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Eggermont F, van der Linden Y, Verdonschot N, Dierselhuis E, Ligthert S, Bitter T, Westhoff P, Tanck E. A Patient-Specific Fracture Risk Assessment Tool for Femoral Bone Metastases: Using the Bone Strength (BOS) Score in Clinical Practice. Cancers (Basel) 2022; 14:cancers14235904. [PMID: 36497388 PMCID: PMC9740241 DOI: 10.3390/cancers14235904] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/18/2022] [Accepted: 11/24/2022] [Indexed: 12/04/2022] Open
Abstract
Patients with femoral metastases are at risk of fracturing bones. It is important to prevent fractures in order to maintain mobility and quality of life. The BOne Strength (BOS) score is based on a computed tomography (CT)-based patient-specific finite element (FE) computer model that objectively calculates bone strength. In this pilot study, the added clinical value of the BOS score towards treatment-related decision making was assessed. In December 2019, the BOS score was implemented in four radiotherapy centers. The BOS scores and fracture risks of individual patients were calculated and returned to the physician to assist in treatment decisions. The physicians filled out a questionnaire, which was qualitatively analyzed. A follow-up to identify fractures and/or death was performed after six months. Until June 2021, 42 BOS scores were delivered (20 high, 9 moderate, and 13 low fracture risk). In 48%, the BOS score led to an adaptation of treatment plans. Physicians indicated that the BOS score provided objective insight into fracture risk, was reassuring for physicians and patients, and improved multidisciplinary discussions and shared decision making. In conclusion, the BOS score is an objective tool to assess fracture risk in femoral bone metastases and aids physicians and patients in making a more informed decision regarding the most appropriate treatment.
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Affiliation(s)
- Florieke Eggermont
- Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Correspondence:
| | - Yvette van der Linden
- Department of Radiotherapy, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Netherlands Comprehensive Cancer Organisation (IKNL), 3511 DT Utrecht, The Netherlands
| | - Nico Verdonschot
- Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Laboratory of Biomechanical Engineering, University of Twente, 7522 NB Enschede, The Netherlands
| | - Edwin Dierselhuis
- Department of Orthopedics, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Steven Ligthert
- Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Thom Bitter
- Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Paulien Westhoff
- Department of Radiation Oncology, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Esther Tanck
- Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
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Staals EL, Sambri A, Campanacci DA, Muratori F, Leithner A, Gilg MM, Gortzak Y, Van De Sande M, Dierselhuis E, Mascard E, Windhager R, Funovics P, Schinhan M, Vyrva O, Sys G, Bolshakov N, Aston W, Gikas P, Schubert T, Jeys L, Abudu A, Manfrini M, Donati DM. Expandable distal femur megaprosthesis: A European Musculoskeletal Oncology Society study on 299 cases. J Surg Oncol 2020; 122:760-765. [PMID: 32506533 DOI: 10.1002/jso.26060] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 04/25/2020] [Revised: 04/25/2020] [Accepted: 05/19/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES Expandable distal femur prostheses have become more popular over the last decades, but scientific data is limited. METHODS A retrospective study was performed, including cases treated between 1986 and 2019 in 15 European referral centers for bone sarcomas. RESULTS A total of 299 cases were included. Average follow-up was 80 months (range, 8-287 months). Mean patient age was 10 years. Most (80%) of the implants were noninvasive growers and a fixed hinge knee was used more often (64%) than a rotating hinge. Most prosthetic designs showed good (>80%) implant survival at 10 years, but repeat surgery was required for 63% of the patients. The most frequent reason for revision procedure was the completion of lengthening potential. Noninvasive expandable implants showed less risk of infection compared to invasive growers (11.8% vs 22.9% at 10 years). No difference in aseptic loosening was found between cemented and uncemented stems. CONCLUSIONS This study shows the increasing popularity of expandable distal femur prostheses, with overall good results for function and implant survival. However, repeat surgery is frequently required, especially in patients under the age of 10 years old. Infection is less frequent in noninvasive growers compared to implants that require invasive lengthening procedures.
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Affiliation(s)
| | - Andrea Sambri
- Orthopedic Surgery, AOSP Sant'Orsola-Malpighi, Bologna, Italy
| | | | - Francesco Muratori
- Orthopedic Surgery, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | | | | | - Yair Gortzak
- Orthopedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | | | | | - Eric Mascard
- Orthopedic Surgery, hôpital-Necker, Paris, France
| | | | | | | | - Oleg Vyrva
- Orthopedic Surgery, Sytenko Institute of Spine and Joint Pathology, Kharkiv, Ukraine
| | - Gwen Sys
- Orthopedic Surgery, Universitai Ziekenhuis Gent, Gent, Belgium
| | - Nikolay Bolshakov
- Orthopedic Surgery, National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Will Aston
- Orthopedic Surgery, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Panagiotas Gikas
- Orthopedic Surgery, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Thomas Schubert
- Orthopedic Surgery, Clinic Universitaires Saint-Luc, Brussels, Belgium
| | - Lee Jeys
- Orthopedic Surgery, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - Adesegun Abudu
- Orthopedic Surgery, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - Marco Manfrini
- Orthopedic Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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de Lange B, van der Weij AM, Dierselhuis E. [A boy with pain in the popliteal fossa]. Ned Tijdschr Geneeskd 2020; 164:D4158. [PMID: 32608925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A 12-year-old boy was referred by the general practitioner with a 3-week history of pain in the popliteal fossa. There was no sign of trauma or infection, physical examination was normal, and his CRP level was mildly elevated. X-ray and MRI revealed a Brodie's abscess, which was treated surgically and with antibiotics and he made a good recovery.
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Affiliation(s)
- B de Lange
- Jeroen Bosch Ziekenhuis, afd. SEH, Den Bosch
- Contact: B. de Lange
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