Limb Salvage With Tumor Endoprostheses for Malignant Tumors of the Knee

Plötz, Werner; Rechl, H.; Burgkart, Rainer; Messmer, Caroline; Schelter, R; Hipp, E; Gradinger, R.

doi:10.1097/00003086-200212000-00027

Cited by 108 publications

(94 citation statements)

References 26 publications

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“…Restoration of good function to a limb and maintaining it in the long term after resection of a bone tumor remain challenging. The ideal reconstruction should be biologically similar to existing bone, be resistant to infection, and be both strong and durable [23,24]. In this study, we demonstrated that the mean Musculoskeletal Tumor Society functional score was 91.5 % at a mean of 202 months after reconstruction, and no patients lost their functional ability after recovering their own best functional score.…”

Section: Discussionmentioning

confidence: 62%

Over 10-year follow-up of functional outcome in patients with bone tumors reconstructed using distraction osteogenesis

Watanabe

Tsuchiya

Yamamoto

et al. 2013

Journal of Orthopaedic Science

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Section: Discussionmentioning

confidence: 62%

Over 10-year follow-up of functional outcome in patients with bone tumors reconstructed using distraction osteogenesis

Watanabe

Tsuchiya

Yamamoto

et al. 2013

Journal of Orthopaedic Science

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“…It has been attributed to: a long interface "implant-cement-bone" [17], to the stresses generated by the important lever arms of the constrained hinges [15], by an altered transmission of the axial loads when walking [7], and high functional demands of young patients [18]. Besides these reasons, we believe that the fact that the structural allograft did not integrate in any of the cases of our series had a determinant role in the development of the aseptic loosening and the subsequent failure of the megaprosthesis.…”

Section: Discussionmentioning

confidence: 99%

“…Nowadays, reconstructive surgery after great tumor resections contemplates a series of alternatives: osteoarticular allograft [2], arthrodesis with intercalary bone allograft [3], Allograft Megaprosthesis Composite (AMC) [4] and Modular Megaprosthesis (MMP) [5]. Megaprosthesis ( Figure 1) are actually considered the best treatment option because they allow a better preservation of the joint function [6,7].…”

Section: Introductionmentioning

confidence: 99%

Megaprosthesis Revision Caused by Aseptic Loosening and Nonunion of the Structural Allograft in Patients Younger Than 40 Years

Cisneros¹

2015

ORP

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Background: The use of structural allografts is aimed to restore the resected bone segment in order to maintain enough bone stock for future revisions. The aim of this study was to describe the mechanical failures of Allograft Megaprosthesis Composite (AMC) revised to Modular Megaprosthesis (MMP) due to nonunion of the structural allograft in patients younger than 40 years. Material and methods:A retrospective revision in a referral hospital for the treatment of musculoskeletal tumors was performed between January 1 st 2009 and January 31 st 2012. We looked in the surgical records of the musculoskeletal tumors unit for all of the procedures coded as "megaprosthesis-revision-arthroplasty". We included patients younger than 40 year-old in which primary reconstructive surgery at any segment of the lower limb was performed by means of AMC, and revision surgery was performed by means of MMP. We looked in those records for information regarding integration of the structural allograft to the native bone.Six revisions from AMC to MMP were performed: 5 knees and 1 hip. The mean age at the time of revision surgery was 28.83 year-old (range 18-38). Primary oncological diagnoses were: 4 osteosarcomas of the distal femur, one Giant Cell Tumor (GCT) of the femoral head and 1 GCT of the proximal tibia. Results:In none of the cases integration of the structural bone allograft to the native bone was observed, reason why it had to be completely resected in all patients. The reason for revision surgery in all cases was aseptic loosening secondary to nonunion of the structural bone allograft. Mean time elapsed from implantation of AMC to revision surgery to MMP was 103 months. Mean time elapsed from revision surgery to last follow-up visit was 26 months. Conclusion:Structural bone allografts in limb salvage surgery after massive tumor resection, may not be the best reconstructive option because the high probability that the grafted bone segment might not integrate to the native bone, even in young patients, may lead to prosthetic failure because of aseptic loosening.

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“…5%, loosening rate: 2-7%, polyethylene wear, 2%, local recurrence 4-11%, wound complication 6%, infection 5-15%, neuropraxia 5% [7][8][9][16][17][18][19][24][25][27][28][29][30]32,[35][36][37]. The expandable prosthesis has the highest complication rate, may be up the 70% [8][9][19][20]38].…”

Section: Biomedical Engineering-applications Basis and Communicationsmentioning

confidence: 99%

Endoprosthesis-Related Complications After Limb-Salvage Operation of Malignant Bone Tumors Around the Knee

Yang

2004

Biomed. Eng. Appl. Basis Commun.

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Endoprosthetic reconstruction using a custom-made metallic megaendoprosthesis is one of the common modalities for the limb salvage operation. The new promising advance of material science, design and fabrication of the endoprosthesis enable an immediate rehabilitation program and provide a durable and functional limb. Thus a successful limb reconstruction is possible in the well-selected patients. In addition to the endoprosthesis-related increased stress, a limited soft tissue support and constraint after limb salvage procedure usually results in an increased incidence of complications, especially in the long term survivors. Some patients may even need revision of the endoprosthesis and, at times, amputation. The complications after oncological endoprosthectic reconstructions usually occur more frequent than the conventional primary total joint arthroplasty. Considering the characteristics of the surgical procedure and the high demands on the implants, such a relatively high frequency of complications is not unexpected. The common complications include wound necrosis, aseptic loosening, fatigue fracture, local osteolysis, joint contracture, dislodgement/dislocation, nerve or vascular injury, rotational deformity, leg length discrepancy, infection, periprosthectic fracture, etc. Some complications are encountered with other modality of limb salvage procedure, whereas the other endoprosthesis-related complications are endoprosthetic-unique and not uncommon. The major causes of such a relatively high endoprosthesis-related complications include (1) extensive excision of soft tissue, leading to change of biomechanical ergonomics, little soft tissue constraints or support for a long replacement segments, and decreased local defense to infection, (2) increased stress on the implants due to higher activity level in the youthful active individuals, relatively narrower medullary canals with less cancellous bone for fixation, (3) special needs for the stability resulting an increased mechanical constraints placed directly within the endoprosthesis, thus raising the local stress transferred to the prosthesis, and to the prosthesis-bone interface, (4) poor immunological, hematological, or nutritional status resulting from chronic oncologic diseases or chemotherapy. It in turn accelerates the wear processes of the components, induces the wear particulate disease and local osteolysis, as well as to cause the aseptic loosening eventually. Early detection and early correction of minor complications has an important role of preventing the major complications, thus reduces the necessity of reoperation, and at times, amputation. We will review these complications in this article.

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Limb Salvage With Tumor Endoprostheses for Malignant Tumors of the Knee

Cited by 108 publications

References 26 publications

Over 10-year follow-up of functional outcome in patients with bone tumors reconstructed using distraction osteogenesis

Over 10-year follow-up of functional outcome in patients with bone tumors reconstructed using distraction osteogenesis

Megaprosthesis Revision Caused by Aseptic Loosening and Nonunion of the Structural Allograft in Patients Younger Than 40 Years

Endoprosthesis-Related Complications After Limb-Salvage Operation of Malignant Bone Tumors Around the Knee

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