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Westphal LM, Theil C, Gosheger G, Ellerbrock M, Deventer N, Schneider KN. Patients Regularly Return to Medium- and Low-Impact Types of Sporting Activities Following Distal Femoral or Proximal Tibial Replacement After Resection of a Primary Bone Sarcoma. J Arthroplasty 2024:S0883-5403(24)00613-2. [PMID: 38880406 DOI: 10.1016/j.arth.2024.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 06/07/2024] [Accepted: 06/10/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND Little is known about the resumption of sporting activities following megaprosthetic reconstruction of the distal femur and proximal tibia after resection of a bone sarcoma. Thus, the aims of our study were: (1) to assess the functional outcome; (2) to evaluate pre- and post-operatively performed sporting activities; and (3) to identify potential beneficial and limiting factors. METHODS Between 1993 and 2015, a total of 230 patients underwent distal femoral replacement (DFR), and 96 patients underwent proximal tibial replacement (PTR). The exclusion criteria were death, amputation, living overseas, and a congenital disability. Functional outcome and sporting activities were assessed using the Musculoskeletal Tumor Society Score (MSTS), Toronto Extremity Salvage Score (TESS), Forgotten Joint Score (FJS), subjective knee value (SKV), the Tegner activity score (TS), and the modified weighted activity score (WAS). RESULTS There were 93 patients who had a median follow-up of 182 months (interquartile range (IQR) 130 to 260) after DFR with the following median scores: MSTS 18 (IQR 12 to 23), TESS 75% (IQR 60 to 84), FJS 25 (IQR 8 to 40), SKV 53% (IQR 40 to 70), TS 3 (IQR 3 to 4), and WAS 4 (IQR 0 to 8). There were 42 patients who had a median follow-up of 193 months (IQR 137 to 244) after PTR had the following median scores: MSTS 17 (IQR 15 to 22), TESS 78% (IQR 68 to 88), FJS 32 (IQR 20 to 46), SKV 60% (IQR 40 to 70), TS 3 (IQR 3 to 4), and WAS 4 (IQR 1 to 10). Postoperatively, 61% of DFR and 76% of PTR patients participated in at least one sporting activity. CONCLUSIONS The functional outcome is overall good with a regular resumption of sporting activities. Patients' age at surgery and higher preoperative sporting levels were associated with better functional outcomes and higher postoperative sporting activity.
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Affiliation(s)
- Lucia M Westphal
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Münster, Germany
| | - Christoph Theil
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Münster, Germany
| | - Georg Gosheger
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Münster, Germany
| | - Moritz Ellerbrock
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Münster, Germany
| | - Niklas Deventer
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Münster, Germany
| | - Kristian N Schneider
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Münster, Germany
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Grumezescu V, Gherasim O, Gălățeanu B, Hudiță A. Antitumoral-Embedded Biopolymeric Spheres for Implantable Devices. Pharmaceutics 2024; 16:754. [PMID: 38931875 PMCID: PMC11207774 DOI: 10.3390/pharmaceutics16060754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024] Open
Abstract
The bioactive surface modification of implantable devices paves the way towards the personalized healthcare practice by providing a versatile and tunable approach that increase the patient outcome, facilitate the medical procedure, and reduce the indirect or secondary effects. The purpose of our study was to assess the performance of composite coatings based on biopolymeric spheres of poly(lactide-co-glycolide) embedded with hydroxyapatite (HA) and methotrexate (MTX). Bio-simulated tests performed for up to one week evidenced the gradual release of the antitumor drug and the biomineralization potential of PLGA/HA-MTX sphere coatings. The composite materials proved superior biocompatibility and promoted enhanced cell adhesion and proliferation with respect to human preosteoblast and osteosarcoma cell lines when compared to pristine titanium.
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Affiliation(s)
- Valentina Grumezescu
- Lasers Department, National Institute for Lasers, Plasma and Radiation Physics, 077125 Magurele, Romania
| | - Oana Gherasim
- Lasers Department, National Institute for Lasers, Plasma and Radiation Physics, 077125 Magurele, Romania
| | - Bianca Gălățeanu
- Department of Biochemistry and Molecular Biology, University of Bucharest, 050095 Bucharest, Romania
| | - Ariana Hudiță
- Department of Biochemistry and Molecular Biology, University of Bucharest, 050095 Bucharest, Romania
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Karampikas V, Gavriil P, Goumenos S, Trikoupis IG, Roustemis AG, Altsitzioglou P, Kontogeorgakos V, Mavrogenis AF, Papagelopoulos PJ. Risk factors for peri-megaprosthetic joint infections in tumor surgery: A systematic review. SICOT J 2024; 10:19. [PMID: 38819289 PMCID: PMC11141517 DOI: 10.1051/sicotj/2024008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/05/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Peri-megaprosthetic joint infections (PJI) in tumor surgery are complex and challenging complications that significantly impact the outcomes of the patients. The occurrence of PJI poses a substantial threat to the success of these operations. This review aims to identify and summarize the risk factors associated with PJI in tumor surgery with megaprosthetic reconstruction as well as to determine the overall risk of PJI in limb salvage surgery. METHODS A thorough examination of published literature, scrutinizing the incidence of PJI in tumor prostheses after limb salvage surgery was done. Research studies that documented the incidence of PJI in tumor patients who underwent limb salvage surgery, and explored the risk factors associated with the occurrence of PJI were deemed eligible. RESULTS A total of 15 studies were included in the analysis and underwent comprehensive examination. After the exploration of key parameters, several significant risk factors for PJI concerning the type of implant coating, surgical site characteristics, patient demographics, and procedural factors were recorded. DISCUSSION The findings underscore the need for a nuanced approach in managing tumor patients undergoing limb salvage surgery and megaprosthetic reconstruction, with emphasis on individualized risk assessments and individualized preventive strategies.
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Affiliation(s)
- Vasileios Karampikas
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Street, 15562, Holargos, Athens, Greece
| | - Panayiotis Gavriil
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Street, 15562, Holargos, Athens, Greece
| | - Stavros Goumenos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Street, 15562, Holargos, Athens, Greece
| | - Ioannis G Trikoupis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Street, 15562, Holargos, Athens, Greece
| | - Anastasios G Roustemis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Street, 15562, Holargos, Athens, Greece
| | - Pavlos Altsitzioglou
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Street, 15562, Holargos, Athens, Greece
| | - Vasileios Kontogeorgakos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Street, 15562, Holargos, Athens, Greece
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Street, 15562, Holargos, Athens, Greece
| | - Panayiotis J Papagelopoulos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Street, 15562, Holargos, Athens, Greece
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Borghi A, Gronchi A. Extremity and Truncal Soft Tissue Sarcoma: Risk Assessment and Multidisciplinary Management. Semin Radiat Oncol 2024; 34:147-163. [PMID: 38508780 DOI: 10.1016/j.semradonc.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Extremity and truncal soft tissue sarcomas are a heterogeneous group of rare cancers that arise from mesenchymal tissues. Hence, the adoption of tailored risk assessment and prognostication tools plays a crucial role in optimizing the decision-making for which of the many possible treatment strategies to select. Management of these tumors requires a multidisciplinary strategy, which has seen significant development in recent decades. Surgery has emerged as the primary treatment approach, with the main goal of achieving microscopic negative tumor margins. To reduce the likelihood of local recurrence, loco-regional treatments such as radiation therapy and isolated limb perfusion are often added to the treatment regimen in combination with surgery. This approach also enables surgeons to perform limb-sparing surgery, particularly in cases where a positive tumor margin is expected. Chemotherapy may also provide a further benefit in decreasing the probability of local recurrence or reducing distant metastasis in selected patients. Selecting the optimal treatment strategy for these rare tumors is best accomplished by an experienced multi-disciplinary team.
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Affiliation(s)
- Alessandra Borghi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy..
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Eidmann A, Lüdemann M, Raab P, Rudert M. [Individualized surgical treatment of sarcomas of the extremities]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:288-293. [PMID: 38360873 DOI: 10.1007/s00104-024-02049-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 02/17/2024]
Abstract
Sarcomas of the extremities are rare entities, the treatment of which requires special expertise. Even if the treatment of patients is always interdisciplinary, the surgical R0 resection is the key point of each curatively intended treatment. In addition to resection in sano, the aim is to preserve the extremities and function, so that defect reconstruction after resection plays a decisive role. Due to the heterogeneity of tumors as well as their localization and extent, reconstruction is always an individually adapted treatment. Modular tumor endoprostheses are often used in this context, which can be constructed according to the size of the defect. The transplantation of autologous or allogeneic bone is also frequently used alone or as an additive procedure. Patient-specific (mega)prostheses are used particularly for pelvic tumors. Defect reconstruction using scaffold-based procedures from the field of tissue engineering is being tested as a promising procedure for the future. This article provides an overview of the treatment principles for sarcomas of the extremities and their individual reconstruction options.
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Affiliation(s)
- Annette Eidmann
- Lehrstuhl für Orthopädie, Orthopädische Klinik König-Ludwig-Haus Würzburg, Universität Würzburg, Brettreich-Str. 11, 97074, Würzburg, Deutschland.
| | - Martin Lüdemann
- Lehrstuhl für Orthopädie, Orthopädische Klinik König-Ludwig-Haus Würzburg, Universität Würzburg, Brettreich-Str. 11, 97074, Würzburg, Deutschland
| | - Peter Raab
- Lehrstuhl für Orthopädie, Orthopädische Klinik König-Ludwig-Haus Würzburg, Universität Würzburg, Brettreich-Str. 11, 97074, Würzburg, Deutschland
| | - Maximilian Rudert
- Lehrstuhl für Orthopädie, Orthopädische Klinik König-Ludwig-Haus Würzburg, Universität Würzburg, Brettreich-Str. 11, 97074, Würzburg, Deutschland
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Carlisle E, Steadman P, Lowe M, Rowell P, Sommerville S. What Factors Are Associated With Stem Breakage in Distal Femoral Endoprosthetic Replacements Undertaken for Primary Bone Tumors? Clin Orthop Relat Res 2023; 481:2214-2220. [PMID: 37368003 PMCID: PMC10566930 DOI: 10.1097/corr.0000000000002746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 04/08/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND The advantages of distal femoral replacement prostheses for reconstructions after tumors are well known; one such implant, the Global Modular Replacement System (GMRS), has been widely used since 2003. Although implant breakage has been reported, the frequency of this event has varied across different studies. QUESTIONS/PURPOSES (1) What percentage of patients who underwent distal femur resection and replacement using the GMRS for primary bone tumors at one center experienced stem breakage? (2) At what timepoints did these breakages occur, and what factors were common among the stems that broke? METHODS We performed a retrospective study of all patients who underwent distal femur resection and replacement using the GMRS for a diagnosis of primary bone sarcoma by the Queensland Bone and Soft-tissue Tumor service from 2003 to 2020 who had a minimum of 2 years of follow-up. Standard follow-up for primary bone sarcoma involves radiographic imaging of the femur at 6 weeks and 3 months postoperatively and yearly thereafter. From a chart review, we identified patients with femoral stem breakage. Patient and implant details were recorded and analyzed. A total of 116 patients had undergone a distal femoral replacement with the GMRS prosthesis for primary bone sarcoma; however, 6.9% (eight of 116 patients) died before completing the 2-year follow-up period and were excluded. Of the remaining 108 patients, 15% (16 patients) had died at the time of this review; however, given that they completed the 2-year follow-up period and did not experience stem breakage, they were included. Furthermore, 15% (16 patients) were considered lost to follow-up and excluded because they have not been seen in the past 5 years but were not known to have died or experienced stem breakage. This left 92 patients for analysis. RESULTS Stem breakages were identified in 5.4% (five of 92) of patients. All stem breakages occurred in stem diameters 11 mm or less with a porous body construct; the percentage of patients with breakage in this group was 16% (five of 31). All patients with stem fracture demonstrated minimal ongrowth to the porous coated body. The median time to stem fracture was 10 years (range 2 to 12 years); however, two of the five stems broke within 3 years. CONCLUSION We recommend the use of a larger-diameter GMRS cemented stem (> 11 mm), and either the line-to-line cementing method or an uncemented stem from an alternative company should be considered in order to achieve this larger stem in smaller canals. If a stem less than 12 mm in diameter must be used or there is evidence of minimal ongrowth, then close follow-up and prompt investigation of new symptoms should occur. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Emma Carlisle
- Queensland Bone and Soft-tissue Tumor Service, Department of Orthopaedics, Princess Alexandra Hospital, Brisbane, Australia
| | - Peter Steadman
- Queensland Bone and Soft-tissue Tumor Service, Department of Orthopaedics, Princess Alexandra Hospital, Brisbane, Australia
- The University of Queensland, Brisbane, Australia
| | - Martin Lowe
- Queensland Bone and Soft-tissue Tumor Service, Department of Orthopaedics, Princess Alexandra Hospital, Brisbane, Australia
| | - Philip Rowell
- Queensland Bone and Soft-tissue Tumor Service, Department of Orthopaedics, Princess Alexandra Hospital, Brisbane, Australia
| | - Scott Sommerville
- Queensland Bone and Soft-tissue Tumor Service, Department of Orthopaedics, Princess Alexandra Hospital, Brisbane, Australia
- The University of Queensland, Brisbane, Australia
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Schneider KN, Ellerbrock M, Gosheger G, Westphal LM, Deventer N, Klingebiel S, Rickert C, Theil C. Distal Humeral Replacement in Patients with Primary Bone Sarcoma: The Functional Outcome and Return to Sports. Cancers (Basel) 2023; 15:3534. [PMID: 37444644 DOI: 10.3390/cancers15133534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/28/2023] [Accepted: 07/06/2023] [Indexed: 07/15/2023] Open
Abstract
Distal humeral replacement (DHR) is a limb-salvage option for the endoprosthetic reconstruction of bone defects following the resection of a primary bone sarcoma. As primary bone sarcomas are only occasionally located around the distal humerus, there is a paucity of information regarding postoperative function, and patients' resumption of sporting activities. With advances in diagnostics and in surgical and oncological treatment leading to an increased patient life expectancy and higher quality of life, patients' functional outcome and return to sports activities are of increasing interest. Between 1997 and 2021, a total of 24 patients underwent DHR with a single-design modular implant at a tertiary sarcoma center. A total of 14 patients who died of their disease were excluded, leaving a study cohort of 10 patients, with a median age of 30 years on the day of surgery (IQR 20-37). At the last follow-up, after a median of 230 months (IQR 165-262), the median MSTS was 19 (IQR 13-24), the median TESS was 79 (IQR 66-87), the median SEV was 38% (IQR 24-53), the median TS was 6 (IQR 4-7), and the median WAS was 3 (IQR 1-8). Among the variables of gender, surgery on the dominant extremity, intraoperative nerve resection, extra-articular tumor resection, chemotherapy, radiotherapy, and revision surgeries, none were associated with a better/lower functional outcome score or return to sports activities. However, a higher level of sports performance prior to diagnosis (WAS > 10) was associated with a higher level of sports performance postoperatively (p = 0.044).
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Affiliation(s)
| | - Moritz Ellerbrock
- Department of Orthopaedics and Tumor Orthopaedics, Albert-Schweitzer Campus 1, 48149 Münster, Germany
| | - Georg Gosheger
- Department of Orthopaedics and Tumor Orthopaedics, Albert-Schweitzer Campus 1, 48149 Münster, Germany
| | - Lucia Maria Westphal
- Department of Orthopaedics and Tumor Orthopaedics, Albert-Schweitzer Campus 1, 48149 Münster, Germany
| | - Niklas Deventer
- Department of Orthopaedics and Tumor Orthopaedics, Albert-Schweitzer Campus 1, 48149 Münster, Germany
| | - Sebastian Klingebiel
- Department of Orthopaedics and Tumor Orthopaedics, Albert-Schweitzer Campus 1, 48149 Münster, Germany
| | - Carolin Rickert
- Department of Orthopaedics and Tumor Orthopaedics, Albert-Schweitzer Campus 1, 48149 Münster, Germany
| | - Christoph Theil
- Department of Orthopaedics and Tumor Orthopaedics, Albert-Schweitzer Campus 1, 48149 Münster, Germany
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Li Z, Lu M, Zhang Y, Gong T, Min L, Zhou Y, Luo Y, Tu C. 3D-printed custom-made short stem with porous structure for fixation of massive endoprosthesis in joint-preserving reconstruction after tumor resection. J Orthop Surg Res 2023; 18:468. [PMID: 37386639 DOI: 10.1186/s13018-023-03954-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/23/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Large malignant bone tumors and revision limb salvage procedures often result in massive bone loss, leaving a short residual bone segment that cannot accommodate a standard stem for endoprosthesis fixation. Three-dimensional-printed (3DP) short stem with porous structure seems to be an alternative for short-segment fixation. This retrospective study aims to evaluate surgical outcomes, radiographical results, limb functions, and complications of using 3DP porous short stems in massive endoprosthesis replacement. METHODS Between July 2018 to February 2021, 12 patients with massive bone loss undergoing reconstruction with custom-made, short-stemmed massive endoprostheses were identified. Endoprosthesis replacement involved the proximal femur (n = 4), distal femur (n = 1), proximal humerus (n = 4), distal humerus (n = 1), and proximal radius (n = 2). RESULTS The mean percentage of resected bone was 72.4% of the whole length of the bone, ranging from 58.4 to 88.5%. The mean length of 3DP porous short stems was 6.3 cm. The median follow-up was 38 months (range, 22-58 months). The mean MSTS score was 89%, ranging from 77% to 93%. Radiographical assessment results showed bone in-growth to the porous structure in 11 patients, and the implants were well osseointegrated. Breakage of the 3DP porous short stem occurred in one patient intraoperatively. The patient developed aseptic loosening (Type 2) four-month after surgery and underwent revision with a plate applied to assist fixation. The implant survivorship was 91.7% at 2 years. No other complications were detected, such as soft-tissue failures, structural failures, infection, or tumor progression. CONCLUSIONS 3DP custom-made short stem with porous structure is a viable method for fixation of the massive endoprosthesis in the short segment after tumor resection, with satisfactory limb function, great endoprosthetic stability, and low complication rates.
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Affiliation(s)
- Zhuangzhuang Li
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Minxun Lu
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yuqi Zhang
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Taojun Gong
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Li Min
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yong Zhou
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yi Luo
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China.
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
| | - Chongqi Tu
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China.
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
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Conti L, Buriro F, Baia M, Pasquali S, Miceli R, De Rosa L, Gronchi A, Fiore M. Contemporary role of amputation for patients with extremity soft tissue sarcoma. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 49:934-940. [PMID: 36517316 DOI: 10.1016/j.ejso.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/01/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION limb-sparing surgery is the mainstream treatment for primary extremity soft tissue sarcoma (ESTS) at referral centers, following advances in surgical reconstructions and multimodal management. However, amputation is still needed in selected patients and has not yet been described for a ESTS cohort in a contemporary scenario. MATERIAL AND METHODS consecutive patients who underwent surgery for primary ESTS from 2006 to 2018 were extracted from a prospectively collected database at our reference center. Patients receiving amputation for either primary tumor or local recurrence (LR) after limb-sparing surgery were selected for analysis. RESULTS Among 1628 primary ESTS, 29 patients underwent primary amputation (1.8%), 22/1159 (1.9%) for upper limb and 7/469 (1.5%) for lower limb ESTS. Patients were mainly affected by grade III FNCLCC (89.6%) of notable dimension (median size 16 cm, IQR 10-24). 65.5% of patients received preoperative treatments (systemic or regional chemotherapy, radiotherapy or chemo-radiation). Secondary amputation for LR was performed after a median of 23 months in 16/1599 patients (1%). Median survival time was 16.2 and 29.6 months after primary or secondary amputation respectively. Factors prompting the need for a primary amputation were most often a combination of multifocal disease, bone invasion and pain or neurovascular bundle involvement and relevant comorbidities, mainly for grade III tumors in elderly patients. CONCLUSION Contemporary rate of amputation for ESTS at a reference center is extremely low. Still, amputation is required in selected cases with advanced presentations, especially in elderly, frail patients.
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Ellerbrock M, Theil C, Gosheger G, Deventer N, Klingebiel S, Rickert C, Schneider KN. Function and return to sports after proximal humeral replacement in patients with primary bone sarcoma. J Orthop Traumatol 2022; 23:59. [PMID: 36571630 PMCID: PMC9792634 DOI: 10.1186/s10195-022-00678-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/04/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Improved patient and limb survival rates have led to an increased interest in the functional outcome and return to sports of patients undergoing megaprosthetic reconstruction in musculoskeletal oncology. This study evaluates the functional outcome and postoperatively performed level of sports in patients undergoing proximal humeral replacement (PHR) following resection of a primary bone sarcoma and identifies potential beneficial and limiting factors. PATIENTS AND METHODS Between 2007 and 2020, a total of 606 patients underwent resection of a primary bone sarcoma and reconstruction with a single-design modular implant. For 112 (18%) patients, the location of the tumour was the proximal humerus. Exclusion criteria were death (n = 65), patients living overseas (n = 8), and subsequent amputation (n = 1), leaving 38 patients for evaluation, of whom 32 were available for the study (13 women, median age 42 years). Clinical data regarding oncological and surgical treatment as well as subsequent complications were obtained from the patients' electronic medical records. Functional outcome was determined using the Musculoskeletal Tumor Society Score (MSTS) and Toronto Extremity Salvage Score (TESS) as well as the Subjective Shoulder Value (SSV). Return to sports was assessed using the Tegner Activity Score (TS) and the modified Weighted Activity Score (WAS). RESULTS At the last follow-up after a median of 30 months (IQR 22-58), median MSTS was 18 (IQR 12-24), median TESS was 80% (IQR 69-87), median SSV was 35% (IQR 10-58), median TS was 5 (IQR 4-6) and median WAS was 5 (IQR 0-10). Preservation of the axillary nerve, a reverse shoulder reconstruction and a WAS of > 10 prior to surgery were associated with better functional outcome and return to sports activity scores. CONCLUSION Following PHR, good to excellent functional outcomes are possible, and patients regularly return to participate in sports activities-most commonly in low-impact types of sports, but some individuals are even able to participate in high-impact sports activities. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Moritz Ellerbrock
- Department of Orthopaedics and Tumor Orthopaedics, Albert-Schweitzer Campus 1, 48149 Münster, Germany
| | - Christoph Theil
- Department of Orthopaedics and Tumor Orthopaedics, Albert-Schweitzer Campus 1, 48149 Münster, Germany
| | - Georg Gosheger
- Department of Orthopaedics and Tumor Orthopaedics, Albert-Schweitzer Campus 1, 48149 Münster, Germany
| | - Niklas Deventer
- Department of Orthopaedics and Tumor Orthopaedics, Albert-Schweitzer Campus 1, 48149 Münster, Germany
| | - Sebastian Klingebiel
- Department of Orthopaedics and Tumor Orthopaedics, Albert-Schweitzer Campus 1, 48149 Münster, Germany
| | - Carolin Rickert
- Department of Orthopaedics and Tumor Orthopaedics, Albert-Schweitzer Campus 1, 48149 Münster, Germany
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Koulaxouzidis G, Schlagnitweit P, Anderl C, Braig D, Märdian S. Microsurgical Reconstruction in Orthopedic Tumor Resections as Part of a Multidisciplinary Surgical Approach for Sarcomas of the Extremities. Life (Basel) 2022; 12:1801. [PMID: 36362956 PMCID: PMC9695779 DOI: 10.3390/life12111801] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/17/2022] [Accepted: 10/28/2022] [Indexed: 11/22/2023] Open
Abstract
A central element of modern sarcoma therapy is complete surgical tumor resection with an adequate safety margin, embedded in an interdisciplinary multimodal therapy concept. Along with ensuring patient survival, functional limb preservation is an important goal for sarcomas of the extremities. This review provides an overview of the relevant literature on indications and goals of reconstructive options, the scope and contribution of microsurgical reconstructive procedures, and the associated interdisciplinary decision making and workup. Furthermore, the impact of (neo)-adjuvant therapy on reconstructive decisions will be highlighted. These aspects will be illustrated by four comprehensive case studies that demonstrate both useful strategies and the need for individually tailored therapies. Nowadays, extremity-preserving therapy is possible in more than 90% of sarcomas. Technical and procedural innovations such as microsurgery and microsurgical reconstructive procedures have significantly contributed to this evolution of therapy.
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Affiliation(s)
- Georgios Koulaxouzidis
- Department of Plastic, Aesthetic and Reconstructive Surgery, Congregational Hospital Linz, Sisters of Mercy, 4010 Linz, Austria
| | - Paul Schlagnitweit
- Department of Plastic, Aesthetic and Reconstructive Surgery, Congregational Hospital Linz, Sisters of Mercy, 4010 Linz, Austria
| | - Conrad Anderl
- Department of Orthopaedic Surgery, Congregational Hospital Linz, Sisters of Mercy, 4010 Linz, Austria
| | - David Braig
- Department of Plastic and Hand Surgery, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- Division of Hand, Plastic and Aesthetic Surgery, Ludwig Maximilian University of Munich, 80336 Munich, Germany
| | - Sven Märdian
- Centre for Musculoskeletal Surgery, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin Insitute of Health, 13353 Berlin, Germany
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12
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Holm CE, Soerensen MS, Yilmaz M, Petersen MM. Evaluation of tumor-prostheses over time: Complications, functional outcome, and comparative statistical analysis after resection and reconstruction in orthopedic oncologic conditions in the lower extremities. SAGE Open Med 2022; 10:20503121221094190. [PMID: 35492888 PMCID: PMC9047786 DOI: 10.1177/20503121221094190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 03/22/2022] [Indexed: 11/26/2022] Open
Abstract
Objectives: Previous multicenter studies report variable outcomes and failure rates after
tumor-prosthetic reconstructions. The purpose of this study was (1) to
evaluate implant survival, limb survival, and functional outcome in a cohort
of patients who underwent resection of primary malignancies or aggressive
benign bone tumors and reconstruction with modern tumor-prostheses in the
lower extremities and (2) to provide comparison to a historical cohort on
previous generations of tumor-prostheses from the same center. Methods: A longitudinal retrospective single-center study of 72 consecutive patients
(F/M = 30/42), mean age = 44 (range = 7–84) years with bone, soft tissue
sarcoma adjacent to bone (n = 69), and aggressive benign bone tumors (n = 3)
having surgery between 2006 and 2016 with bone resection and reconstruction
with tumor-prostheses were compared to a historical cohort from1985 to 2005.
Revisions were classified as major and minor revisions. Causes of failure
were classified according to the Henderson classification. Fine and Gray
competing risk analysis was used for assessing cumulative incidence for
implant revision and limb amputation. Functional outcome was evaluated with
Musculoskeletal Tumor Society Score system. Results: Forty-seven patients were alive at the end of the study. Mean follow-up was
6 years (range = 2–13 years). Ten-year cumulative risk of major revision was
18% (95% confidence interval = 9%–28%). Deep infection and recurrence of
tumor caused most revisions in modern tumor-prostheses. Ten-year cumulative
incidence of limb amputation was 11% (95% confidence interval = 3%–18%).
According to the Henderson classification, the overall predominant failure
mode was non-mechanical (n = 20, 51%). Mean Musculoskeletal Tumor Society
Score was 20 (67%) (range = 0–30). Conclusion: A minimum of 2 years follow-up with modern modular tumor-prostheses
demonstrated a relatively low risk of implant failure and amputation and
also an acceptable functional outcome. No statistical difference of, implant
survival, limb survival and functional outcome between tumor-prostheses over
two time periods was observed, possibly explained by Type 2 error.
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Affiliation(s)
- Christina Enciso Holm
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen Ø, Denmark
| | - Michala Skovlund Soerensen
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen Ø, Denmark
| | - Müjgan Yilmaz
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen Ø, Denmark
| | - Michael Mørk Petersen
- Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen Ø, Denmark
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