Functional outcome after endoprosthetic limb-salvage therapy of primary bone tumours—a comparative analysis using the MSTS score, the TESS and the RNL index

Tunn, Per‐Ulf; Pomraenke, D.; Goerling, Ute; Hohenberger, Peter

doi:10.1007/s00264-007-0388-8

Cited by 75 publications

(83 citation statements)

References 23 publications

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“…Modular prostheses are frequently used in the reconstruction of the resulting defects and provide a good functional outcome [1][2][3]. However, dislocation of the hip is a challenging complication following modular proximal femoral replacement due to concomitant soft tissue detachment, especially after tumor resection.…”

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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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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“…A similar spread is seen in the TESS scores (13-90%). Mean TESS scores after TFP range from 47% to 69% in the literature, with equally large interpatient variability [7,21]. A mean TESS score of 69% after PTTF is relatively high.…”

Section: Discussionmentioning

confidence: 97%

The push-through total femoral prosthesis offers a functional alternative to total femoral replacement: a case series

Gorter

Ploegmakers

Have

et al. 2017

International Orthopaedics (SICOT)

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Purpose Oncologic resections or complications of segmental femoral prostheses can result in severe bone loss of the femur for which a total femoral prosthesis (TFP) is required. This study assesses whether the loss of stability and function caused by the loss of muscle attachments can be improved by using a push-through total femoral endoprosthesis (PTTF), because it saves parts of the femur and its muscle attachments. Methods In this retrospective case series, ten patients aged 25-77 (mean 54) who received a PTTF between 2005 and 2014 were included for baseline, complications and survival analysis with a mean follow-up of 5.3 (1.1-9.6) years. Functional outcome was assessed in six patients using the Musculoskeletal Tumor Society (MSTS) score, WHO performance scale, Toronto Extremity Salvage Score (TESS), SF36, EQ-5D, NRS pain score, fatigue score and satisfaction score. Results The mean MSTS score was 64% (23-93%). Five patients had a WHO performance scale of 1, one patient of 3. Mean TESS was 69% (13-90%). SF36 was most notably limited by physical functioning (mean 48), vitality (68) and general health (67). NRS score was 1.9, 1.8 and 8.3 for pain, fatigue and satisfaction, respectively. There were four failures: two infections (one resulting in amputation and one in a minor revision) and two mechanical failures (which required one revision to a TFP and one minor revision). Patient survival was 100%, limb survival 90%, and prosthesis survival 80%. Conclusion The push-through total femoral endoprosthesis allows preservation of muscle attachments and offers a good alternative to total femoral prostheses.

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“…W ska li MSTS uzy ska li śred nią w wy so ko ści 77%. Pa cjen ci nie mie li pro blemów z in te gra cją w spo łe czeń stwie [19].…”

Section: Discussionunclassified

“…Od se tek opi sy wa nych po wi kłań in fek cyj nych jest róż ny -od 1,2-19,5%. Jed nym z naj więk szych czynni ków ry zy ka in fek cji jest przed ope ra cyj na ra dio tera pia [19,[22][23][24].…”

Section: Piśmiennictwo / Referencesunclassified

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Treatment Outcomes and Quality of Life after the Implantation of Modular Prostheses of the Proximal Femur in Patients with Cancer Metastases

Guzik¹

2016

Ortop Traumatol Rehabil

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STRESZCZENIEWstęp. Le cze nie ope ra cyj ne zła mań pa to lo gicz nych bli ższej czę ści ko ści udo wej z za sto so wa niem prę tów śród sz piko wych przy no si do bre krót ko trwa łe re zul ta ty, jed nak czę sto u cho rych z do brym ro ko wa niem, po cza sie do cho dzi do de sta bi li za cji ze spo leń i po trze by re ope ra cji. Lep sze dłu go trwa łe wy ni ki osią ga się sto su jąc pro te zy mo du lar ne.Ma te riał i me to dy. W la tach 2010-2014 w Od dzia le Or to pe dii On ko lo gicz nej w Brzo zo wie wy ko na no 64 ope ra cje resek cji gu zów prze rzu to wych bli ższej czę ści ko ści udo wej po łą czo nych z im plan ta cją pro tez mo du lar nych. Wska za niem do za sto so wa nia pro tez mo du lar nych by ły roz le głe ubyt ki ko ści obej mu ją ce na sa dę i przy na sa dę bli ższą ko ści udo wej i dobry stan ogól ny cho rych. Oce nia no stan cho rych, bó le w ska li VAS, spraw ność w ska li Kar no fsky'ego. Po ope ra cjach dodat ko wo oce nia no wy dol ność cho du i spraw no ści w ska lach MSTS oraz HHS. Ope ro wa no 38 ko biet i 26 mę żczyzn. Śred -nia wie ku ko biet wy nio sła 66 lat, mę żczyzn 69. Okres ob ser wa cji wy no sił od 3,6 do 1,2 ro ku, śred nio 1,8 ro ku.Wy ni ki: Im plan to wa no 28 pro tez GMRS -Stry ker oraz 36 MU TARS -Im plant Cast. Im plan ta cja w 19 przy padkach od by wa ła się z za sto so wa niem ce men tu kost ne go, na to miast w 45 bez je go uży cia.Wszy scy cho rzy po le cze niu ope ra cyj nym po da wa li po pra wę kom for tu ży cia. Śred nia war tość bó lu w ska li VAS wy nio sła 3,8, a spraw ność w skali Kar no fsky'ego 65. Wy dol ność cho dze nia i spraw ność oce nio na po 6 ty go dniach od ope ra cji w ska lach HHS i MSTS wy no si ła śred nio 75 i 20 pkt. Wszy scy pa cjen ci by li zdol ni do cho dze nia, więk szość bez po mo cy kul lub z 1 ku lą. Po wi kła nia ob ser wo wa no rzad ko. U jed ne go pa cjen ta do szło do ma syw nej wzno wy z ob lu zo wa niem pro te zy. Nie ob ser wo wa no głę bo kich in fek cji wy ma ga ją cych usu nię cia pro tez, ob lu zo wań ani zwich nięć.Wnio ski. 1. Le cze nie ope ra cyj ne prze rzu tów do ko ści z uży ciem pro tez mo du lar nych da je do bre wy ni ki. 2. Prote zy mo du lar ne ja ko roz wią za nie ope ra cyj ne zde cy do wa nie po pra wia ją ja kość ży cia a w ob ser wa cjach po ope ra cyj nych wy ka zu ją nie wiel ki po zy tyw ny pro gres. 3. Po wi kła nia w po sta ci in fek cji, ob lu zo wa nia czy wzno wy gu za w pre zen towa nym ma te ria le nie od bie ga ły od pre zen to wa nych w pi śmien nic twie.Słowa kluczowe: przerzuty do kości, resekcje guzów kości, protezoplastyka poresekcyjna kości SUMMARY Background. Surgical treatment of pathological fractures of the proximal femur with intramedullary rods produces good short-term outcomes, but after some time the fixation often becomes unstable in patients with a good prognosis and a repeat surgery is required. Modular prostheses allow for better long-term outcomes.Material and methods. A total of 64 surgical resection procedures for metastatic tumours of the proximal femur combined with t...

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Functional outcome after endoprosthetic limb-salvage therapy of primary bone tumours—a comparative analysis using the MSTS score, the TESS and the RNL index

Cited by 75 publications

References 23 publications

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

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

The push-through total femoral prosthesis offers a functional alternative to total femoral replacement: a case series

Treatment Outcomes and Quality of Life after the Implantation of Modular Prostheses of the Proximal Femur in Patients with Cancer Metastases

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