A rotating-hinge knee replacement for malignant tumors of the femur and tibia

Kawai, Akira; Healey, John H.; Boland, Patrick J.; Athanasian, Edward A.; Jeon, Dae‐Geun

doi:10.1016/s0883-5403(99)90124-9

Cited by 94 publications

(96 citation statements)

References 21 publications

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“…This observation has also been made by other authors [11][12][13]. The better patient survival for proximal tibial tumours has been attributed to the smaller size of the lesion at presentation and earlier detection of proximal tibial tumours [9].…”

Section: Discussionsupporting

confidence: 73%

“…This places tremendous responsibility on tumour surgeons to provide durable and fully functional solutions for the patient. Progress in biomedical engineering along with better surgical and chemotherapeutic techniques has increased overall 5-year survival rate after endoprosthetic replacement from 20% to 85% in the past three decades [1,4,8,12,15].…”

Section: Introductionmentioning

confidence: 99%

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Distal femoral tumours treated by resection and custom mega-prosthetic replacement

Natarajan

Sivaseelam

Ayyappan

et al. 2005

International Orthopaedics (SICOT)

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We have analysed the results of 246 cases of distal femoral tumours treated by resection and prosthetic replacement between 1988 and 2002. Patient ages ranged from 6-67 years averaging 24 years; 133 were males. The most common tumour was osteosarcoma (67% of patients). The follow-up ranged from 2 to 14 years. Stage II tumours were seen in 72% of patients. The technique of sleeve resection of the quadriceps musculature was followed to achieve local clearance of the tumour. The prosthesis used was a rotating hinge custom mega-prosthesis manufactured locally. The functional result achieved was excellent or good in 87%; 86% of the patients had no evidence of disease, and 13% had died. The 10-year patient survival was 76.9%. Periprosthetic fracture and infection were the most common complications.Résumé Nous avons analysé les résultats de 246 cas de tumeurs fémorales distales traitées par résection et remplacement prothétique entre 1988 et 2002. L'âges des malades s'étendait de 6 à 67 ans avec une moyenne de 24 ans. Cent trente trois étaient des hommes. La tumeur la plus fréquente était l'ostéosarcome (67% des malades). Le suivi était de 2 à 14 années. Des tumeurs de stade II étaient présentes chez 72% des malades. La technique de résection a été conduite pour faire une ablation complète de la tumeur. La prothèse qui a été utilisée était une méga prothèse à charnière rotatoire fabriqué localement. Le résultat fonctionnel obtenu était excellent ou bon dans 87%. Quatre-vingt-six pourcent des malades n'avait pas d'évidence de maladie et 13% étaient morts. La survie à dix ans était de 76,9%. Les fractures périprothétiques et l'infection étaient les complications les plus fréquentes.

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Section: Discussionsupporting

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Distal femoral tumours treated by resection and custom mega-prosthetic replacement

Natarajan

Sivaseelam

Ayyappan

et al. 2005

International Orthopaedics (SICOT)

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“…6), resection of extra tissue, such as uninvolved joint surfaces, can have major long-term functional consequences [10,13,14,21,27]. Here, we evaluated whether a custom jigassisted bone tumor resection technique reproduces a welldefined preoperative plan more accurately and consistently than traditional manual resection techniques.…”

Section: Discussionmentioning

confidence: 99%

Surgical Technique: Computer-generated Custom Jigs Improve Accuracy of Wide Resection of Bone Tumors

Khan

Lipman

Pearle

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Manual techniques of reproducing a preoperative plan for primary bone tumor resection using rudimentary devices and imprecise localization techniques can result in compromised margins or unnecessary removal of unaffected tissue. We examined whether a novel technique using computer-generated custom jigs more accurately reproduces a preoperative resection plan than a standard manual technique. Description of TechniqueUsing CT images and advanced imaging, reverse engineering, and computer-assisted design software, custom jigs were designed to precisely conform to a specific location on the surface of partially skeletonized cadaveric femurs. The jigs were used to perform a hemimetaphyseal resection. Methods We performed CT scans on six matched pairs of cadaveric femurs. Based on a primary bone sarcoma model, a joint-sparing, hemimetaphyseal wide resection was precisely outlined on each femur. For each pair, the resection was performed using the standard manual technique on one specimen and the custom jig-assisted technique on the other. Superimposition of preoperative and postresection images enabled quantitative analysis of resection accuracy. Results The mean maximum deviation from the preoperative plan was 9.0 mm for the manual group and 2.0 mm for the custom-jig group. The percentages of times the maximum deviation was greater than 3 mm and greater than 4 mm was 100% and 72% for the manual group and 5.6% and 0.0% for the custom-jig group, respectively. Conclusions Our findings suggest that custom-jig technology substantially improves the accuracy of primary bone tumor resection, enabling a surgeon to reproduce a given preoperative plan reliably and consistently.

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“…Although endoprosthetic reconstruction is a well-accepted method for treatment of primary bone tumors of the distal femur, the long-term survival of these implants varies from 67% to 90% at 5 years [22]. The complications for this reconstruction option are aseptic loosening (3%-40%), infection (3%-28%), and mechanical wear/prosthetic or component fracture (1%-67%) [2,6,8,12,13,15,19,27,30,33]. Intercalary allografts offer a joint-sparing reconstructive option, but nonunion, delayed union, infection, and graft fractures are well-described complications [20,21,23,24].…”

Section: Introductionmentioning

confidence: 99%

Megaprosthesis versus Condyle-sparing Intercalary Allograft: Distal Femoral Sarcoma

Zimel¹,

Cizik

Rapp³

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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Although functionally appealing in preserving the native knee, the condyle-sparing intercalary allograft of the distal femur may be associated with a higher risk of tumor recurrence and endoprosthetic replacement for malignant distal femoral bone tumors. We therefore compared the risk of local tumor recurrence between patients in these two types of reconstruction groups. We retrospectively reviewed 85 patients (mean age, 22 years; range, 4-82 years), 38 (45%) of whom had a condyle-sparing allograft and 47 (55%) of whom had endoprostheses. The minimum followup for both groups was 2 years (mean, 7 years; range, 2-19 years). Local recurrences occurred in 11% (five of 47) of the patients having implants versus 18% (seven of 38) of the patients having allografts. Using time to local recurrence as an end point, the Kaplan-Meier

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A rotating-hinge knee replacement for malignant tumors of the femur and tibia

Cited by 94 publications

References 21 publications

Distal femoral tumours treated by resection and custom mega-prosthetic replacement

Distal femoral tumours treated by resection and custom mega-prosthetic replacement

Surgical Technique: Computer-generated Custom Jigs Improve Accuracy of Wide Resection of Bone Tumors

Megaprosthesis versus Condyle-sparing Intercalary Allograft: Distal Femoral Sarcoma

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