Titanium Implant Failure After Chest Wall Osteosynthesis

Berthet, Jean‐Philippe; Gomez, Abel; Solovei, Laurence; Gilbert, Matthieu; Bommart, Sébastien; Gaudard, Philippe; Canaud, Ludovic; Alric, Pierre; Marty-Ané, Charles-Henri

doi:10.1016/j.athoracsur.2015.02.040

Cited by 60 publications

(41 citation statements)

References 19 publications

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“…The failure was located at the rib clip in the region with the hole in the bar, which is different from any of the failures reported in this study. A recent study by Berthet and associates [6] from two European hospitals shows the same three types of failures observed by us when they used the STRATOS system for rib osteosynthesis in a 4-year period. Those researchers did not go into the mechanistic causes of the failure of this material, now elucidated by this very study.…”

Section: Commentsupporting

confidence: 76%

“…Long-term results are lacking, as a search of the literature results in only a dozen papers reporting small series, almost all dealing with repair after chest wall resection [5], very few reporting pectus repair. The only exception is a paper by Berthet and colleagues [6], who reported in 2015 in The Annals failure in approximately half of their 25 pectus patients at a mean follow-up of 20.2 months. We were alerted by a patient presenting with sudden intense pain after hearing a "snapping" sound in her chest.…”

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confidence: 99%

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Implant Failure: STRATOS System for Pectus Repair

Sharma

Willems

Touw

et al. 2017

The Annals of Thoracic Surgery

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Combined tensile, compressive, bending, and torsional loading on the implant during each breathing cycle caused loosening and fatigue fractures, which led to failure. Excessive rubbing at the fracture and loosening site caused the release of large amounts of titanium in the surrounding tissue, which may lead to metallosis. Long and sharp pieces of failed implant in the cardiothoracic region is a grave danger to vital organs. All patients should be closely followed, and in our opinion, all implants should be removed. Serious reconsideration for clinical use of this implant is necessary.

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Section: Commentsupporting

confidence: 76%

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confidence: 99%

Implant Failure: STRATOS System for Pectus Repair

Sharma

Willems

Touw

et al. 2017

The Annals of Thoracic Surgery

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“…During the follow-up, the same author noted that the implant failure is quite high (44.4%), but without severe complications and often the rupture or the dislocation were asymptomatic. They identified the anterior location of chest wall resection and the presence of three or more implant as a significant risk factors of failure (18). Similarly other titanium rigid reconstruction systems are effectively used and reported in literature (6).…”

Section: A B a B Cmentioning

confidence: 99%

Short and long-term results of sternectomy for sternal tumours

et al. 2017

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Background: We analyzed our experience in sternal resections (SRs) for primary or secondary neoplasm focusing on technical aspects of reconstruction, post-operative outcomes and long term survival. Methods: From January 2005 to December 2015, 36 patients (24 males, 67%) underwent surgical excision of primary (chondrosarcoma n=18 patients, 50%; osteosarcoma n=2, 6%; Ewing sarcoma n=1, 3%; other n=2, 6%) or secondary (breast cancer n=7, 19%; kidney carcinoma n=2, 6%) sternal tumour. We performed n=30 partial sternectomy and n=6 total sternectomy with en-bloc resection of the sternocostal cartilages in all patient and extended resection in 7 patients. Stability was obtained with prosthetic material, rigid and non-rigid and a muscular flap: rigid material [Strasbourg Thoracic Osteosynthesis System (STRATOS), MedXpert GmbH] and muscle flap n=11 (30.6%); polytetrafluoroethylene patch and muscle flap n=6 (16.7%); muscle flap alone n=19 (52.8%). Results:The 30-day mortality rate was 0, overall complication rate was 19%. The median ICU stay was 1.5 days and mean hospital stay was 10.6±5.9 days. We obtained a complete (R0) resection in all patients. Overall survival (OS) at 5 and 10 years were 59% and 40%; in the group of primary neoplasm OS rate at 5 and 10 years was 79% and 54%. Disease free survival (DFS) rate at 5 years was 61%. Higher grading was identified as negative prognostic factor.Conclusions: Wide radical resections of anterior chest wall are basilar in a multimodality treatment for primary or metastatic neoplasm of the sternum. Stabilization with titanium bars and clips provides rigidity of chest wall with good functional results.

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“…There were good results using bioabsorbable materials for chest wall repair, mainly important in the growing pediatric patients (30,57). A new recent development could be a computed tomography with reconstructed 3-dimensional (3D) images, that could guide the production, via a 3D printing technology, accurate resin, polymer, metal and degradable biomaterial prosthesis.…”

Section: A Look Into the Futurementioning

confidence: 99%

Materials and techniques in chest wall reconstruction: a review

et al. 2017

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Extensive chest wall resection and reconstruction are a challenging procedure that requires a multidisciplinary approach, including input from thoracic surgeon, plastic surgeon and oncologist. In particular chest wall neoplastic pathology is associated with high surgical morbidity and can result in full thickness defects hard to reconstruct. The goals of a successful chest wall reconstruction are to restore the chest wall rigidity, preserve pulmonary mechanic and protect the intrathoracic organs minimizing the thoracic deformity. In case of large full thickness defects synthetic, biologic or composite meshes can be used, with or without titanium plate to restore thoracic cage rigidity as like as more recently the use of allograft to reconstruct the sternum. After skeletal stability is established full tissue coverage can be achieved using direct suture, skin graft or local advancement flaps, pedicled myocutaneous flaps or free flaps. The aim of this article is to illustrate the indications, various materials and techniques for chest wall reconstruction with the goal to obtain the best chest wall rigidity and soft tissue coverage. by scapula and shoulder girdle, with the exception of defects lower than 4th rib posteriorly, with the tip of the scapula at risk to entrapment (3,12,13). With the increased availability of reconstruction materials, then, and particularly biologic materials, some surgeons proposed the reconstruction of nearly all chest wall defects, with the objective to avoid patient perception of chest wall instability (3,5,13).The primary goals of all chest wall reconstructions are to obliterate dead space, restore chest wall rigidity, preserve pulmonary mechanic, protect intrathoracic organs, provide soft tissue coverage, minimize deformity and allow patients to receive adjuvant radiotherapy if indicated (3,9). Therefore, a multidisciplinary approach, including input from thoracic surgeons, plastic surgeons, neurosurgeons as well as medical and radiation oncologists is essential.Actually several synthetic, biologic, and metallic materials are available to reconstruct the chest wall defects, but each prosthetic material has its own advantages and disadvantages and none have proven to be clearly superior (4,12). In particular, the benefit of each material and technique of reconstruction need to be weighed against to main indicators, as the risk of infection and other major complications that could be fail the reconstructive result.The recent advance in allograft and homograft production have provided new alternatives for restoring structural stability, preventing the infective complications (3,14).We would describe the main reconstructive techniques and materials more adopted on Literature reports and an overview to the incoming future of chest wall reconstruction. Synthetic, biologic and titanium meshesThe use of a metal prostheses was first reported by a French surgeon in 1909 (15), but in the 1940s better-tolerated and easier to use materials, as plastic components emerged, modifying the ...

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Titanium Implant Failure After Chest Wall Osteosynthesis

Abstract: Long-term follow-up after chest wall osteosynthesis using titanium implants is required, especially in anteriorly placed implants. The high rate of implant failure at 1 year advocates for early removal whenever possible and suggests the need for improvements in design.

Cited by 60 publications

References 19 publications

Implant Failure: STRATOS System for Pectus Repair

Implant Failure: STRATOS System for Pectus Repair

Short and long-term results of sternectomy for sternal tumours

Materials and techniques in chest wall reconstruction: a review

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