Outcome of the intramedullary diaphyseal segmental defect fixation system for bone tumors

Ruggieri, Pietro; Mavrogenis, Andreas F.; Bianchi, Giuseppe; Sakellariou, Vassileios I.; Mercuri, Mario; Papagelopoulos, Panayiotis J.

doi:10.1002/jso.21893

Cited by 47 publications

(78 citation statements)

References 42 publications

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“…This study presents the functional outcomes of 44 reconstructive operations in 41 patients using a modular intercalary endoprosthesis. These results are comparable to similar studies involving intercalary endoprostheses and the inclusion of 41 patients (44 implants) from three musculoskeletal oncology centers makes this one of the largest studies to date using this type of reconstruction [1,2,9,10,18,24,31,33] (Table 3). This study has several limitations which bear discussion.…”

Section: Discussionsupporting

confidence: 80%

“…Segmental resection of the diaphysis of a long bone allows preservation of joint function and in skeletally immature patients allows for preservation of the physes. Many surgical options for the resection, reconstruction, and stabilization of segmental intercalary defects have been described and include the biologic options of autografts [7,8,29], allografts [5,6,11,12,15,22,23,25,26], and distraction osteogenesis [13,36] or use of metal constructs including segmental intercalary endoprostheses [9,10,31] and, although less practical, custom implants [1,2,4,18,24,33]. There have been few reports that analyze functional outcomes after treatment with modular segmental intercalary endoprostheses.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of a Modular Intercalary Endoprosthesis as Treatment for Segmental Defects of the Femur, Tibia, and Humerus

Benevenia

Kirchner

Patterson

et al. 2016

Clinical Orthopaedics &Amp; Related Research

103

120

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Background Resection of diaphyseal bone tumors for local tumor control and stabilization often results in an intercalary skeletal defect and presents a reconstructive challenge for orthopaedic surgeons. Although many options for reconstruction have been described, relatively few studies report on the functional outcomes and complications of patients treated with modular intercalary endoprostheses. Questions/purposes The objectives of this study were to examine clinical outcomes after reconstruction with a modular intercalary endoprosthesis with a specific focus on (1) the rate of complication or failure; (2) differences in complication rates by anatomic site; (3) functional results as assessed by the Musculoskeletal Tumor Society System (MSTS); and (4) differences in complication rate between patients treated with cemented versus noncemented fixation. Methods We conducted a retrospective chart review of patients treated with a modular intercalary endoprosthesis from three musculoskeletal oncology centers from 2008 to 2013. The indication for use of this intercalary endoprosthesis was segmental bone loss from aggressive or malignant tumor with sparing of the joint above and below and deemed unsuitable for biologic reconstruction. No other implant was used for this indication during this period. During this period, 41 patients received a total of 44 intercalary implants, which included 18 (40%) humeri, 5 (11%) tibiae, and 21 (48%) femora. There were 27 (66%) men and 14 (34%) women with a mean age of 63 years (range, 18-91 years). Eight patients (20%) had primary bone tumors and 33 (80%) had metastatic lesions. Thirtyfive (85%) patients were being operated on as an initial treatment and six (15%) for revision of a previous reconstruction. Twenty-nine (66%) procedures had cemented stem fixation and 15 (34%) were treated with noncemented fixation. The overall mean followup was 14 months (range, 1-51 months). Patients with primary tumors had a mean followup of 19 months (range, 4-48 months) and patients One or more of the authors (JB) has received funding from the Musculoskeletal Transplant Foundation and has also received fees from Merete Inc (Berlin, Germany) and Implant Cast (Buxtehude, Germany) outside of the submitted work and holds several patents and licensing fees with CreOsso LLC (Montclair, NJ, USA with metastatic disease had a mean followup of 11 months (range, 1-51 months). Causes of implant failure were categorized according to Henderson et al. [19] into five types as follows: Type I (soft tissue failure), Type II (aseptic loosening), Type III (structural failure), Type IV (infection), and Type V (tumor progression). At 2 years of followup, 38 (93%) of these patients were accounted for with three (7%) lost to followup. MSTS functional assessment was available for 39 of 41 patients (95%). Results At latest followup of these 41 patients, 14 (34%) patients were dead of disease, two patients (5%) dead of other causes, seven (17%) are continuously disease-free, one (2%) shows no evidence of disease, a...

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Section: Discussionsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Outcomes of a Modular Intercalary Endoprosthesis as Treatment for Segmental Defects of the Femur, Tibia, and Humerus

Benevenia

Kirchner

Patterson

et al. 2016

Clinical Orthopaedics &Amp; Related Research

103

120

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“…Many techniques for knee arthrodesis have been described, including the Charnley compression arthrodesis technique, Putti-Juvara technique, xenograft, external fixation, intramedullary nail with bone graft, intramedullary nail and cement, and segmental allograft [5-7, 12, 14, 21, 27, 28, 30, 35, 40]. Each technique has inherent disadvantages and can yield unpredictable and suboptimal results [5,6,9,30,40,48]. To provide improved and more uniform outcomes, modular prosthetic arthrodesis systems were developed [3,16,48].…”

Section: Introductionmentioning

confidence: 99%

Is There a Role for Knee Arthrodesis With Modular Endoprostheses for Tumor and Revision of Failed Endoprostheses?

Angelini

Henderson

Trovarelli

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Knee arthrodeses are performed to treat infection after arthroplasty and tumors requiring extensive soft tissue resection. Many techniques have been described, but most have important disadvantages. Currently, endoprosthetic arthrodesis implants are available, but little is known about them. Questions/purposes Our objective was to analyze a series of knee arthrodeses with a modular prosthetic system to evaluate (1) survivorship of the implant, (2) complications, (3) whether survivorship differed between arthrodeses done for primary tumor resection and revision reconstructions, and (4) whether survivorship differed based on the presence of previous infection or the use of a gastrocnemius flap. Methods We present 32 patients with modular knee arthrodeses; arthrodeses were performed in 25 patients with tumors and in seven patients without tumors. There were 14 implants done at the time of tumor resection and 18 for revision of failed implants. Survivorship and complications were analyzed with Kaplan-Meier curves. Log-rank test was used for comparison between primary and revision implants, not infected and previously infected implants, and use or nonuse of a gastrocnemius flap.

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“…This is important, as structural failure was also demonstrated in another study [6] using the same device with a similar high risk of complications in the femur, more specifically, in the proximal of the two stems. This raises the question whether intercalary endoprosthetic replacement for segmental defects is a viable option in the lower extremity, especially in the femur.…”

Section: Where Do We Need To Go?mentioning

confidence: 67%

“…Once integrated, allograft and autograft reconstruction permit full weight bearing and perhaps fewer long-term complications. Previously published studies reported the nononcological failure rate of these reconstructions as ranging from 14% to 50% at mid-term followup [1,2,[4][5][6].…”

mentioning

confidence: 99%

CORR Insights®: Outcomes of a Modular Intercalary Endoprosthesis as Treatment for Segmental Defects of the Femur, Tibia, and Humerus

Windhager

2016

Clinical Orthopaedics &Amp; Related Research

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Outcome of the intramedullary diaphyseal segmental defect fixation system for bone tumors

Cited by 47 publications

References 42 publications

Outcomes of a Modular Intercalary Endoprosthesis as Treatment for Segmental Defects of the Femur, Tibia, and Humerus

Outcomes of a Modular Intercalary Endoprosthesis as Treatment for Segmental Defects of the Femur, Tibia, and Humerus

Is There a Role for Knee Arthrodesis With Modular Endoprostheses for Tumor and Revision of Failed Endoprostheses?

CORR Insights®: Outcomes of a Modular Intercalary Endoprosthesis as Treatment for Segmental Defects of the Femur, Tibia, and Humerus

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