Imaging of Complications After Limb Prostheses Implantation in Children with Bone Tumors

Abstract

SummaryBackgroundTumors of the developmental age are an important problem in clinical practice. Primary bone tumors constitute 1–1.5% of all tumors, and 7% of all tumors diagnosed in the developmental age. The aim of the study was to assess the capabilities of imaging methods in diagnosing complications of limb endoprostheses in children with osteoarticular tumors.Material/MethodsWe included 155 patients with limb endoprostheses, aged 7–26 years. There were 113 patients with knee prostheses, 1 patient with bilateral knee prostheses, 16 patients with shoulder prostheses, 14 patients with hip prostheses, 11 patients with hip and knee prostheses, and 1 patient with a femoral prosthesis. All patients underwent plain radiography and an ultrasound study.ResultsComplications were found in 50 patients (32% of all patients). The following complications were seen – inflammatory changes in soft tissues and bones (12 patients, 7.7%), stump fractures (11 patients, 7%), lack of elongation effect or shortening of the prosthesis (7 patients, 4.5%), prosthesis fractures (4 patients, 2.5%), crural fractures (4 patients, 2.5%), loosening of the prosthesis (3 patients, 1.9%), joint dislocation (2 patients, 1.3%), stump and prosthesis fracture (1 patient, 0.6%) and local recurrence (6 patients, 3.9%). Prostheses were exchanged for the following reasons – fractures (5 patients, 3.2%), inflammation (2 patients with 3 exchanges, 1.9%). Local recurrence and inflammation were confirmed by a biopsy.ConclusionsRadiography and ultrasonography are of crucial importance in monitoring patients after implantation of limb endoprostheses. The findings did not require confirmation in additional studies: CT and MRI. Suspicion of local recurrence and inflammation required a biopsy confirmation.

Ultrasound image of malignant bone tumors in children. An analysis of nine patients diagnosed in 2011–2016

“…Ultrasonography is not mentioned in diagnostic algorithms as a useful tool for early detection and diagnosis of these pathologies. It is mainly used in post-operative assessment, treatment monitoring and evaluation of local complications (3) . US is commonly believed to be helpful in the assessment of neoplasms and soft tissue tumors.…”

“…Bone tumors are principally diagnosed in radiography and computed tomography (CT), while local progression is precisely assessed in magnetic resonance imaging (MRI) (1,2) . Ultrasonography (US) is generally considered useful only in restricted cases, mainly for post-operative assessment (3) , particularly in patients with prostheses that generate artifacts in CT and MRI, thereby hindering assessment, as well as for detection and monitoring of local complications of the tumor. Literature reports on its usefulness in the detection of bone tumors and on their US presentation are very limited (4) .…”

Functional results in the surgical treatment of a tumor lesion of the proximal humerus with endoprosthetics

“…B. Iwanowska и соавт. проанализировали результаты хирургического лечения 27 пациентов, у которых наблюдалась послеоперационная нестабильность протеза [17].…”

“…Согласно данным этих авторов, она была обусловлена рядом причин, в числе которых подлопаточные разрывы (10 случаев), массивные разрывы вращательной манжеты (6 случаев), неправильные положения компонентов (8 случаев), диссоциация компонентов (2 случая) и укорочение плечевой кости (1 случай) [17].…”

“…До начала XXI в. при онкологическом эндопротезировании этого сустава применялись так называемые анатомические, или однополюсные, эндопротезы, головка которых фиксировалась в ложе удаленной плечевой кости и плечевого сустава к суставному отростку лопатки и акромиону. Подобная методика позволяла добиться адекватной стабильности плечевого сустава, однако у большинства пациентов после операции наблюдалось значительное ограничение отведения и сгибания конечности -в данном суставе из-за недостаточной конгруэнтности головки эндопротеза и суставной поверхности плечевого отростка лопатки [13][14][15][16][17].…”