Musculoskeletal oncology reconstructions in India – Changes in this millennium!

Abstract

This article briefly describes the evolution of orthopaedic oncology as practised in India over the last two decades. Striking the right balance between adequate resection and functional reconstruction with locally available expertise and resources is a challenging task. Techniques practised by Indian surgeons' have garnered global acceptability, both as durable biological options and cost effective practices in a world which faces ever increasing healthcare budgetary constraints and limitations.

The impact of cost on quality of surgical management in non-metastatic extremity sarcoma: A cross-country narrative literature review with a systematic approach

“…19 This was especially attractive in paediatric osteosarcoma where expandable endoprostheses were unaffordable. 28 In cases of proximal humerus osteosarcoma where function could not be preserved, a cement spacer with $16 nail and $99 plate had comparable outcomes to endoprosthesis, with just 10 per-cent of the material costs. 22,28,29 Tumour-bearing bone treated with liquid nitrogen was used as an autograft at various sites including proximal humerus, femur and distal fibula with good functional outcomes.…”

“…28 In cases of proximal humerus osteosarcoma where function could not be preserved, a cement spacer with $16 nail and $99 plate had comparable outcomes to endoprosthesis, with just 10 per-cent of the material costs. 22,28,29 Tumour-bearing bone treated with liquid nitrogen was used as an autograft at various sites including proximal humerus, femur and distal fibula with good functional outcomes. 30,31 At one centre in Egypt, the liquid nitrogen treatment process cost just $80 – far lower in cost than an endoprosthesis.…”

“…Limb salvage surgery had greater up-front costs than amputation. 24,25 Type of reconstruction Endoprosthesis and allograft reconstruction often unaffordable Low-cost reconstruction methods required including rotationplasty, cement spacer with nail, recycling of tumour-bearing bone 19,22,28,29 Endoprosthesis more costly than allograft for reconstruction at knee and humerus Functional restoration was more costly but had greater cost-utility than soft tissue reconstruction for lower-extremity STS. 33 Staged reconstruction brachytherapy had higher up-front costs than immediate reconstruction brachytherapy.…”

“…38 However, the reliability and durability of these low-cost 'indigenous' prostheses has been questioned. 28,39 One study reported over 50% infection rates and an inevitability of prosthetic fracture or dislocation with a locally made hinge knee prosthesis. 39 Local design and manufacture of tumour endoprostheses offers significant cost savings, but requires rigorous planning, in vitro testing for durability and clinical trials to ensure quality.…”

Inequities in global cancer surgery: Challenges and solutions

“…51 Similarly, an indigenously developed megaprosthesis for knee replacement after surgery for osteosarcomas reduced costs associated with surgery substantially. 52 There has also been a move towards human-centered surgical device design specifically for LMICs, often in partnership with HIC funders and innovators. For example, laparoscopic surgery can have several benefits in cancer surgery including shorter postoperative recovery and reduced wound infection rates, however, introduction in LMICs is often hindered by high costs, maintenance requirements, the need for expensive consumables (such as medical-grade carbon dioxide), and a lack of stable electricity required for laparoscopic monitors and cameras.…”