Cost‐utility of osteoarticular allograft versus endoprosthetic reconstruction for primary bone sarcoma of the knee: A markov analysis

Wilson, Robert J.; Sulieman, Lina; VanHouten, Jacob P.; Halpern, Jennifer L.; Schwartz, Herbert S.; Devin, Clinton J.; Holt, Ginger E.

doi:10.1002/jso.24525

Cited by 16 publications

(17 citation statements)

References 43 publications

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“…Therefore, the Type A and B intercalary prostheses that were elaborated in this study proved several universal advantages that have been certified in the 3D-printed intercalary prostheses that were utilized for the diaphyseal bone defect of other long bones according to previous studies [ 18 – 20 ]. Moreover, based on previous studies, the cost-effective evaluation of endoprostheses was favored for osteoarticular allografts when utilized for massive bone defects [ 42 ]. Thus, this reconstruction method can be regarded as a cost-effective choice due to its satisfactory incremental cost-effectiveness ratios and low postoperative revision rate and major complication rate [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, based on previous studies, the cost-effective evaluation of endoprostheses was favored for osteoarticular allografts when utilized for massive bone defects [ 42 ]. Thus, this reconstruction method can be regarded as a cost-effective choice due to its satisfactory incremental cost-effectiveness ratios and low postoperative revision rate and major complication rate [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

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Reconstruction of massive bone defects after femoral tumor resection using two new-designed 3D-printed intercalary prostheses: a clinical analytic study with the cooperative utilization of multiple technologies

Shao

Dou

et al. 2023

BMC Musculoskelet Disord

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Background To reconstruct massive bone defects of the femoral diaphysis and proximal end with limited bilateral cortical bone after joint-preserving musculoskeletal tumor resections, two novel 3D-printed customized intercalary femoral prostheses were applied. Methods A series of nine patients with malignancies who received these novel 3D-printed prostheses were retrospectively studied between July 2018 and November 2021. The proximal and diaphyseal femur was divided into three regions of interest (ROIs) according to anatomic landmarks, and anatomic measurements were conducted on 50 computed tomography images showing normal femurs. Based on the individual implant-involved ROIs, osteotomy level, and anatomical and biomechanical features, two alternative 3D-printed prostheses were designed. In each patient, Hounsfield Unit (HU) value thresholding and finite element analysis were conducted to identify the bone trabecula and calcar femorale and to determine the stress distribution, respectively. We described the characteristics of each prosthesis and surgical procedure and recorded the intraoperative data. All patients underwent regular postoperative follow-up, in which the clinical, functional and radiographical outcomes were evaluated. Results With the ROI division and radiographic measurements, insufficient bilateral cortical bones for anchoring the traditional stem were verified in the normal proximal femur. Therefore, two 3D-printed intercalary endoprostheses, a Type A prosthesis with a proximal curved stem and a Type B prosthesis with a proximal anchorage-slot and corresponding locking screws, were designed. Based on HU value thresholding and finite element analysis, the 3D-printed proximal stems in all prostheses maximally preserved the trabecular bone and calcar femorale and optimized the biomechanical distribution, as did the proximal screws. With the 3D-printed osteotomy guide plates and reaming guide plates, all patients underwent the operation uneventfully with a satisfactory duration (325.00 ± 62.60 min) and bleeding volume (922.22 ± 222.36 ml). In the follow-up, Harris Hip and Musculoskeletal Tumor Society scores were ameliorated after surgery (P < 0.001 and P < 0.001, respectively), reliable bone ingrowth was observed, and no major complications occurred. Conclusions Two novel 3D-printed femoral intercalary prostheses, which achieved acceptable overall postoperative outcomes, were used as appropriate alternatives for oncologic patients with massive bone defects and limited residual bone and increased the opportunities for joint‐preserving tumor resection. Several scientific methodologies utilized in this study may promote the clinical design proposals of 3D-printed implants.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Reconstruction of massive bone defects after femoral tumor resection using two new-designed 3D-printed intercalary prostheses: a clinical analytic study with the cooperative utilization of multiple technologies

Shao

Dou

et al. 2023

BMC Musculoskelet Disord

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“…The first study was of LSS for knee osteosarcoma in USA. 26 Endoprosthetic reconstruction ($82,209) was significantly more expensive than osteoarticular allograft reconstruction ($37,274). 26 Similarly, for humeral reconstruction in USA, the costs for a humeral endoprosthesis ($5644–$23,356) were far greater than those for a allograft ($3202).…”

Section: Discussionmentioning

confidence: 99%

“…The authors acknowledged that costs varied with different complication and revision rates, and that data from the total knee arthroplasty literature may not apply to osteosarcoma. 26 All studies that described long-term costs were published in the USA and UK, with none in LMC.…”

Section: Care After Initial Treatment and Recoverymentioning

confidence: 99%

The impact of cost on quality of surgical management in non-metastatic extremity sarcoma: A cross-country narrative literature review with a systematic approach

Kuek

Schilling

Choong

2023

J Orthop Surg (Hong Kong)

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Background: Extremity sarcoma surgery entails significant costs for patients, governments and insurers. Multiple studies have described individual costs, however, the overall impact of cost on the quality of surgical care remains unclear. Objectives: A narrative review with a systematic approach was undertaken to compare the impact of cost on the quality of extremity sarcoma care across low-middle-income and high-income countries. Data Sources: MEDLINE, EMBASE, Cochrane, PsycInfo, DARE, NHS-EED, HTA. Methods: A systematic search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Inclusion criteria were: discussion of costs and the surgical management of primary extremity sarcoma. There were no restrictions on study design, publication type, date, geographic location or publication status. A data extraction table was used to identify study location, type and findings. Results: 1012 studies were retrieved and 44 met the inclusion criteria. Four additional studies were identified from the reference lists of included articles. 27 studies were published in high-income countries (HIC) including all four full health economic analyses and 20 studies were published in low-middle income countries (LMC). Within LMC, cost impeded access to diagnosis, resection and options for reconstruction. In HIC, cost varied with choice of management, particularly during the long-term postoperative period. Conclusions: Within LMC, cost impaired the provision of quality, curative care for patients with extremity sarcoma. Within HIC, while costs varied with chosen management, they were not prohibitive to the provision of quality care. Further research is required, specific to both socioeconomic contexts, to further describe the long-term cost-utility of different methods for the surgical management of extremity sarcoma.

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“…While debates have raged in the clinical communities as to whether metal 1,2 or allograft bone [3][4][5] provided a better material for reconstruction, most of the evidence provided was focused on mechanical function and durability. [6][7][8][9][10][11] Despite a plethora of evidence demonstrating that infection is the primary cause of failure irrespective of material, 8,12 infection has never been a driver in the debate among implants because bacterial colonization and downstream infection were always assumed to be equivalent among avascular implant materials.…”

Section: Introductionmentioning

confidence: 99%

Evading the host response: Staphylococcus “hiding” in cortical bone canalicular system causes increased bacterial burden

et al. 2020

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Extremity reconstruction surgery is increasingly performed rather than amputation for patients with large-segment pathologic bone loss. Debate persists as to the optimal void filler for this “limb salvage” surgery, whether metal or allograft bone. Clinicians focus on optimizing important functional gains for patients, and the risk of devastating implant infection has been thought to be similar regardless of implant material. Recent insights into infection pathophysiology are challenging this equipoise, however, with both basic science data suggesting a novel mechanism of infection of Staphylococcus aureus (the most common infecting agent) into the host lacunar–canaliculi network, and also clinical data revealing a higher rate of infection of allograft over metal. The current translational study was therefore developed to bridge the gap between these insights in a longitudinal murine model of infection of allograft bone and metal. Real-time Staphylococci infection characteristics were quantified in cortical bone vs metal, and both microarchitecture of host implant and presence of host immune response were assessed. An orders-of-magnitude higher bacterial burden was established in cortical allograft bone over both metal and cancellous bone. The establishment of immune-evading microabscesses was confirmed in both cortical allograft haversian canal and the submicron canaliculi network in an additional model of mouse femur bone infection. These study results reveal a mechanism by which Staphylococci evasion of host immunity is possible, contributing to elevated risks of infection in cortical bone. The presence of this local infection reservoir imparts massive clinical implications that may alter the current paradigm of osteomyelitis and bulk allograft infection treatment.

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Cost‐utility of osteoarticular allograft versus endoprosthetic reconstruction for primary bone sarcoma of the knee: A markov analysis

Cited by 16 publications

References 43 publications

Reconstruction of massive bone defects after femoral tumor resection using two new-designed 3D-printed intercalary prostheses: a clinical analytic study with the cooperative utilization of multiple technologies

Reconstruction of massive bone defects after femoral tumor resection using two new-designed 3D-printed intercalary prostheses: a clinical analytic study with the cooperative utilization of multiple technologies

The impact of cost on quality of surgical management in non-metastatic extremity sarcoma: A cross-country narrative literature review with a systematic approach

Evading the host response: Staphylococcus “hiding” in cortical bone canalicular system causes increased bacterial burden

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