jean Palussière
- Department of Radiology, Institut Bergonié, 229 cours de l'Argonne, 33076 Bordeaux Cedex, France.
| | - Afshin Gangi
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg (HUS), 1, place de l'Hopital, 67000 Strasbourg, France.
| | - Xavier Buy
- Department of Radiology, Institut Bergonié, 229 cours de l'Argonne, 33076 Bordeaux Cedex, France.
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Anract P, Biau D, Boudou-Rouquette P. Metastatic fractures of long limb bones. Orthop Traumatol Surg Res 2017; 103:S41-S51. [PMID: 28089230 DOI: 10.1016/j.otsr.2016.11.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 06/27/2016] [Accepted: 11/02/2016] [Indexed: 02/02/2023]
Abstract
The diagnosis of pathological fracture should be considered routinely in patients with long limb-bone fractures. Investigations must be performed to establish the diagnosis of pathological fracture then to determine that the bone lesion is a metastasis. In over 85% of cases, the clinical evaluation combined with a detailed analysis of the radiographs is sufficient to determine that the fracture occurred at a tumour site. Aetiological investigations establish that the tumour is a metastasis. In some patients, the diagnosis of metastatic cancer antedates the fracture. When this is not the case, a diagnostic strategy should be devised, with first- to third-line investigations. When these fail to provide the definitive diagnosis, a surgical biopsy should be performed. The primaries most often responsible for metastatic bone disease are those of the breast, lung, kidney, prostate, and thyroid gland. However, the survival gains provided by newly introduced treatments translate into an increased frequency of bone metastases from other cancers. The optimal treatment of a pathological fracture is preventive. The Mirels score is helpful for determining whether preventive measures are indicated. When selecting a treatment for a pathological fracture, important considerations are the type of tumour, availability of effective adjuvant treatments, and general health of the patient. Metastatic fractures are best managed by a multidisciplinary team. The emergent treatment should start with optimisation of the patient's general condition, in particular by identifying and treating metabolic disorders (e.g., hypercalcaemia) and haematological disorders. Treatment decisions also depend on the above-listed general factors, location of the tumour, and size of the bony defect. Prosthetic reconstruction is preferred for epiphyseal fractures and internal fixation for diaphyseal fractures.
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Affiliation(s)
- P Anract
- Département de chirurgie orthopédique, hôpital Cochin, Assistance publique-Hôpitaux de Paris, université Paris Descartes, Sorbonne Paris cité, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France.
| | - D Biau
- Département de chirurgie orthopédique, hôpital Cochin, Assistance publique-Hôpitaux de Paris, université Paris Descartes, Sorbonne Paris cité, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - P Boudou-Rouquette
- Département d'oncologie médicale, hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Sorbonne Paris cité, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
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Di Martino A, Caldaria A, De Vivo V, Denaro V. Metastatic epidural spinal cord compression. Expert Rev Anticancer Ther 2016; 16:1189-1198. [PMID: 27654149 DOI: 10.1080/14737140.2016.1240038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Metastatic epidural spinal cord compression (MESSC) is a frequent event in patients affected by solid tumor metastases. Current available approaches for MESCC include corticosteroids, radiotherapy and surgery. In the last few years, surgery has evolved from decompression by laminectomy alone, with the introduction of instrumentation systems by metalware (screws and hooks), and this has been associated to an improvement of clinical results compared to radiotherapy alone. Areas covered: In this narrative review, we outline the phases of management of cancer patients affected by MESSC, and discuss the timing of treatments, their impact on the Quality of life (QoL), and the relative benefits and harms of surgery and radiotherapy. Expert commentary: Despite the fact that clinical and surgical trials will be required to determine the most appropriate surgical technique and timing of surgery, we do expect a newer and more important role for radiotherapy in the management of MESCC patients in the next future. In particular, the implementation of radiotactic stereosurgery as adjuvant to decompressive surgery is expected to increase in the next few years, above all in those patients that can be candidate to the so called separation surgery.
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Affiliation(s)
- Alberto Di Martino
- a CIR- Center of Integrated Research, Department of Orthopaedics and Trauma Surgery , University Campus Bio-Medico of Rome , Rome , Italy
| | - Antonio Caldaria
- a CIR- Center of Integrated Research, Department of Orthopaedics and Trauma Surgery , University Campus Bio-Medico of Rome , Rome , Italy
| | - Vincenzo De Vivo
- a CIR- Center of Integrated Research, Department of Orthopaedics and Trauma Surgery , University Campus Bio-Medico of Rome , Rome , Italy
| | - Vincenzo Denaro
- a CIR- Center of Integrated Research, Department of Orthopaedics and Trauma Surgery , University Campus Bio-Medico of Rome , Rome , Italy
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