Expandable endoprosthesis for limb-sparing surgery in children: Long-term results

Abstract

Purpose Most children today with bone sarcomas undergo limb-sparing surgery. When treating children younger than 12 years of age, the result is significant limb length discrepancy (LLD). One of the solutions is the use of an expandable endoprosthesis. Methods A retrospective analysis of 38 skeletally immature patients with bone sarcoma of the lower limb in whom different types of expandable endoprostheses were used from January 1988 to December 2005 were included. All patients were under the age of 14 years. There were 26 osteosarcoma and 12 Ewing's sarcomas. The data collected included the tumor characteristics, the surgical and other treatment modalities, complications and their treatment, and the final LLD and functional results.Results Fifty-five percent of the patients survived and had a mean follow-up of 113 months. All survivors reached skeletal maturity at the time of last follow-up. Seventy-one percent of the survivors had satisfactory function and 29% had a poor result. There were three secondary amputations due to local recurrence. Complications were documented in 58% of patients; the most common was infection that was diagnosed 56 times (primary 16% and secondary 84%). A significant correlation was found between function and final LLD (greater than 5 cm = inferior function), the number of complications, and the number of surgical procedures performed other than prosthesis elongation. The younger the patient was at definitive surgery, the shorter the time it took for the prosthesis to fail. Conclusion In order to improve results, the number of operations must be reduced. This can be achieved by the use of novel non-invasive expandable endoprostheses or biological reconstruction.

Are Complications Associated With the Repiphysis® Expandable Distal Femoral Prosthesis Acceptable for Its Continued Use?

“…The introduction of less-invasive expandable prostheses is purported to allow for implant expansion without further surgical interventions and without use of general anesthesia, making this type of reconstruction increasingly popular in the treatment of skeletally immature children with malignant bone tumors of the extremities [6,11,12,15,17,26,27]. However, we found that use of a particular expandable prosthesis was associated with many complications, resulting in failure of the prosthesis, inability to achieve Expandable = mini-invasive mechanically expandable prosthesis; Noninvasive expand = noninvasive expandable prosthesis; bone = segmental massive bone allograft; DAIR = débridement, antibiotics, and implant retention; EPD = epiphysiodesis; MSTS = Musculoskeletal Tumor Society; *= did not undergo lengthening.…”

“…The Repiphysis 1 Limb Salvage System was later acquired by MicroPort Orthopedics Inc (Arlington, TN, USA), which is the current manufacturer of the implant [20]. Initially, there were positive reports on short-term results of the implant [6,11,17,26], but there have been increasing concerns regarding high complication rates and poor function at longer followup [3,4,16,22].…”

Marsdenia tenacissima extract sensitizes MG63 cells to doxorubicin-induced apoptosis

“…Osteosarcoma is the most common primary tumor of bone, and early pulmonary metastasis is liable to occur with bad prognosis (Dotan et al, 2010;Broadhead et al, 2011). Although chemotherapeutic drugs such as doxorubicin has a killing effect on osteosarcoma cells, the resistance and toxic side effects after long-term application remain a main obstacle for clinicians (Zhang et al, 2011).…”

Non-invasive expandable prosthesis in musculoskeletal oncology paediatric patients for the distal and proximal femur. First results

“…One year after surgery, all the children were back to normal school and the mean MSTS after physical rehabilitation was 26.3 (21)(22)(23)(24)(25)(26)(27)(28)(29). Knee flexion was up to 100°in six cases and between 60°and 80°in one case.…”