Expandable Endoprosthesis Reconstruction in Skeletally Immature Patients With Tumors

Eċkardt, Jeffrey J.; Kabo, J. Michael; Kelley, Cynthia; Ward, William G.; Asavamongkolkul, Apicat; Wirganowicz, Phillip; Yang, Rong‐Sen; Eilber, Frederick R.

doi:10.1097/00003086-200004000-00008

Cited by 138 publications

(88 citation statements)

References 14 publications

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“…In addition, children tend to be more active than adults and may be less compliant with activity restrictions [26]. Overall we observed fewer complications with the nonsurgical lengthening prostheses, however, this limited series and those in the literature cannot provide statistical justification of one device over another [8,9,15,16,18,20,24,25,28,31]. When considering inflation, the maintenance reimbursements for our noninvasive lengthening devices were similar to that reported by Grimer et al, albeit with less followup [14].…”

Section: Discussionsupporting

confidence: 73%

“…Failure rates for extendible tumor endoprostheses are high and revision surgery is not uncommon for complications including infection, tumor recurrence, and prosthesis fracture [28,[31][32][33]. Higher reimbursements for growing prostheses are explained partially by the added complexity of their lengthening mechanisms and their use in children [8,16,31], therefore opening them to modes of failure in addition to those described [19]. A high rate of prosthesis fracture is attributed to reduced structural integrity owing to the lengthening mechanism [28].…”

Section: Discussionmentioning

confidence: 99%

“…Over four decades these devices evolved with changes in the lengthening mechanisms. Early devices required the addition of metallic spacers or exchange of modular components to facilitate expansion and required additional surgery for lengthening [8,23]. Recent devices have used a worm drive actuated by a screw accessible by percutaneous dissection ( Fig.…”

Section: Introductionmentioning

confidence: 99%

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What are Estimated Reimbursements for Lower Extremity Prostheses Capable of Surgical and Nonsurgical Lengthening?

Henderson

Pepper

Letson

2012

Clinical Orthopaedics &Amp; Related Research

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Background Growing prostheses accommodate skeletally immature patients with bone tumors undergoing limbpreserving surgery. Early devices required surgical procedures for lengthening; recent devices lengthen without surgery. Expenses for newer expandable devices that lengthen without surgery are more than for their predecessors but overall reimbursement amounts are not known.Questions/purposes We sought to determine reimbursement amounts associated with lengthening of growing prostheses requiring surgical and nonsurgical lengthening. Methods We retrospectively reviewed 17 patients with growing prostheses requiring surgical expansion and eight patients with prostheses capable of nonsurgical expansion. Insurance documents were reviewed to determine the reimbursement for implantation, lengthening, and complications. Growth data were obtained from the literature. Results Mean reimbursement amounts of surgical and nonsurgical lengthenings were $9950 and $272, respectively. Estimated reimbursements associated with implantation of a growing prosthesis varied depending on age, sex, and location. The largest difference was found for 4-year-old boys with distal femoral replacement where reimbursement for expansion to maturity for surgical and nonsurgical lengthening prostheses would be $379,000 and $208,000, respectively. For children requiring more than one surgical expansion, net reimbursements were lower when a noninvasive lengthening device was used. Annual per-prosthesis maintenance reimbursements to address complications for surgical and nonsurgical lengthening prostheses were $3386 and $1856, respectively.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

What are Estimated Reimbursements for Lower Extremity Prostheses Capable of Surgical and Nonsurgical Lengthening?

Henderson

Pepper

Letson

2012

Clinical Orthopaedics &Amp; Related Research

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“…Therefore some surgeons argue primary amputation for the pediatric patients. The development of the expandable prosthesis provides a temporary solution at the expense of higher rate of complications, and these patients almost require major revision before or at skeletal maturity [8,[19][20]38,[40][41]. These expandable endoprostheses may be lengthened invasively through multiple operations with a higher risk of infection.…”

Section: Shortening Leg Length Discrepancymentioning

confidence: 99%

“…These expandable endoprostheses may be lengthened invasively through multiple operations with a higher risk of infection. New generation growing endoprosthesis can be lengthened either by the external magnetic field, or by knee bending kinetic energy [8,[19][20]38,[41][42][43][44][45][46]. The risk of infection and other complications may be reduced whereas it needs further investigation.…”

Section: Shortening Leg Length Discrepancymentioning

confidence: 99%

Endoprosthesis-Related Complications After Limb-Salvage Operation of Malignant Bone Tumors Around the Knee

Yang

2004

Biomed. Eng. Appl. Basis Commun.

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Endoprosthetic reconstruction using a custom-made metallic megaendoprosthesis is one of the common modalities for the limb salvage operation. The new promising advance of material science, design and fabrication of the endoprosthesis enable an immediate rehabilitation program and provide a durable and functional limb. Thus a successful limb reconstruction is possible in the well-selected patients. In addition to the endoprosthesis-related increased stress, a limited soft tissue support and constraint after limb salvage procedure usually results in an increased incidence of complications, especially in the long term survivors. Some patients may even need revision of the endoprosthesis and, at times, amputation. The complications after oncological endoprosthectic reconstructions usually occur more frequent than the conventional primary total joint arthroplasty. Considering the characteristics of the surgical procedure and the high demands on the implants, such a relatively high frequency of complications is not unexpected. The common complications include wound necrosis, aseptic loosening, fatigue fracture, local osteolysis, joint contracture, dislodgement/dislocation, nerve or vascular injury, rotational deformity, leg length discrepancy, infection, periprosthectic fracture, etc. Some complications are encountered with other modality of limb salvage procedure, whereas the other endoprosthesis-related complications are endoprosthetic-unique and not uncommon. The major causes of such a relatively high endoprosthesis-related complications include (1) extensive excision of soft tissue, leading to change of biomechanical ergonomics, little soft tissue constraints or support for a long replacement segments, and decreased local defense to infection, (2) increased stress on the implants due to higher activity level in the youthful active individuals, relatively narrower medullary canals with less cancellous bone for fixation, (3) special needs for the stability resulting an increased mechanical constraints placed directly within the endoprosthesis, thus raising the local stress transferred to the prosthesis, and to the prosthesis-bone interface, (4) poor immunological, hematological, or nutritional status resulting from chronic oncologic diseases or chemotherapy. It in turn accelerates the wear processes of the components, induces the wear particulate disease and local osteolysis, as well as to cause the aseptic loosening eventually. Early detection and early correction of minor complications has an important role of preventing the major complications, thus reduces the necessity of reoperation, and at times, amputation. We will review these complications in this article.

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Bone Tumors

Damron

2017

Holland‐Frei Cancer Medicine

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Overview Bone tumors are uncommon lesions that affect all ages of patients and may involve any bone in the body. Bone lesions may be benign neoplasms or reactive lesions, primary bone sarcomas, metastatic carcinomas to bone, myeloma, or lymphoma. The benign bone lesions, which predominate in children and young adults, may behave in an inactive, active, or aggressive fashion, and the latter may simulate malignancy. Primary bone sarcomas have a bimodal distribution, whereas metastatic disease, myeloma, and lymphoma of bone predominate in adults. Despite the broad spectrum of bone tumors, each individual entity has a distinct clinical and radiographic presentation, with a predilection for specific locations, which lends itself to narrowing the differential diagnosis and selecting appropriate management. Bone sarcomas account for less than 0.2% of all cancers. During 2014, approximately 3020 new cases of primary bone sarcomas were diagnosed, and approximately 1460 deaths occurred. The three most common bone sarcomas are osteosarcoma, chondrosarcoma, and Ewing sarcoma. However, the most common primary malignancy of bone is myeloma, and the most common cancer that involves bone is metastatic carcinoma. The pathologic classification of bone tumors continues to evolve. To a large extent, classification continues to be according to the cell of origin or tissue type. Primary bone tumors may derive from cartilage cells, bone cells, and vascular cells, among others, but for some tumors, the cell of origin is unknown. The most widely accepted pathologic classification system to date is that of the World Health Organization.

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Expandable Endoprosthesis Reconstruction in Skeletally Immature Patients With Tumors

Cited by 138 publications

References 14 publications

What are Estimated Reimbursements for Lower Extremity Prostheses Capable of Surgical and Nonsurgical Lengthening?

What are Estimated Reimbursements for Lower Extremity Prostheses Capable of Surgical and Nonsurgical Lengthening?

Endoprosthesis-Related Complications After Limb-Salvage Operation of Malignant Bone Tumors Around the Knee

Bone Tumors

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