A comparison of osteoarticular allografts and allograft-prosthesis composites for reconstruction of the distal femur after resection of a bone tumour in childhood

Jamshidi, Khodamorad; Bagherifard, Abolfazl; Mirzaei, Alireza

doi:10.1302/0301-620x.104b10.bjj-2022-0235.r1

Cited by 10 publications

(11 citation statements)

References 22 publications

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“…The last few decades have seen continuous optimizations in the surgical treatment of extremity STS with function-preserving alternatives for local control without compromising on overall disease survival. [12][13][14][15] Optimizations of adjuvant treatments such as radiotherapy, along with surgical procedures, will also result in better STS control in future studies. This study compared the effect of preoperative and postoperative radiotherapy on the complications and oncologic outcomes of the extremity STS.…”

Section: Discussionmentioning

confidence: 99%

Comparison of preoperative and postoperative radiation therapy for extremity soft-tissue sarcoma: a randomized clinical trial

Mahmoudi

Arefpour

Jamshidi

et al. 2021

Current Orthopaedic Practice

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Background:The optimal sequencing of radiotherapy and surgery for the treatment of soft-tissue sarcoma (STS) is an ongoing source of controversy. In this study, the authors compared preoperative and postoperative radiotherapy in patients with extremity STS. Methods:Eighty patients with localized extremity STS were randomly assigned to either preoperative or postoperative radiotherapy group. Baseline characteristics of the patients were not significantly different between the two study groups. Primary outcome measures were pain, acute complications (wound dehiscence and infection), and late complications (limb edema, subcutaneous fibrosis, and joint stiffness). The severity of late complications was evaluated using the radiation therapy oncology group criteria. Secondary outcome measures were oncologic outcomes, including local recurrence and distant metastasis. Results:The mean pain level was not significantly different between the two groups (P = 0.1). Infection was not seen in any of the patients. The rate of wound dehiscence and infection was not significantly different between the two groups (P = 0.32 for both). Of the late complications, the rate of limb edema and subcutaneous fibrosis was similar in the two groups (P = 0.16 and P = 0.35, respectively). In contrast, the rate of joint stiffness was significantly more in the postoperative radiotherapy group (P < 0.001). The severity of all three late complications also was more in the postoperative radiotherapy group at 6 and 12 mo. There were no significant differences between the two groups regarding local recurrence and distant metastasis (P = 0.99 and P = 0.77, respectively). Conclusions:The authors suggest preoperative radiotherapy in patients with localized extremity STS because of its lower rate of and less severe complications, particularly joint stiffness.

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Section: Discussionmentioning

confidence: 99%

Comparison of preoperative and postoperative radiation therapy for extremity soft-tissue sarcoma: a randomized clinical trial

Mahmoudi

Arefpour

Jamshidi

et al. 2021

Current Orthopaedic Practice

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“…The median time to the appearance of HO was shorter than the median time to the appearance of LR (8 months [3][4][5][6][7][8][9][10][11][12][13] versus 16 months [11][12][13][14][15][16][17][18][19][20][21]; p < 0.001). The median time to the initial LR of osteosarcoma was reported to be 14 months in an earlier study [20].…”

Section: Features That Allow the Surgeon To Differentiate Ho From Loc...mentioning

confidence: 99%

“…The distal femur is the most common site of primary bone sarcoma, followed by the proximal tibia [5,19]. An oncologic prosthesis is a popular option for the reconstruction of the defect of these areas after resection of a bone sarcoma because of its availability, durability, and permitting early weightbearing [10,13]. Even so, local recurrence (LR) remains a devastating oncologic outcome after the resection of musculoskeletal tumors [11,12,23] with morbidity and mortality, despite adjuvant therapy and obtaining adequate margin.…”

Section: Introductionmentioning

confidence: 99%

How Can We Differentiate Local Recurrence From Heterotopic Ossification After Resection and Implantation of an Oncologic Knee Prosthesis in Patients with a Bone Sarcoma?

Jamshidi

Bagherifard

Al-Baseesee

et al. 2020

Clin Orthop Relat Res

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Background Heterotopic ossification (HO) is common after total joint arthroplasty and usually does not cause diagnostic problems. However, the occurrence of HO after oncologic prostheses implantation can be troublesome as it may mimic a locally recurrent tumor. Because this distinction could have a profound impact on the surgeon and patient, it is important to distinguish the two entities; to our knowledge, no study has evaluated this after oncologic endoprosthetic reconstruction around the knee after tumor resection. Questions/purposes (1) How common is the occurrence of HO compared with local recurrence (LR) after resection of bone sarcoma and the use of an oncologic knee prosthesis? (2) Are there any factors associated with the development of HO after limb salvage procedures with an endoprosthesis? (3) What features allow the surgeon to differentiate HO from a locally recurrent tumor in this setting? Methods Between 2002 and 2018, we performed 409 resections of primary bone tumors followed by reconstructions with oncologic endoprostheses. Of these, 17% (71 of 409) died before 2 years and did not have HO at that time, 2% (8 of 409) were lost to follow-up before 2 years, and another 2% (10 of 409) did not have radiographs available at a minimum of 2 years after surgery (and had not developed HO before then), and so could not be analyzed, leaving 320 patients for analysis in this retrospective study. Forty-two patients were excluded; 2% (5 of 320) for a history of failed allograft reconstruction, 3% (8 of 320) for pathologic fracture at presentation, 2% (6 of 320) for inadequate or complicated biopsy, 1% (2 of 320) for stem fractures, 2% (7 of 320) for stem loosening, and 4% (14 of 320) for extracortical bone bridging, leaving 278 patients for final evaluation. Two observers analyzed AP and lateral radiographs for signs of HO at a mean follow-up of 63 ± 33 months after surgery. We defined HO as extraskeletal bone formation in soft tissues. The primary study endpoint was survivorship free from HO, as ascertained by a competing-risks estimator. To identify factors associated with HO appearance, the demographic, radiographic, clinical, pathologic, and surgical characteristics were compared between patients with HO and those who had no lesion. Characteristic features were also compared between patients with HO and those with LR to help their differentiation. Univariate analysis was used for all statistical evaluations. Results HO developed in 8% (21 of 278) of patients in whom oncologic knee prosthesis was implanted. LR developed in 10% (28 of 278) of the patients. According to survivorship estimates, the HO-free survival rate was not different from the LR-free survival rate at 2 years after oncologic knee reconstruction (76 ± 5% [95% CI 63 to 87] versus 74 ± 5% [95% CI 62 to 88]; p = 0.19). History of infection was more common in patients with HO than in patients with no lesion (19% [4 of 21] versus 5% [12 of 229], Odds ratio [OR] 6 [95% CI 2 to 17]; p < 0.001). The male sex was more common in the HO group as well (76% [16 of 21] versus 55% [128 of 229], OR 2 [95% CI 1 to 5]; p = 0.03). The Modular Universal Tumor and Revision System prosthesis was more frequently used in patients with HO (67% [14 of 21]) compared to those with no lesions (40% [92 of 229]; OR 2 [95% CI 1 to 5]; p = 0.02). The lesion border in radiographs was ill-defined in 19% (4 of 21) of patients with HO and 100% (28 of 28) of patients with LR (OR 8 [95% CI 3 to 20]; p < 0.001). The median time to the appearance of HO was shorter than the time to LR (8 months [3 to 13] versus 16 months [11 to 21], [95% CI 10 to 13]; p < 0.001). Pain at presentation was more frequent in patients with LR than in those with HO (86% [24 of 28] versus 14% [3 of 21], OR 36 [95% CI 7 to 181]; p < 0.001). Conclusion HO may occur after the use of oncologic knee prostheses for reconstruction after tumor resection. In most patients, HO could be differentiated from local recurrence through identifying a well-defined border on radiographs. Otherwise, factors such as an earlier time of presentation and absence of pain could suggest an HO, rather than an LR. Level of Evidence Level III, therapeutic study.

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“…There also remain indications for bony reconstruction beyond impaction grafting. In this issue, Jamshidi et al 10 compare osteoarticular allografts with allograft prosthetic composites in skeletally immature children. These are tremendously challenging situations that require creative solutions.…”

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confidence: 99%

Bone loss: still seeking solutions

Haddad

2022

The Bone & Joint Journal

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A comparison of osteoarticular allografts and allograft-prosthesis composites for reconstruction of the distal femur after resection of a bone tumour in childhood

Cited by 10 publications

References 22 publications

Comparison of preoperative and postoperative radiation therapy for extremity soft-tissue sarcoma: a randomized clinical trial

Comparison of preoperative and postoperative radiation therapy for extremity soft-tissue sarcoma: a randomized clinical trial

How Can We Differentiate Local Recurrence From Heterotopic Ossification After Resection and Implantation of an Oncologic Knee Prosthesis in Patients with a Bone Sarcoma?

Bone loss: still seeking solutions

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