Endoprosthetic Replacement for Stage IIB Osteosarcoma

Eċkardt, Jeffrey J.; Eilber, Frederick C.; Rosen, Gerald; Mirra, J.; Dorey, Frederick J.; Ward, William G.; Kabo, J. Michael

doi:10.1097/00003086-199109000-00027

Cited by 75 publications

(92 citation statements)

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“…Nevertheless, the overall results, indicating a survival rate of 61.6%, clearly justify the use of this procedure in specialised centres. The critical argument of repeated revisions being required in patients provided with endoprostheses [1] is counterbalanced by the fact that the functional outcome in these patients is good and the quality of life remains high, even after several revisions [3]. One problem during the first two periods was the high rate of intralesional resections within the pelvis and the spinal region when en bloc resection without implantation of a prosthesis was used.…”

Section: Discussionmentioning

confidence: 99%

Advances in bone tumour treatment in 30 years with respect to survival and limb salvage. A single institution experience

Kotz

Dominkus

Zettl

et al. 2002

International Orthopaedics (SICOT)

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We analysed 721 patients with primary malignant bone tumours treated in a single institution with regard to diagnosis, treatment and prognosis. From 1965From to 1974 patients were treated, of whom 17% had no surgery, 36% underwent resection and 46% underwent amputation. Margins of resection were intralesional in 21%, 72% of patients received chemotherapy and overall survival rate was 24%. From 1975 to 1984, 174 patients were treated, of whom 12% had no surgery, 54% underwent limb salvage procedures and 34% underwent amputation or resection-replantation. Margins of resection were intralesional in 16% 67% of patients received chemotherapy and overall survival rate was 46%. From 1985 to 1994, 393 patients were treated, of whom 7% had no surgery, 77% underwent limb salvage procedures -mainly with endoprostheses -and 15% underwent amputation or resection-replantation. Margins of resection were intralesional in 12%, 68% of patients received chemotherapy and overall survival rate was 62%. Advancements in the treatment of primary malignant bone tumours justify limb salvage procedures in combination with highly effective polychemotherapy in specialised centres and has resulted in an overall survival rate of more than 60%.Résumé 721 malades porteur d'une tumeur osseuse maligne primitive traités dans une seule institution ont été analysés quant à diagnostic, traitement et pronostic. De 1965 à 1974, parmi 154 malades traités, 17% n'avaient aucune chirurgie, 36% ont eu une résection et 46% ont subi l'amputation. Les marges de résection étaient intralésionelles dans 21% des cas. 72% des malades ont reçu de la chimiothérapie. La survie totale était de 24%. De 1975 à 1984, parmi 174 malades traités, 12% n'avaient aucune chirurgie, 54% ont subi des procé-dures du sauvetage du membre et une amputation ou ré-section -replantation était exécuté dans 34%. Les marges de résection étaient intralésionelles dans 16% des cas. 67% des malades ont reçu de la chimiothérapie. La survie totale était 46%. De 1985De -1994 393 malades ont été traités de que 7% n'avaient aucune chirurgie, 77% ont subi des procédures du sauvetage du membre avec endoprosthèses et amputation ou résection -replantation a été exécuté dans 15%. Les marges de résection étaient intralesionales dans 12%. 68% des malades ont reçu la chimiothérapie. La survie totale était 62%. Les avancements dans le traitement de tumeurs osseuses malin primaires justifient des procédures du sauvetage du membre dans combinaison avec polychimiothérapie très efficace dans les centres spécialisés et ont résulté en un taux de la survie total de plus que 60%.

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Section: Discussionmentioning

confidence: 99%

Advances in bone tumour treatment in 30 years with respect to survival and limb salvage. A single institution experience

Kotz

Dominkus

Zettl

et al. 2002

International Orthopaedics (SICOT)

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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%

“…These few studies about the condyle-sparing or epiphyseal preservation technique have been case reports or series with less than 20 patients [4,23] but raise concerns regarding the adequacy of surgical margins and the risk of local recurrence when preserving the distal femoral condyle [23]. The rate of local recurrence for published series on endoprosthestic reconstruction ranges from as low as ''none reported'' to as high as 6%, whereas the rate in the allograft literature ranges from 4% to 10% [1,6,15,19,21,27,33]. However, given the variations in the reports, it remains unclear whether the local recurrence rate or revision rate differs for endoprosthetic and condyle-sparing reconstruction.…”

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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“…These limitations may be attributed to difficulties in the reconstruction of the extensor mechanism [3,5,15]. A procedure used to overcome this problem is the medial gastrocnemius transposition to the residual patellar tendon [3,8,14]. In the osteochondral allograft surgical procedure, a higher incidence of infection, fractures, and loss of fixation is reported [5,12,17,20,23].…”

Section: Introductionmentioning

confidence: 99%

Total knee replacement versus osteochondral allograft in proximal tibia bone tumours

Colangeli

Donati

Benedetti

et al. 2007

International Orthopaedics (SICO

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Total knee modular megaprosthesis or osteochondral allograft are used to preserve joint movement in bone tumours of the proximal tibia. The aim of this study was to compare two groups of patients with total knee modular megaprosthesis and osteochondral allograft through an objective analysis. Eighteen patients, ten treated with prosthesis (TKR group) and eight with osteochondral allografts (AL group), were included in the study. X-ray, muscular strength measurements, and studies of gait analysis including electromyography (EMG) were used to compare functional results of patients. In the TKR group a higher incidence of knee extension lag was found. While the TKR group had a prevalent knee stiff/hyperextension pattern with reduced rectus femoris activity, the AL group had a higher percentage of normal knee pattern. Knee extensor muscular strength was reduced in the TKR group. TKR functional performance during gait is in most cases abnormal, consistent with the weakness of the extensor apparatus and knee extension lag. Although a greater rate of normal walking was found in the AL group, problems related to a short patellar tendon, knee instability, and joint mismatching were considered to be responsible for abnormal knee kinematics. An allograft, when optimal reconstruction is performed, gives better functional results.Résumé Les prothèses totales massives et les allogreffes ostéochondrales sont utilisées pour préserver le mouvement articulaire dans les tumeurs du tibia proximal. Le but de cette étude était de comparer 2 groupes de patients ayant reçus ces traitements. 18 patients étaient inclus dans l'étude, 10 traités par prothèse (groupe TKR) et 8 par allogreffe ostéochondrale (groupe AL). Les radiographies, la mesure de la force musculaire, l'étude de la boiterie incluant l'EMG étaient utilisées pour comparer les résultats fonctionnels. Dans le groupe TKR une plus grande incidence de perte d'extension était notée. Tandis que le groupe TKR avait une réduction de l'activité du Rectus fémorus , le groupe AL avait un plus grand pourcentage de fonction normale. La force musculaire des extenseurs était réduite dans le groupe TKR. La performance fonctionnelle durant la marche des TKR étaient la plupart du temps anormal avec faiblesse de l'appareil extenseur et perte d'extension. Bien qu'un taux plus élevé de marche normale était trouvé dans le groupe AL, les problèmes dû à un tendon rotulien court, une instabilité articulaire et à une articulation mal adaptée étaient supposés responsable d'une cinématique anormale du genou. L'allogreffe, quand une reconstruction optimale était réalisée donnait un meolleur résultat fonctionnel.

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Endoprosthetic Replacement for Stage IIB Osteosarcoma

Cited by 75 publications

References 0 publications

Advances in bone tumour treatment in 30 years with respect to survival and limb salvage. A single institution experience

Advances in bone tumour treatment in 30 years with respect to survival and limb salvage. A single institution experience

Megaprosthesis versus Condyle-sparing Intercalary Allograft: Distal Femoral Sarcoma

Total knee replacement versus osteochondral allograft in proximal tibia bone tumours

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