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Sullivan MH, Mills GL, Saifuddin H, Brinkman EJ, Carlsen BT, Moran SL, Houdek MT. Targeted Muscle Reinnervation to Reduce Postoperative Pain in Patients Undergoing Hindquarter Resections. Anticancer Res 2023; 43:3513-3516. [PMID: 37500121 DOI: 10.21873/anticanres.16528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND/AIM Pre-emptive targeted muscle reinnervation (TMR) at the time of amputation results in less phantom limb pain (PLP) compared with untreated amputee controls. There is limited literature describing the technique in patients undergoing hindquarter amputation despite up to 90% of these patients reporting PLP and 50% presenting with painful neuroma. The purpose of the current study was to describe the motor nerves accessible through a primary hind-quarter amputation to be used for TMR and review pain outcomes in clinical case correlates of patients with TMR. PATIENTS AND METHODS Six limbs were obtained from three fresh adult cadavers and proximal sensory and motor nerves were dissected. A review of patients undergoing hindquarter amputation with TMR was conducted. RESULTS Transfers for the sciatic, femoral, and obturator nerves were identified in cadavers. In reviews of patients, they were taking narcotic and neuro-leptic pain medication for a mean of 23 days and 168 days. At most recent follow-up, no patient reported debilitating phantom pain nor pain associated with neuromas. CONCLUSION Given the positive preliminary results in our study group as well as the accessible neuroanatomy, pre-emptive TMR should be considered at the time of surgery to limit PLP and dependence on pain medications.
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Affiliation(s)
| | - Gavin L Mills
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, U.S.A
| | - Hiba Saifuddin
- Division of Plastic and Reconstructive Surgery, Louisiana State University, New Orleans, LA, U.S.A
| | - Elyse J Brinkman
- Department of Orthopedic Surgery, University of Washington, Seattle, WA, U.S.A
| | - Brian T Carlsen
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, U.S.A
| | - Steven L Moran
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, U.S.A
| | - Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, U.S.A.;
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González AK, Rodríguez-Reséndiz J, Gonzalez-Durán JEE, Olivares Ramírez JM, Estévez-Bén AA. Development of a Hip Joint Socket by Finite-Element-Based Analysis for Mechanical Assessment. Bioengineering (Basel) 2023; 10:bioengineering10020268. [PMID: 36829762 PMCID: PMC9952638 DOI: 10.3390/bioengineering10020268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/04/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
This article evaluates a hip joint socket design by finite element method (FEM). The study was based on the needs and characteristics of a patient with an oncological amputation; however, the solution and the presented method may be generalized for patients with similar conditions. The research aimed to solve a generalized problem, taking a typical case from the study area as a reference. Data were collected on the use of the current improving prosthesis-specifically in interaction with its socket-to obtain information on the new approach design: this step constituted the work's starting point, where the problems to be solved in conventional designs were revealed. Currently, the development of this type of support does not consider the functionality and comfort of the patient. Research has reported that 58% of patients with sockets have rejected their use, because they do not fit comfortably and functionally; therefore, patients' low acceptance or rejection of the use of the prosthesis socket has been documented. In this study, different designs were evaluated, based on the FEM as scientific support for the results obtained, for the development of a new ergonomic fit with a 60% increase in patient compliance, that had correct gait performance when correcting postures, improved fit-user interaction, and that presented an esthetic fit that met the usability factor. The validation of the results was carried out through the physical construction of the prototype. The research showed how the finite element method improved the design, analyzing the structural behavioral, and that it could reduce cost and time instead of generating several prototypes.
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Affiliation(s)
- Ana Karen González
- Engineering Faculty, Universidad Autónoma de Querétaro, Querétaro 76010, Mexico
| | - Juvenal Rodríguez-Reséndiz
- Engineering Faculty, Universidad Autónoma de Querétaro, Querétaro 76010, Mexico
- Correspondence: (J.R.-R.); (J.M.O.R.)
| | | | - Juan Manuel Olivares Ramírez
- Department of Renewable Energy, Universidad Tecnológica de San Juan del Río, Querétaro 76800, Mexico
- Correspondence: (J.R.-R.); (J.M.O.R.)
| | - Adyr A. Estévez-Bén
- Engineering Faculty, Universidad Autónoma de Querétaro, Querétaro 76010, Mexico
- Chemistry Faculty, Universidad Autónoma de Querétaro, Querétaro 76010, Mexico
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Yu H, Wang S, Song Q, You Y, Bao J, Yao M. Delayed femoral vein ligation reduces operative time and blood loss during hip disarticulation in patients with extremity tumors. Open Med (Wars) 2022; 17:1705-1711. [PMID: 36382056 PMCID: PMC9616051 DOI: 10.1515/med-2021-0372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/22/2021] [Accepted: 09/15/2021] [Indexed: 12/12/2022] Open
Abstract
This study aimed to evaluate the effects of delayed femoral vein ligation on the clinical outcomes of hip disarticulation. We retrospectively reviewed 20 patients with extremity tumors (10 bone tumors and 10 soft tissue sarcomas [STS]) who underwent hip disarticulation. Patients treated for hip disarticulation with synchronous femoral vein ligation (n = 10, regular surgery group) and hip disarticulation with delayed femoral vein ligation (n = 10, delayed ligation group), respectively, were enrolled in this study. The operative time and blood loss were used to evaluate the clinical outcomes. The delayed ligation group had significantly lower operative times than the regular surgery group (P < 0.05). Total, hidden, and intraoperative blood loss were all significantly lower in the delayed ligation group than in the regular surgery group (P < 0.05). However, there were no significant differences in postoperative blood loss. In conclusion, delayed femoral vein ligation could significantly reduce the operative time, hidden blood loss, and intraoperative blood loss in patients undergoing hip disarticulation.
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Affiliation(s)
- Hongwei Yu
- Department of Orthopaedics, The Tumor Hospital Affiliated to Harbin Medical University, Harbin, Heilongjiang, China
| | - ShuHuai Wang
- Department of Pathology, The Tumor Hospital Affiliated to Harbin Medical University,
Harbin, Heilongjiang, China
| | - Qi Song
- Department of Orthopaedics, The Hospital of Orthopaedics and Traumatology in Harbin,
Harbin, Heilongjiang, China
| | - Yan You
- Dermatology Department, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Junjie Bao
- Department of Orthopaedics, The Tumor Hospital Affiliated to Harbin Medical University, Harbin, Heilongjiang, China
| | - Meng Yao
- Department of Orthopaedics, The Second Affiliated Hospital of Harbin Medical University, No. 246, Xuefu Road, Nangang District, Harbin 150001, Heilongjiang, China
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Simman R, Klomparens K, Abbas FT, Lamaj S, Rehman N. Hip Disarticulation in Wound Care: A Case Series. Eplasty 2022; 22:e28. [PMID: 36000009 PMCID: PMC9361390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Hip disarticulation (HD) is a radical lower extremity amputation performed by carefully transecting all muscles and nerves surrounding the hip joint and separating the leg at the joint capsule. It is considered a last resort to be used as a life-preserving measure under emergent circumstances due to high rates of morbidity and mortality. METHODS This case series presents 4 patients who underwent HD. The procedure was performed due to various indications including necrotizing fasciitis, gangrene, stump necrosis from previous above-the-knee amputation, and septic joint secondary to chronic osteomyelitis, 3 of which were planned and 1 was emergent. RESULTS The procedure was performed successfully in all 4 patients. Furthermore, all patients were eventually discharged to home or to a long-term care facility for wound care or rehabilitation. CONCLUSIONS Overall, HD should be reserved as a life-saving treatment for various indications including infections that fail other modalities, limb ischemia, trauma, and malignancy. Ideally, this procedure would be planned and performed on proper candidates; however, HD should still be a consideration in the emergent setting regardless of most optimal patients due to its life-saving potential.
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Affiliation(s)
- Richard Simman
- Jobst Vascular Institute, ProMedica Health Network, Toledo, OH
- University of Toledo, College of Medicine and Life Science, Toledo, OH
- University of Toledo, Department of Surgery, Toledo, Ohio
| | | | | | - Suela Lamaj
- University of Toledo, College of Medicine and Life Science, Toledo, OH
| | - Naveen Rehman
- University of Toledo, College of Medicine and Life Science, Toledo, OH
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Tsai S, Lanier HD, Tran N, Pham T, Huerta S. Current Predictors of Mortality in Veteran Patients Undergoing Major Lower Extremity Amputations: Risk Factors Have Not Changed and Mortality Remains High. Am Surg 2022:31348221074235. [PMID: 35124982 DOI: 10.1177/00031348221074235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Major lower extremity amputation (LEA-above the ankle) carries a high rate of mortality. In the present study, we performed an institutional review of all patients submitting to LEAs at a Veteran Administration Hospital (between 2009 and 2021) accompanied with a review of the literature.For the past 12 years, 1042 LEAs were performed in 603 patients at our hospital. The 30-day, 1-year, and 5-year mortalities were 8.5%, 28.9%, and 53.0%, respectively. Age, hypoalbuminemia, and Clavien-Dindo Class were independent predictors of mortality in all the time intervals in the analysis. Cardiac disease was not an independent predictor of mortality. In 39 studies reviewed, the average 30-day, 1-year, and 5-year mortality was 14%, 36%, and 56%, respectively. There was no difference in mortality in multiple studies analyzed. No significant temporal variation was identified between 1950 and 2000 vs. 2001 and 2021. Predictors of mortality were not substantially different from our institutional experience.The mortality rate for LEAs remains constant over time. Increasing age and hypoalbuminemia are strong predictors of short- and long-term mortality.
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Affiliation(s)
- Shirling Tsai
- Department of Vascular, 20115VA North Texas Health Care System, Dallas, TX, USA
| | - Heather D Lanier
- General Surgery, 12334University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Nguyen Tran
- General Surgery, 12334University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Thai Pham
- General Surgery, 12334University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Sergio Huerta
- General Surgery, 12334University of Texas Southwestern Medical School, Dallas, TX, USA
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Iwasa S, Uchiyama Y, Kodama N, Koyama T, Domen K. Regaining Gait Using an Early Postoperative Hip Prosthesis: A Case Report of an Elderly Woman. Prog Rehabil Med 2021; 6:20210011. [PMID: 33598585 PMCID: PMC7882425 DOI: 10.2490/prm.20210011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 01/27/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Hip prostheses are generally avoided in elderly patients because of cognitive decline and/or reduced muscle strength. The present report describes the case of an elderly woman who regained gait using a prosthesis prescribed during the early postoperative phase following hip disarticulation. Case: A 78-year-old woman suffered from a pathological fracture caused by liposarcoma of the left thigh. Before hospitalization, the patient was fully independent in her activities of daily living, including gait. The right and left handgrip strengths were 12.9 and 14.2 kg, respectively, and the patient had no signs of cognitive decline. Radical treatment involving hip disarticulation was scheduled. Before surgery, the possibility of fitting a hip prothesis that would allow the patient to walk was discussed, to which she consented. On postoperative day 23, the patient was fitted with a hip prosthesis and began gait training. On day 31, she was able to walk using a fixed walker and, eventually, using a crutch. Discussion: The present case demonstrated the successful reacquisition of gait using a hip prothesis prescribed during the early postoperative phase after amputation, suggesting that the applicability of hip prostheses may be widely considered even for elderly patients.
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Affiliation(s)
- Saya Iwasa
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yuki Uchiyama
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Norihiko Kodama
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Tetsuo Koyama
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan.,Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan
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Nazemi AK, Bui DT, Oberly S, Khan FA. Hip disarticulation with pedicled total leg fillet flap for recurrent fungating sarcoma. J Orthop Surg (Hong Kong) 2020; 28:2309499020902539. [PMID: 32124672 DOI: 10.1177/2309499020902539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Soft tissue sarcomas may be treated with limb-sparing procedures in the majority of cases; however, certain cases involving significant tumor spread and fungation may call for amputation. In the thigh, hip disarticulation typically involves a pedicled gluteus maximus flap or a pedicled anterior quadriceps flap. In this case report, we describe a rare situation in which the anterior flap, posterior flap, and adductor flap musculature were contaminated with tumor; therefore, a hip disarticulation was performed applying a pedicled total leg fillet flap for closure. Eighteen months after treatment, the patient continues to have no local recurrence of disease, a stable flap site, and ambulates with a walker. We present this amputation and closure method as a potentially effective modality in treating extensive oncologic disease of the proximal lower extremity.
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Affiliation(s)
- Alireza K Nazemi
- Department of Orthopaedic Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Duc T Bui
- Department of Plastic and Reconstructive Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Susannah Oberly
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Fazel A Khan
- Department of Orthopaedic Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
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Schwartz AJ, Trask DJ, Bews KA, Hanson KT, Etzioni DA, Habermann EB. Hip Disarticulation for Periprosthetic Joint Infection: Frequency, Outcome, and Risk Factors. J Arthroplasty 2020; 35:3269-3273.e3. [PMID: 32653351 DOI: 10.1016/j.arth.2020.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/28/2020] [Accepted: 06/11/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Currently, the largest available series of hip disarticulation (HD) procedures performed for periprosthetic joint infection (PJI) includes only 6 patients. Given the lack of data on this dreadful outcome, we sought to determine the frequency of and risk factors for HD performed for a primary diagnosis of PJI. METHODS The National Inpatient Sample from 1998 to 2016 was used to estimate the annual incidences of HD associated with PJI, elective primary total joint arthroplasty (control group 1), and other surgical procedures associated with PJI (control group 2) using National Inpatient Sample trend weights. RESULTS One-hundred forty-eight HDs for PJI, 2,378,313 primary total joint arthroplasty controls, and 51,580 PJI controls were identified. Median length-of-stay (11 days), proportion of patients with ≥5 comorbidities (22.8%), and median hospital costs ($25,895.60) were all greater for patients with HD compared with both control groups. The weighted frequency of HD hospitalizations increased by 366%, whereas the frequency of cases in control groups 1 and 2 increased by 93% and 310%, respectively, during the same timeframe. Upon multivariable logistic regression, age <65 years without private insurance (reference group: age ≥65 years without private insurance, odds ratio [OR]: 1.55; 95% confidence interval [CI]: 1.08-2.24), diabetes with chronic complications (OR: 1.91; 95% CI: 1.12-3.26), and peripheral vascular disease (OR: 2.59; 95% CI: 1.49-4.48) were significantly associated with increased risk of HD among all patients with PJI. CONCLUSION While the overall frequency of lower extremity amputations may be decreasing, our study documents an alarming increase in the frequency of HD for PJI during the study period. Patients under age 65 years without private insurance were at significantly higher risk of HD among patients with PJI.
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Anderson SR, Wimalawansa SM, Roubaud MS, Mericli AF, Horne BR, Valerio IL. Targeted muscle reinnervation following external hemipelvectomy or hip disarticulation: An anatomic description of technique and clinical case correlates. J Surg Oncol 2020; 122:1693-1710. [PMID: 32885434 DOI: 10.1002/jso.26189] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 08/14/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Targeted muscle reinnervation (TMR) has been shown to decrease or prevent neuropathic pain, including phantom and residual limb pain, after extremity amputation. Currently, a paucity of data and lack of anatomical description exists regarding TMR in the setting of hemipelvectomy and/or hip disarticulations. We elaborate on the technique of TMR, illustrated through cadaveric and clinical correlates. METHODS Cadaveric dissections of multiple transpelvic exposures were performed. The major mixed motor and sensory nerve branches were identified, dissected, and tagged. Amputated peripheral nerves were transferred to identified, labeled target motor nerves via direct end-to-end nerve coaptations per traditional TMR technique. A retrospective review was completed by our multi-institutional teams to include examples of clinical correlates for TMR performed in the setting of hemipelvectomies and hip disarticulations. RESULTS A total of 12 TMR hemipelvectomy/hip disarticulation cases were performed over a 2 to 3-year period (2018-2020). Of these 12 cases, 9 were oncologic in nature, 2 were secondary to traumatic injury, and 1 was a failed limb salvage in the setting of chronic refractory osteomyelitis of the femoral shaft. CONCLUSIONS This manuscript outlines the technical considerations for TMR in the setting of hemipelvectomy and hip disarticulation with supporting clinical case correlates.
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Affiliation(s)
- Spencer R Anderson
- Department of Orthopedic and Plastic Surgery, Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Sunishka M Wimalawansa
- Department of Orthopedic and Plastic Surgery, Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Margaret S Roubaud
- Division of Plastic and Reconstructive Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alexander F Mericli
- Division of Plastic and Reconstructive Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Brandon R Horne
- Department of Orthopedic and Plastic Surgery, Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Ian L Valerio
- Division of Plastic and Reconstructive Surgery, Department of General Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Ghazavi M, Mortazavi J, Patzakis M, Sheehan E, Tan TL, Yazdi H. Hip and Knee Section, Treatment, Salvage: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S459-S462. [PMID: 30348553 DOI: 10.1016/j.arth.2018.09.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Henrichs MP, Singh G, Gosheger G, Nottrott M, Streitbuerger A, Hardes J. Stump lengthening procedure with modular endoprostheses - the better alternative to disarticulations of the hip joint? J Arthroplasty 2015; 30:681-6. [PMID: 25498955 DOI: 10.1016/j.arth.2014.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 10/23/2014] [Accepted: 11/06/2014] [Indexed: 02/01/2023] Open
Abstract
We report outcomes of 28 patients after stump-lengthening procedures (SLPs) with modular tumor endoprostheses following high-thigh amputation and hip disarticulation over 11years. Mean follow up was 41.3months (range 7.4 to 133.6months). Mean Musculoskeletal Tumour Society Score was 56% (n=11); ten out of eleven patients alive used an exoprosthesis regularly. Complications occurred in 15 patients with infection being most common. In 2 cases, the prostheses had to be explanted. Our data suggest that SLP facilitates post-operative rehabilitation and prosthesis usage. Modular endoprostheses for stump-lengthening allow optimization of remnant soft-tissue envelope, reducing the risk of stump perforation.
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Affiliation(s)
| | - Gurpal Singh
- Division of Musculoskeletal Oncology, University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Health System, Singapore
| | - Georg Gosheger
- Department of Orthopaedic Surgery and Tumour Surgery, University Hospital Muenster, Germany
| | - Markus Nottrott
- Department of Orthopaedic Surgery and Tumour Surgery, University Hospital Muenster, Germany
| | - Arne Streitbuerger
- Department of Orthopaedic Surgery and Tumour Surgery, University Hospital Muenster, Germany
| | - Jendrik Hardes
- Department of Orthopaedic Surgery and Tumour Surgery, University Hospital Muenster, Germany
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Amanatullah DF, Trousdale RT, Hanssen AD, Lewallen DG, Taunton MJ. Non-oncologic total femoral arthroplasty: retrospective review. J Arthroplasty 2014; 29:2013-5. [PMID: 25041874 DOI: 10.1016/j.arth.2014.05.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 05/12/2014] [Accepted: 05/20/2014] [Indexed: 02/08/2023] Open
Abstract
Total femoral arthroplasty (TFA) is an option to amputation in the setting of excessive bones loss during revision total hip and knee arthroplasty. Twenty non-oncologic TFAs with a minimum of 2years follow-up were retrospectively reviewed. The average clinical follow-up was 73±49months. The incidence of new infection was 25% (5/20), while the overall infection rate was 35% (7/20). The incidence of primary hip instability was 10% (2/20), while the overall instability rate was 25% (5/20). Six patients (30%) required revision. The average pre-operative HHS was 30.2±13.1. The average post-operative HHS was 65.3±16.9. TFA is a viable alternative to amputation in non-oncologic patients with massive femoral bone deficiency. However, TFA performed poorly in the setting of infection and instability.
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Affiliation(s)
| | | | - Arlen D Hanssen
- Dept of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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