The use of a modular titanium endoprosthesis in skeletal reconstructions after bone tumor resections: method presentation and analysis of 37 cases

Abstract

We analyzed 37 patients who underwent segmental wide resection of bone tumors and reconstruction with a modular titanium endoprosthesis at the Orthopaedic Oncology Group, between 1992 and 1998. Twelve patients were male and 25 were female, with a mean age of 30 years (9 - 81). The mean follow-up was 14 months (2 - 48). The diagnoses were: osteosarcoma (14 cases), metastatic carcinoma (10), Ewing's sarcoma (4), giant cell tumor (4), malignant fibrous histiocytoma (3), chondrosarcoma (1), and aneurysmal bone cyst (1). Eleven articulated total knee, 8 partial proximal femur with bipolar acetabulum, 8 partial proximal humerus, 3 total femur, 2 partial proximal tibia, 2 diaphyseal femur, 2 diaphyseal humerus, and 1 total proximal femur with cementless acetabulum endoprosthesis implant procedures were done. The complications related to the procedure included: infection (5 cases), dislocation (3), module loosening (1), and ulnar nerve paresthesia (1). We used the following criteria for the clinical evaluation: presence of pain, range of motion, reconstruction stability, surgical and oncologic complications, and patient acceptance. The results were good in 56.8% of the cases, regular in 32.4% and poor in 10.8%.

Treatment of proximal humeral chondrosarcoma with resection and allograft

“…5,8,10,13,14,17,26,33 Several reports suggest tumors of bone, including chondrosarcomas that arise in the proximal humerus, are more difficult to treat than other sites because of the proximity of vessels and nerves. 3,4,6,7,11,12,16,27,30,31,34,35 The muscular attachments to the humerus at the shoulder and the alterations in shoulder stability resulting from resection make this site a more complex problem in reconstruction. All reconstruction approaches, including fibular transplant, metallic implants, arthrodesis, and allograft reconstruction, may result in functional problems for the patient.…”

“…All reconstruction approaches, including fibular transplant, metallic implants, arthrodesis, and allograft reconstruction, may result in functional problems for the patient. 3,4,6,7,11,12,16,27,30,31,34,35 The complications for allograft transplants after tumor resection in any site include infection, allograft fracture, and nonunion. These complications and local recurrence have a negative effect on outcome regardless of type of tumor treated or anatomic site.…”

“…These complications and local recurrence have a negative effect on outcome regardless of type of tumor treated or anatomic site. 2,6,15,18,20,[22][23][24][25]28,29,32,35 The purpose of this study was to define the characteristics of chondrosarcomas of the proximal humerus, to evaluate the variation in clinical outcome for these tumors of the proximal humerus compared with other anatomic sites, to assess the problems related to complications of cadaveric allografts in this anatomic site, and to establish the quality of the results when allografts are used in the treatment of chondrosarcomas of the proximal humerus, specifically in terms of functional capabilities. In addition, we compared the 31 patients in this series with 26 patients treated by metallic implants by our group.…”

Modular endoprosthesis for mandibular reconstruction: A preliminary animal study

“…For example, if more bone needs to be removed than planned, the planned prosthetic device may not fit and the search for a replacement will be time consuming and difficult. A modular system has been developed that consists of different components with various dimensions to allow for precise adaptation of the prosthesis to the defect 4,7 . These prostheses are fixed with cement, which eliminates the need for bolts and screws.…”

Comportamento mecânico e análise dimensional de parafusos corticais de aço inoxidável e liga de titânio submetidos a ensaios de torção

“…Por estas características, a liga de titânio é regularmente utilizada em cirurgias ortopédicas (CROCI, 2000;LEIVAS, 1996e BANOVETZ et al, 1996 e odontológicas (PURICELLI; PESCHKE, 2000).…”