Bone Metastases – Pathophysiology, Diagnostic Testing and Therapy (Part 2)

Koob, Sebastian; Kehrer, Michael; Strauß, Andreas C.; Jacobs, Cheryl; Wirtz, Dieter Christian; Schmolders, Jan

doi:10.1055/a-0762-1071

Cited by 4 publications

(3 citation statements)

References 49 publications

(41 reference statements)

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“…Infection rate after implantations of mega-implants ranges from 3 to 36% 5 , 11 , 14 , 16 , 18 , 20 – 22 , 24 , 25 .…”

Section: Discussionmentioning

confidence: 99%

Management of complications of mega-implants following treatment of primary and periprosthetic fractures of the lower extremities

Ghanem,

Kalb,

Heyde

et al. 2023

Sci Rep

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In recent years, indications for implanting mega-implants were established in managing major bone defects linked to revision arthroplasty due to loosening, periprosthetic fractures, re-implantation following periprosthetic joint infection, non-union following fractures as well as complex intraarticular primary fractures. This study was conducted to discuss and analyze the strategy of diagnosis and management of complications following the use of mega-implants in treating primary and periprosthetic fractures of the lower extremities. This is a monocentric retrospective study. Patients aged ≥ 18 years who underwent implantation of a megaendoprosthesis due to periprosthetic or primary fractures of the lower extremity between January 2010 and February 2023 were identified from the authors’ hospital information system. We identified 96 patients with equal numbers of fractures (71 periprosthetic fractures and 25 primary fractures). 90 cases out of 96 were investigated in this study. The drop-out rate was 6.25% (six cases). The average follow-up period was 22 months (1 to 8 years) with a minimum follow-up of 1 year. The diagnosis of complications was provided on the basis of subjective symptoms, clinical signs, radiological findings and laboratory investigations such as C-reactive protein, leucocyte count and the microbiological findings. The indications for implantations of modular mega-implants of the lower extremities were periprosthetic fractures (65 cases/72.22%) and primary fractures (25 cases/27.78%). Pathological fractures due to malignancy were encountered in 23 cases (25.56%), in one case due to primary tumor (1.11%) and 22 cases due to metastatic lesions (24.44%). Two cases (2.22%) presented with primary intraarticular fractures with severe osteoporosis and primary arthrosis. In all cases with malignancy staging was performed. Regarding localization, proximal femur replacement was encountered in 60 cases (66.67%), followed by distal femur replacement (28 cases/31.11%) and total femur replacement (2 cases/2.22%). The overall complication rate was 23.33% (21 complications in 21 patients). The most common complication was dislocation which was encountered in nine cases (10%), all following proximal femoral replacement (9 cases out of 60, making 15% of cases with proximal femoral replacement). The second most common complication was infection (six cases, 6.67%), followed by four aseptic loosenings (4.44%), further intraoperative periprosthetic fracture in one case (1.11%) and a broken implant in one case (1.11%). We noticed no cases with wear and tear of the polyethylene components and no cases of disconnections of the modular components. Mega-endoprostheses enable versatile management options in the treatment of primary and periprosthetic fractures of the lower extremities. The rate of complications such as loosening, implant failure, dislocation and infection are within an acceptable range in this preliminary analysis. However, implantation of mega-endoprostheses must be strictly indicated due the limited salvage options following surgery.

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“…Infection rate after implantations of mega-implants ranges from 3 to 36% 5 , 11 , 14 , 16 , 18 , 20 – 22 , 24 , 25 .…”

Section: Discussionmentioning

confidence: 99%

Management of complications of mega-implants following treatment of primary and periprosthetic fractures of the lower extremities

Ghanem,

Kalb,

Heyde

et al. 2023

Sci Rep

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“…Gleichwohl bestehen ein hohes Infekt- und Komplikationsrisiko peri- und postoperativ [ 4 , 8 ]. Dennoch sind unter Berücksichtigung der, durch neue Immun- und Hormontherapien, immer längeren Überlebenszeiten von Patienten mit Karzinomen Lösungen für eine Wiedererlangung von Mobilität, auch bei größeren Destruktionen des Hüftgelenkes anzubieten und zu entwickeln [ 10 , 13 ]. In einer vorangegangenen Publikation derselben Arbeitsgruppe wurde die Anwendung der MRS-C-Abstützschale („MRS-TITAN® Comfort“, Peter Brehm GmbH, Weisendorf, Deutschland) in der Hüftrevisionsendoprothetik mit guten operativen und funktionellen Ergebnissen vorgestellt [ 15 ].…”

Section: Vorbemerkungenunclassified

Rekonstruktion von metastasenbedingten Defekten des Azetabulums mittels der MRS-C-Abstützschale

Koob,

Kohlhof,

Randau

et al. 2023

Oper Orthop Traumatol

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Zusammenfassung Operationsziel Stabilisierung des metastatisch befallenen Azetabulums mit einer modularen, zementaugmentierten Abstützschale zur Remobilisation von onkologischen Patienten auch im fortgeschrittenen Krankheitsstadium. Indikationen Metastasenbedingte azetabuläre Defektsituationen (Metastatic Acetabular Classification, MAC 2–4) bei mittel- und langfristiger Überlebensprognose des Patienten. Kontraindikationen Starke Einschränkung der Überlebensprognose (< 6 Wochen), persistierendes lokales Infektgeschehen, Vorliegen eines primären Knochentumors mit kurativem Therapievorgehen, ausgeprägte Beckendiskontinuität, laufende wundheilungskompromittierende Chemo- oder Immuntherapie. Operationstechnik Standardhüftgelenkzugang. Resektion bzw. Kürettage der Azetabulummetastase und vorsichtiges Auffräsen zur Einbringung der Probeschale. Nach Festlegung der Schalengröße, Vorbohren der Dom- und Laschenschrauben und Einbringen des Zementes durch die zentrale Schalenöffnung in den azetabulären Defekt. Anschließend Festdrehen der Schrauben im Sinne einer Verbundosteosynthese. Einbringen einer modularen Pfannenkomponente oder Einzementierung eines tripolaren Pfannensystems in Verbindung mit einer Standardfemurschaftprothese oder einem proximalen modularen Femurersatz. Weiterbehandlung Faden‑/Klammerentfernung nach 10 Tagen. Mobilisation unter schmerzadaptierter Vollbelastung. Gangschulung an 2 Unterarmgehstützen. Physiotherapie zur Kräftigung der hüftumgreifenden Muskulatur. Je nach Tumorboard-Beschluss ggf. adjuvante Radiatio nach Abschluss der primären Wundheilung und Fortsetzung der systemischen Therapie. Ergebnisse Im Zeitraum 2012 bis 2019 wurden 14 Patienten mit einem metastasenbedingten azetabulären Defekt mit einer zementaugmentierten Abstützschale („MRS-TITAN® Comfort“, MRS-C, Peter Brehm GmbH, Weisendorf, Deutschland) versorgt. Der Harris-Hip-Score verbesserte sich durchschnittlich um 23,2 Punkte bei einem mittleren Überleben der Patienten von 9,7 Monaten aufgrund der reduzierten Patientenprognose bei Karzinomerkrankung. Bei 13 der 14 implantierten Abstützschalen waren keine Folge- oder Revisionseingriffe notwendig. In einem Fall kam es zu einem weichteildefektbedingten periprothetischen Infekt und zur Explantation der Abstützschale.

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“…Emergency surgical indications for bone metastases include neurological deficits or paraplegia caused by spinal metastases and pathological fractures, and surgical indications for fracture risk and refractory pain are evaluated as selective. Notably, the patient’s life expectancy and prognosis should be considered when evaluating the choice of surgery [ 209 ].…”

Section: Therapies For Bone Metastasismentioning

confidence: 99%

Bone Metastasis of Breast Cancer: Molecular Mechanisms and Therapeutic Strategies

Pang

Gan

et al. 2022

Cancers

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Bone metastasis is a common complication of many types of advanced cancer, including breast cancer. Bone metastasis may cause severe pain, fractures, and hypercalcemia, rendering clinical management challenging and substantially reducing the quality of life and overall survival (OS) time of breast cancer patients. Studies have revealed that bone metastasis is related to interactions between tumor cells and the bone microenvironment, and involves complex molecular biological mechanisms, including colonization, osteolytic destruction, and an immunosuppressive bone microenvironment. Agents inhibiting bone metastasis (such as bisphosphate and denosumab) alleviate bone destruction and improve the quality of life of breast cancer patients with bone metastasis. However, the prognosis of these patients remains poor, and the specific biological mechanism of bone metastasis is incompletely understood. Additional basic and clinical studies are urgently needed, to further explore the mechanism of bone metastasis and develop new therapeutic drugs. This review presents a summary of the molecular mechanisms and therapeutic strategies of bone metastasis of breast cancer, aiming to improve the quality of life and prognosis of breast cancer patients and provide a reference for future research directions.

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Bone Metastases – Pathophysiology, Diagnostic Testing and Therapy (Part 2)

Cited by 4 publications

References 49 publications

Management of complications of mega-implants following treatment of primary and periprosthetic fractures of the lower extremities

Management of complications of mega-implants following treatment of primary and periprosthetic fractures of the lower extremities

Rekonstruktion von metastasenbedingten Defekten des Azetabulums mittels der MRS-C-Abstützschale

Bone Metastasis of Breast Cancer: Molecular Mechanisms and Therapeutic Strategies

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