Limb conservation in primary bone tumours by resection, extracorporeal irradiation and re-implantation

Uyttendaele, Dirk; Schryver, A. De; Claessens, H; Roels, H; Berkvens, P.; Mondelaers, W.

doi:10.1302/0301-620x.70b3.3163694

Cited by 117 publications

(72 citation statements)

References 6 publications

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“…Resection of the anterior part of the axillary nerve was performed twice because this was necessary to perform a ''wide'' resection. Eleven resected specimens were irradiated extracorporeally with 30,000 rad and replaced after the bulk of the lesion had been removed [45]. The shoulder was reconstructed with a reverse total shoulder prosthesis (seven Delta 3. .…”

Section: Methodsmentioning

confidence: 99%

Does Reverse Shoulder Arthroplasty for Tumors of the Proximal Humerus Reduce Impairment?

Wilde

Boileau

Bracht

2011

Clinical Orthopaedics &Amp; Related Research

109

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Background Normal function of the upper limb is seldom restored after limb-sparing surgery for tumors of the proximal humerus. The literature suggests superior shoulder function is achieved in the short term with reverse total shoulder arthroplasty compared to other techniques when performed for conditions with rotator cuff deficiency. It is unclear whether this superiority is maintained when reverse total shoulder arthroplasty is performed for tumors. Questions/purposes When performed for tumors, we determined whether reverse total shoulder arthroplasty restores function and improves motion, the complications associated with the surgery, and whether reverse total shoulder arthroplasty with autologous grafting is associated with bone resorption. Patients and MethodsWe retrospectively reviewed 14 patients who had undergone reverse total shoulder arthroplasty for tumors of the proximal humerus. Four patients died, leaving nine patients for review. The surviving patients were evaluated clinically and radiographically. The minimum followup was 0.6 years (mean, 7.7 years; range, 0.6-12 years). Results At last followup, mean active abduction was 157°a nd mean functional Constant-Murley score was 76%. One patient had a deep infection and one developed a loose prosthesis; both were treated with single-stage exchange. At last followup, both patients had reasonable function without evidence of infection or loosening. Radiographic graft resorption was seen in all but one patient. Conclusions Our observations suggest, at medium-term followup, reverse total shoulder arthroplasty is a reasonable option for tumors of the proximal humerus. It has low morbidity, restores a mean active abduction of 157°, and limits the impairment of activities of daily living.

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Section: Methodsmentioning

confidence: 99%

Does Reverse Shoulder Arthroplasty for Tumors of the Proximal Humerus Reduce Impairment?

Wilde

Boileau

Bracht

2011

Clinical Orthopaedics &Amp; Related Research

109

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“…Several oncological reconstruction methods have been developed as alternative reconstruction methods, including irradiation [4], autoclaving [5], and pasteurization [6]. In particular, a novel method of reconstruction with liquid nitrogen (frozen autograft) was developed and has been implemented in patients since 1999 [7].…”

Section: Introductionmentioning

confidence: 99%

Pedicle versus free frozen autograft for reconstruction in malignant bone and soft tissue tumors of the lower extremities

Shimozaki¹,

Yamamoto²,

Shirai³

et al. 2014

Journal of Orthopaedic Science

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Background Of the biological reconstruction methods for malignant bone and soft tissue tumors, reconstruction with liquid nitrogen has the advantage of maintaining continuity on the distal side of the tumor bone site (pedicle freezing procedure; PFP). This method is expected to result in early blood flow recovery, with early union and low complication rate. The purpose of this study was to compare the outcomes of the PFP and free freezing procedure (FFP) in the lower extremities. Methods The study included 20 patients (12 men and 8 women) with frozen autografts (FFP, 13 cases; PFP, 7 cases). The mean age of the subjects was 36.3 years (range 11-79 years), and the mean follow-up period was 56.4 months (range 12-142 months). Results Final bone union occurred in 11 patients in the FFP group (84.6 %) and in 7 patients in the PFP group (100 %). The mean union period in patients who did not need additional surgery was 9.8 months (range 4-21 months) in the FFP group and 4.8 months (range 2-7 months) in the PFP group. Postoperative complications occurred in 8 cases: infection in 3 cases, fracture in 3 cases, and joint destruction in 2 cases. Six FFP patients, and 2 PFP patients (two cases of fracture), developed postoperative complications. Conclusions The union period was shorter and the rate of postoperative complications was lower with the PFP than with the FFP. We considered that early blood flow recovery might have led to the above results in the PFP.

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“…Extracorporeal irradiation aims at eradicating all tumour cells, as this is the primary goal of treatment, while preserving bone stock [16,17]. In smaller, selected patient series, a low recurrence rate and a favourable graft survival have been reported, with an acceptable functional outcome in the short-to medium-term follow-up.…”

Section: Introductionmentioning

confidence: 99%

Extracorporeally irradiated autografts for the treatment of bone tumours: tips and tricks

Poffyn

Sys

Mulliez

et al. 2010

International Orthopaedics (SICOT)

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We retrospectively reviewed 107 patients with 108 malignant or locally aggressive bone tumours treated between 1978 and 2009 by extracorporeal irradiation with 300 Gy to eradicate the tumour, and reimplantation of the bone as an orthotopic autograft. Patient subgroups were defined according to resection type. We describe the local recurrence rate, the graft infection rate and the factors affecting graft healing and graft survival. No local recurrences were detected in the irradiated grafts. At fiveyear follow-up, graft healing had occurred in 64% of patients, providing a stable and lasting reconstruction. For various reasons, 11% of grafts were removed, although no single factor was predictive of failure. All patient subgroups had comparable results. Early infection predicted the development of pseudarthrosis. Pelvic reconstructions had a worse graft survival. Rigid fixation and bridging of the graft appeared to be important technical points.

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Limb conservation in primary bone tumours by resection, extracorporeal irradiation and re-implantation

Cited by 117 publications

References 6 publications

Does Reverse Shoulder Arthroplasty for Tumors of the Proximal Humerus Reduce Impairment?

Does Reverse Shoulder Arthroplasty for Tumors of the Proximal Humerus Reduce Impairment?

Pedicle versus free frozen autograft for reconstruction in malignant bone and soft tissue tumors of the lower extremities

Extracorporeally irradiated autografts for the treatment of bone tumours: tips and tricks

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