Beckenteilresektion (innere Hemipelvektomie) und endoprothetischer Ersatz bei hüftgelenksnahen Tumoren

Rudert, Maximilian; Holzapfel, Boris Michael; Pilge, Hakan; Rechl, H.; Gradinger, R.

doi:10.1007/s00064-012-0161-z

Cited by 35 publications

(6 citation statements)

References 48 publications

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“…Due to the vertical resection plane, no satisfactory prosthetic anchorage was possible. A hemipelvectomy including the femoral head (Enneking type I/II) and reconstruction with a modified Friedman Eilber procedure (Trevira tube, Implantcast GmbH, Buxtehude, Germany) were planned and performed [ 17 , 18 ] (Figs. 7 , 8 , and 9 ).…”

Section: Methodsmentioning

confidence: 99%

Tumor resection at the pelvis using three-dimensional planning and patient-specific instruments: a case series

et al. 2016

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BackgroundSarcomas are associated with a relatively high local recurrence rate of around 30 % in the pelvis. Inadequate surgical margins are the most important reason. However, obtaining adequate margins is particularly difficult in this anatomically demanding region. Recently, three-dimensional (3-D) planning, printed models, and patient-specific instruments (PSI) with cutting blocks have been introduced to improve the precision during surgical tumor resection. This case series illustrates these modern 3-D tools in pelvic tumor surgery.MethodsThe first consecutive patients with 3-D-planned tumor resection around the pelvis were included in this retrospective study at a University Hospital in 2015. Detailed information about the clinical presentation, imaging techniques, preoperative planning, intraoperative surgical procedures, and postoperative evaluation is provided for each case. The primary outcome was tumor-free resection margins as assessed by a postoperative computed tomography (CT) scan of the specimen. The secondary outcomes were precision of preoperative planning and complications.ResultsFour patients with pelvic sarcomas were included in this study. The mean follow-up was 7.8 (range, 6.0–9.0) months. The combined use of preoperative planning with 3-D techniques, 3-D-printed models, and PSI for osteotomies led to higher precision (maximal (max) error of 0.4 centimeters (cm)) than conventional 3-D planning and freehand osteotomies (max error of 2.8 cm). Tumor-free margins were obtained where measurable (n = 3; margins were not assessable in a patient with curettage). Two insufficiency fractures were noted postoperatively.ConclusionsThree-dimensional planning as well as the intraoperative use of 3-D-printed models and PSI are valuable for complex sarcoma resection at the pelvis. Three-dimensionally printed models of the patient anatomy may help visualization and precision. PSI with cutting blocks help perform very precise osteotomies for adequate resection margins.

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Section: Methodsmentioning

confidence: 99%

Tumor resection at the pelvis using three-dimensional planning and patient-specific instruments: a case series

et al. 2016

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“…In cases of acetabular reconstructions, dislocation rates are reported to be as high as 11-16 % for pelvic prostheses [14,15] or 15 % for pedestal cups [16]. Few data are available for dislocation rates of combined proximal femoral and periacetabular resections (e. g. extra-articular resections of the hip).…”

Section: Introductionmentioning

confidence: 99%

Incidence and management of hip dislocation in tumour patients with a modular prosthesis of the proximal femur

Puchner

Funovics

Hipfl

et al. 2014

International Orthopaedics (SICOT)

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Purpose Little data is available about the incidence and especially the management of hip dislocation following the implantation of modular tumor prostheses of the proximal femur. In this retrospective single-centre study we assessed the incidence of hip dislocation following implantation of a proximal femoral modular prosthesis as well as the success of the subsequent surgical or non-surgical treatment in tumor patients. Methods Between 1982 and 2008, 166 tumor patients received a modular prosthesis of the proximal femur at our institution. The average age at the time of surgery was 50± 20 years (range, six to 84 years). An additional pelvic reconstruction was done in 14 patients. An artificial band for soft tissue reconstruction of the hip was used in 19 patients. The average time of follow-up was 46±64 months (range, one to 277 months). Results The overall dislocation rate after proximal femoral replacement was 13 % after a mean time of seven ± eight months (range, 0.3-33 months) after surgery. Between 1982 and 1986 the dislocation rate was 33 % and declined to 9 % in subsequent years . Patients who had received an additional pelvic reconstruction had a three fold higher dislocation rate (p <0.05). Patients with closed reduction had a 58 % (eight of 12) re-dislocation rate compared to 11 % (one of nine) for open reduction (p=0.0357). Conclusions Dislocation of a modular prosthesis of the proximal femur is a common complication, especially in cases with additional pelvic resection with extensive bone and soft-tissue defects. Open surgical management may be more effective in preventing re-dislocation than closed reduction and bracing alone.

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“…According to the planned osteotomy planes and the acquired CT-data not only the custom-made prosthesis but also special osteotomy guides are constructed by the manufacturer to ensure accurate fitting of the prosthesis. The series reported from our institution showed encouraging results (Figure 2) [50]. …”

Section: Translating Bone Tissue Engineering Concepts Into the CLImentioning

confidence: 99%

“…Considering the dimensions of the tumor it should be possible to achieve tumor-free resection margins. As it has been previously described for the customised metal implants [50], based on the virtual model, special osteotomy guides can be manufactured to facilitate the later resection and implantation process of the scaffold. As the dimensions of the prospective bony defect are exactly known, the dimensions of the scaffold can be virtually adjusted.…”

Section: Translating Bone Tissue Engineering Concepts Into the CLImentioning

confidence: 99%

Can Bone Tissue Engineering Contribute to Therapy Concepts after Resection of Musculoskeletal Sarcoma?

Holzapfel

Chhaya

Melchels

et al. 2013

Sarcoma

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Resection of musculoskeletal sarcoma can result in large bone defects where regeneration is needed in a quantity far beyond the normal potential of self-healing. In many cases, these defects exhibit a limited intrinsic regenerative potential due to an adjuvant therapeutic regimen, seroma, or infection. Therefore, reconstruction of these defects is still one of the most demanding procedures in orthopaedic surgery. The constraints of common treatment strategies have triggered a need for new therapeutic concepts to design and engineer unparalleled structural and functioning bone grafts. To satisfy the need for long-term repair and good clinical outcome, a paradigm shift is needed from methods to replace tissues with inert medical devices to more biological approaches that focus on the repair and reconstruction of tissue structure and function. It is within this context that the field of bone tissue engineering can offer solutions to be implemented into surgical therapy concepts after resection of bone and soft tissue sarcoma. In this paper we will discuss the implementation of tissue engineering concepts into the clinical field of orthopaedic oncology.

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Beckenteilresektion (innere Hemipelvektomie) und endoprothetischer Ersatz bei hüftgelenksnahen Tumoren

Cited by 35 publications

References 48 publications

Tumor resection at the pelvis using three-dimensional planning and patient-specific instruments: a case series

Tumor resection at the pelvis using three-dimensional planning and patient-specific instruments: a case series

Incidence and management of hip dislocation in tumour patients with a modular prosthesis of the proximal femur

Can Bone Tissue Engineering Contribute to Therapy Concepts after Resection of Musculoskeletal Sarcoma?

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