Allograft-prosthetic composite versus megaprosthesis in the proximal tibia—What works best?

Müller, Daniel; Beltrami, Giovanni; Scoccianti, Guido; Cuomo, Pierluigi; Capanna, Rodolfo

doi:10.1016/j.injury.2016.07.043

Cited by 22 publications

(27 citation statements)

References 20 publications

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“…Moreover, the complications were more severe when compared with patients treated with the other surgical methods studied. In particular, the risk of amputation due to infection was highest in patients treated with tumor prosthesis, and infection occurred in the early stages after the operation, consistent with reported findings for proximal tibial replacement following primary malignant bone tumor resection, where infection rates ranged between 6% and 44% (Flint et al 2006, Myers et al 2007, Wu et al 2008, Schwartz et al 2010, Mavrogenis et al 2013, Muller et al 2016. Amputation is the most devastating complication following proximal tibia reconstruction surgery.…”

Section: Discussionsupporting

confidence: 72%

Surgical treatment of skeletal metastases in proximal tibia: a multicenter case series of 74 patients

et al. 2021

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Background and purpose — The proximal tibia is a rare site for metastatic bone disease and is a challenging anatomical site to manage due to the proximity to the knee joint and poor soft tissue envelope. We investigated implant survival and complications of different surgical strategies in the treatment of proximal tibia pathological fractures. Patients and methods — The study comprised a 4 medical center, retrospective analysis of 74 patients surgically treated for metastases of the proximal tibia. Patient records were reviewed to identify outcome, incidence, and type of complications as well as contributing factors. Results — Reconstruction techniques comprised cement-augmented osteosynthesis (n = 33), tumor prosthesis (n = 31), and total knee arthroplasty with long cemented stems (n = 10). Overall implant survival was 88% at 6 months and 1 year, and 67% at 3 years. After stratification by technique, the implant survival was 82% and 71% at 1 and 3 years with tumor prosthesis, 100% at 1 and 3 years with total knee arthroplasty, and 91% at 1 year and 47% at 3 years with osteosynthesis. Preoperative radiotherapy decreased implant survival. Complications were observed in 19/74 patients. Treatment complications led to amputation in 5 patients. Interpretation — In this study, the best results were seen with both types of prothesis reconstructions, with good implant survival, when compared with treatment with osteosynthesis. However, patients treated with tumor prosthesis showed an increased incidence of postoperative infection, which resulted in poor implant survival. Osteosynthesis with cement is a good alternative for patients with short expected survival whereas endoprosthetic replacement achieved good medium-term results.

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Section: Discussionsupporting

confidence: 72%

Surgical treatment of skeletal metastases in proximal tibia: a multicenter case series of 74 patients

et al. 2021

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“…43 The use of skeletal allograft surrounding an endoprosthesis allows for improved distribution of forces, while also providing a biologic surface for reattachment of tendons. 45 Allograft prosthetic composites are difficult and very technically involved, requiring longer operating time and thus potential increased risk of infection. Additionally, studies have widely reported high rates of fracture, often attributed to allograft resorption.…”

Section: Discussionmentioning

confidence: 99%

Complications following allograft reconstruction for primary bone tumors: Considerations for management

Ippolito

Martinez

Thomson

et al. 2019

Journal of Orthopaedics

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The aim of this study was to investigate complication rates and types following allograft reconstruction and discuss unique considerations for management. Methods: Seventy-four consecutive patients underwent large segment allograft reconstruction following resection of primary musculoskeletal tumors from 1991 to 2016. Mean patient age was 32 ± 20 years (range, 5-71 years). Minimum follow-up was 2 years unless patients were lost to disease prior. Mean follow-up was 105 months. Results: Thirty-five patients had complications requiring subsequent surgery at a mean of 30 months (range, 1-146 months) post-operatively. Individual complication rates were 29%, 50%, and 42% for Allograft Prosthetic Composite, Intercalary, and Osteoarticular allograft reconstruction, respectively. Risk factors for complication included age less than 30 (OR 4.5; p = 0.002), male gender (OR 2.8; p = 0.031), chemotherapy (OR 4.4; p = 0.003), lower extremity disease (OR 3.4; p = 0.025). In patients with complications, limb-retention rate was 91% and mean MSTS scores were 23.6. Conclusion: Despite considerable complication rates, management with a systematic approach results in successful outcomes with limb-retention greater than 90% and mean MSTS scores of 79%. In carefully selected patients, allografts provide a reliable method of reconstruction with treatable complications occurring at a mean of 30 months.

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“…Soft-tissue coverage can be more difficult with allograft-prosthetic composites because megaprostheses can be designed to be smaller, whereas the combination of the allograft, the prosthesis, and the stabilizing plate that is often used can make the construct bulky. 46 A recent review comparing allograft-prosthetic composites with megaprostheses highlighted a 93% 10-year survival rate of allograftprosthetic composites versus 78.8% for megaprostheses, with improved function of the extensor mechanism in the former 46 (Figure 5).…”

Section: Proximal Tibiamentioning

confidence: 99%

Lower Extremity Megaprostheses in Orthopaedic Oncology

Calderón

Kuechle

Raskin

et al. 2018

J Am Acad Orthop Surg

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The megaprosthesis is designed to reproduce the form and function of a removed or lost large segment of bone and accompanying soft tissues. Slow but substantial improvements in the design and surgical implementation of these devices have advanced the capacity to restore patients' functional abilities. The essential challenges include identifying the ideal materials, bonding these materials to bone and soft tissues, reproducing functional anatomy, and adapting to the growing skeleton. Failure of these devices can result from soft-tissue insufficiency, aseptic loosening, structural failures, infection, and tumor recurrence. The history of the use of megaprostheses in the pelvis, proximal femur, distal femur, total femur, and proximal tibia has shown that each anatomic area presents unique challenges. Improvements that have been made over the years will guide the development of the next generation of devices. Despite early high complication rates, these devices are a reasonable choice in the right patient.

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Allograft-prosthetic composite versus megaprosthesis in the proximal tibia—What works best?

Cited by 22 publications

References 20 publications

Surgical treatment of skeletal metastases in proximal tibia: a multicenter case series of 74 patients

Surgical treatment of skeletal metastases in proximal tibia: a multicenter case series of 74 patients

Complications following allograft reconstruction for primary bone tumors: Considerations for management

Lower Extremity Megaprostheses in Orthopaedic Oncology

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