Large tumor endoprostheses and extracortical bone-bridging: 28 patients followed 10-20 years

Shin, Duk-Seop; Choong, Peter; Chao, Edmund Y H; Sim, Franklin H.

doi:10.1080/000164700317411933

Cited by 24 publications

(29 citation statements)

References 23 publications

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“…6), resection of extra tissue, such as uninvolved joint surfaces, can have major long-term functional consequences [10,13,14,21,27]. Here, we evaluated whether a custom jigassisted bone tumor resection technique reproduces a welldefined preoperative plan more accurately and consistently than traditional manual resection techniques.…”

Section: Discussionmentioning

confidence: 99%

“…Because the jig is constructed to mate with the bone surface, a proximally based jig must make contact either with the actual surface of the bone surrounding the tumor or with the periosteum and requires the surgeon peel back soft tissue in the region next to, but not on top of, the tumor to expose the underlying bone (or periosteum). Such soft tissue stripping may decrease the success of a biologically based reconstruction [23,27,28].…”

Section: Appendix 1 Proximally Based Versus Distally Based Jig Designmentioning

confidence: 99%

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Surgical Technique: Computer-generated Custom Jigs Improve Accuracy of Wide Resection of Bone Tumors

Khan

Lipman

Pearle

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Manual techniques of reproducing a preoperative plan for primary bone tumor resection using rudimentary devices and imprecise localization techniques can result in compromised margins or unnecessary removal of unaffected tissue. We examined whether a novel technique using computer-generated custom jigs more accurately reproduces a preoperative resection plan than a standard manual technique. Description of TechniqueUsing CT images and advanced imaging, reverse engineering, and computer-assisted design software, custom jigs were designed to precisely conform to a specific location on the surface of partially skeletonized cadaveric femurs. The jigs were used to perform a hemimetaphyseal resection. Methods We performed CT scans on six matched pairs of cadaveric femurs. Based on a primary bone sarcoma model, a joint-sparing, hemimetaphyseal wide resection was precisely outlined on each femur. For each pair, the resection was performed using the standard manual technique on one specimen and the custom jig-assisted technique on the other. Superimposition of preoperative and postresection images enabled quantitative analysis of resection accuracy. Results The mean maximum deviation from the preoperative plan was 9.0 mm for the manual group and 2.0 mm for the custom-jig group. The percentages of times the maximum deviation was greater than 3 mm and greater than 4 mm was 100% and 72% for the manual group and 5.6% and 0.0% for the custom-jig group, respectively. Conclusions Our findings suggest that custom-jig technology substantially improves the accuracy of primary bone tumor resection, enabling a surgeon to reproduce a given preoperative plan reliably and consistently.

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Section: Discussionmentioning

confidence: 99%

Section: Appendix 1 Proximally Based Versus Distally Based Jig Designmentioning

confidence: 99%

Surgical Technique: Computer-generated Custom Jigs Improve Accuracy of Wide Resection of Bone Tumors

Khan

Lipman

Pearle

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…The result is stress-shielding of the surrounding bone and a higher risk of aseptic loosening [5,17,20,29,30,39,41,53,59,60]. Interestingly, studies seldomly point to the prosthetic design as the cause of aseptic loosening [ 17, 56,64].…”

Section: Introductionmentioning

confidence: 99%

“…Interestingly, studies seldomly point to the prosthetic design as the cause of aseptic loosening [ 17, 56,64]. The anatomic location, percentage of bone resected, age of the patient, number of screws used for cross-fixation, positioning of the implant, osteoporotic bone, or insufficient mobilization are more often suspected causes, if at all discussed [1, 8,23,27,41,45,53,57,59,691.…”

Section: Introductionmentioning

confidence: 99%

Uncemented short‐length diaphyseal segmental replacement prosthesis fixation—Finite element analysis and long‐term results

Werner

Jacob

Ramseier

et al. 2005

Journal Orthopaedic Research

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Introduction: Extensively porous coated segmental replacement prostheses with intramedullary cementless fixation to bone over the whole length of stem often exhibit resorption of the surrounding bone due to stress-shielding. This makes them particularly susceptible to aseptic loosening.Study: A finite element analysis of the state of loading of a short-length fixation in a new prosthetic stem design has shown a definite advantage over long-length fixation. The stress pattern within the bone surrounding the prosthesis confirmed that shortening of the-ongrowth area in length increases the stress values at the resection level significantly. This stem (Endlock) has been used for diaphyseal anchorage in the treatment of tumors in combination with an artificial joint of proven design in order to reduce stress shielding.Results: No Endlock stem fractures or aseptic loosenings were observed at recent follow-up. The early clinical results comply with the theoretical assumptions.Conclusions: A short-length fixation system based on intramedullary anchorage of segmental replacement endoprostheses would possibly support physiologic adaptive processes more than fixation over the full length of the stem.

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“…A higher complication rate is well known and accepted because of the extended bone and soft tissue defects, the complex biomechanical reconstruction and the size of the implants [5,7,24].…”

Section: Introductionmentioning

confidence: 99%

Megaprostheses for the treatment of malignantbone tumours of the lower limbs

Heisel

Kinkel

Bernd

et al. 2006

International Orthopaedics (SICOT)

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Lower limb salvage surgery remains a challenge in orthopaedic oncology. Both cemented and cementless, modular, endoprosthetic systems are widely used to treat defects of different sizes. The systems have changed over the years, and each major orthopaedic company offers a modular tumour and revision system for the lower extremities. All systems have worse long-term results compared to conventional total hip or total knee systems. This is due to the large defects that need to be bridged with a more difficult fixation in the diapyhsis of the femur and tibia and a more complex restoration of joint biomechanics. This article summarises the results of several clinical studies with different systems. Newer systems without clinical follow-up are described. We previously reported a prospective study of 50 consecutive patients treated with the MUTARS endoprostheses. The follow-up was 2-7 years. Clinical evaluation showed good results compared to other systems. The review of the literature and our own results do not validate the support or favouring of one specific system. The surgeon should choose a system with which he/she is familiar and that provides the modularity needed intraoperatively to bridge any defect in the lower limbs.Résumé Le sauvetage des membres demeure un challenge en oncologie orthopédique. Les prothèses modulaires, cimentées ou non, sont largement utilisées et chaque grand fabriquant offre des systèmes pour reconstruction des membres inférieurs. Tous les systèmes ont de moins bons résultats à long terme que les prothèses conventionnelles de hanche ou de genou. Ceci est due aux larges défauts osseux nécessitant la fixation dans les diaphyses fémorales et tibiales et la difficile restauration de la biomécanique articulaire. Cet article résume les résultats de plusieurs études cliniques avec différents systèmes. Nous avons rapporté une étude prospective de 50 patients traités avec une prothèse MUTARS, avec 2 à 7 ans de recul et un bon résultat comparable aux autres systèmes. La revue de la littérature et notre expérience ne permet pas de conseiller un système particulier. Le chirurgien doit choisir un système avec lequel il est familier et qui lui donne la possibilité opératoire de compenser les pertes de substances du membre inférieur.

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Large tumor endoprostheses and extracortical bone-bridging: 28 patients followed 10-20 years

Cited by 24 publications

References 23 publications

Surgical Technique: Computer-generated Custom Jigs Improve Accuracy of Wide Resection of Bone Tumors

Surgical Technique: Computer-generated Custom Jigs Improve Accuracy of Wide Resection of Bone Tumors

Uncemented short‐length diaphyseal segmental replacement prosthesis fixation—Finite element analysis and long‐term results

Megaprostheses for the treatment of malignantbone tumours of the lower limbs

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