Desarthrodesis and prosthetic reconstruction of the knee after resection of bone tumors

Ruggieri, Pietro; Kasimatis, Georgios; Errani, Costantino; Bosco, G; Mercuri, Mario

doi:10.1002/jso.21726

Cited by 14 publications

(11 citation statements)

References 36 publications

(64 reference statements)

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“…Sufficient soft tissue and an intact extensor mechanism are important factors in achieving good clinical results of a conversion. Therefore, conversion should be evaluated on a case-by-case basis [7,8]. It is important that patients are highly motivated and have realistic expectations about the procedure, risk of complications and postoperative results in order to be successful [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, conversion should be evaluated on a case-by-case basis [7,8]. It is important that patients are highly motivated and have realistic expectations about the procedure, risk of complications and postoperative results in order to be successful [7][8][9]. Judgment of patients generally has been positive and satisfied after conversion, even after a complicated postoperative course or outcome [3,7,8].…”

Section: Introductionmentioning

confidence: 99%

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Conversion from knee arthrodesis to arthroplasty: systematic review

Kernkamp

Verra

Pijls

et al. 2016

International Orthopaedics (SICOT)

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Purpose Arthrodesis (AD) of the knee reduces pain and provides stability, but has severe functional and social limitations. There has been ample discussion on the value of a conversion of an AD to a total knee arthroplasty (TKA). The aim of this study was to perform a review and meta-analysis of the current literature on conversion of an AD to TKA and assess clinical outcome, complication rate, surgical technique and overall patient-related outcome measures. Methods PubMed, Embase, Web of Science, Cochrane, CENTRAL, CINAHL, Academic Search Premier, ScienceDirect and searching by hand for papers on conversion of AD of the knee to TKA. Two reviewers independently reviewed all titles and abstracts, and extracted the available data. Study eligibility criteria were: conversion of knee AD to TKA, five cases or more and non-oncology patients. Data consisted of study characteristics, patient demographics, clinical outcome and complications. Additionally, details on surgical technique were reviewed. Results Of the 866 unique references identified, six papers were included for further analyses, comprising a total of 123 knees with conversion of AD of the knee to TKA. Mean gain of knee flexion was 80 degrees and the mean HSS score improved with 20 points. A complicated postoperative course was found in 65 % of all cases. The most frequent complication was skin necrosis (25 %), followed by arthrofibrosis (13 %), infection (11 %) and revision (11 %). Major complications such as refusion, amputation and death occurred in less than 5 % of all cases. Discussion The majority of the papers consisted of small case series of moderate methodological quality, resulting in 123 included knees. Further series are necessary to draw definitive conclusions. Conclusions This is the first systematic review and metaanalysis on conversion of a knee arthrodesis to TKA. Good clinical results can be expected after conversion, albeit at a high risk of postoperative complications.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Conversion from knee arthrodesis to arthroplasty: systematic review

Kernkamp

Verra

Pijls

et al. 2016

International Orthopaedics (SICOT)

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“…It is also possible to subsequently successfully carry out a secondary revision of the cement spacer to a prosthesis or biological arthrodesis if the need arises or the patient desires it. 41 …”

Section: Introductionmentioning

confidence: 99%

Limb salvage: When, where, and how?

Puri

2015

IJOO

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From an era where amputation was the only option to the current day function preserving resections and complex reconstructions has been a major advance in the treatment of musculoskeletal sarcomas. The objectives of extremity reconstruction after oncologic resection include providing skeletal stability where necessary, adequate wound coverage to allow early subsequent adjuvant therapy, optimising the aesthetic outcome and preservation of functional capability with early return to function. This article highlights the concepts of surgical margins in oncology, discusses the principles governing safe surgical resection in these tumors and summarises the current modalities and recent developments relevant to reconstruction after limb salvage. The rationale of choice of a particular resection modality and the unique challenges of reconstruction in skeletally immature individuals are also discussed. Striking the right balance between adequate resection, while yet retaining or reconstructing tissue for acceptable function and cosmesis is a difficult task. Complications are not uncommon and patients and their families need to be counseled regarding the potential setbacks that may occur in the course of their eventual road to recovery, Limb salvage entails a well orchestrated effort involving various specialties and better outcomes are likely to be achieved with centralization of expertise at regional centers.

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“…Currently, the most common indications for knee arthrodesis are chronic infection after arthroplasty and tumors requiring extensive resection of the bony and soft tissues about the knee, rendering the joint with inadequate soft tissue coverage and extensor mechanism loss [39]. In appropriate patients, arthrodesis provides pain relief, stability, and improved mobility [44].…”

Section: Introductionmentioning

confidence: 99%

Is There a Role for Knee Arthrodesis With Modular Endoprostheses for Tumor and Revision of Failed Endoprostheses?

Angelini

Henderson

Trovarelli

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Knee arthrodeses are performed to treat infection after arthroplasty and tumors requiring extensive soft tissue resection. Many techniques have been described, but most have important disadvantages. Currently, endoprosthetic arthrodesis implants are available, but little is known about them. Questions/purposes Our objective was to analyze a series of knee arthrodeses with a modular prosthetic system to evaluate (1) survivorship of the implant, (2) complications, (3) whether survivorship differed between arthrodeses done for primary tumor resection and revision reconstructions, and (4) whether survivorship differed based on the presence of previous infection or the use of a gastrocnemius flap. Methods We present 32 patients with modular knee arthrodeses; arthrodeses were performed in 25 patients with tumors and in seven patients without tumors. There were 14 implants done at the time of tumor resection and 18 for revision of failed implants. Survivorship and complications were analyzed with Kaplan-Meier curves. Log-rank test was used for comparison between primary and revision implants, not infected and previously infected implants, and use or nonuse of a gastrocnemius flap.

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Desarthrodesis and prosthetic reconstruction of the knee after resection of bone tumors

Abstract: Our findings indicate that conversion of oncological knee arthrodesis to total knee arthroplasty should be taken into consideration only after giving the patient extensive information about the high risk of serious complications.

Cited by 14 publications

References 36 publications

Conversion from knee arthrodesis to arthroplasty: systematic review

Conversion from knee arthrodesis to arthroplasty: systematic review

Limb salvage: When, where, and how?

Is There a Role for Knee Arthrodesis With Modular Endoprostheses for Tumor and Revision of Failed Endoprostheses?

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