Knee arthrodesis using a vascularised fibular rotatory graft after tumor resection

Nouri, H.; Meherzi, M.H.; Jenzeri, M.; Daghfous, M.; Hdidane, R.; Zehi, K.; Tarhouni, L.; Karray, S.; Baccari, S.; Mestiri, M.; Zouari, Mohamed

doi:10.1016/j.otsr.2009.11.001

Cited by 7 publications

(5 citation statements)

References 24 publications

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“…In this study, the patients who underwent resection arthrodesis reconstruction had a worse functional outcome than those who underwent osteoarticular allograft, which aligns with previous reports 31,32 . Patients with resection arthrodesis in our series had a lower function and emotional acceptance score compared to patients who underwent osteoarticular allograft reconstruction.…”

Section: Discussionsupporting

confidence: 89%

Resection arthrodesis and osteoarticular allografts reconstruction after resection of primary bone tumors around the knee: Long‐term clinical outcomes and prognostic factors for failure of biological reconstruction

Wisanuyotin

Paholpak

Sirichativapee

et al. 2021

Asia-Pac J Clncl Oncology

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Aim:The biological reconstruction of the knee with osteoarticular allografts and resection arthrodesis have been reported but there has not yet been a direct comparison between both these procedures. This study aimed to identify the prognostic factors that influence failure of biological reconstruction and compared the results between both procedures.Methods: Between 1994 and 2017, we performed 92 limb-sparing procedures using resection arthrodesis (n = 53) and osteoarticular allograft reconstruction (n = 39) for the management of primary bone tumors around the knee. The minimum follow-up time was 2 years in both groups. Results:The failure rate of reconstruction in the osteoarticular allograft and resection arthrodesis group was 48.7% and 39.6%, respectively (p = 0.75). The mean MSTS score in the osteoarticular allograft and resection arthrodesis group was 23.7 and 21.8, respectively (p = 0.01). The significant risk factor for failure after biological reconstruction was the administration of chemotherapy (p = 0.001; HR = 3.39; 95% CI, 1.60-7.17). Conclusion:Patients who underwent osteoarticular allograft had a better functional outcome than those who underwent resection arthrodesis reconstruction, but clinical outcomes between the groups were comparable. Chemotherapy is a significant adverse prognostic factor for failure of biological reconstruction.

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Section: Discussionsupporting

confidence: 89%

Resection arthrodesis and osteoarticular allografts reconstruction after resection of primary bone tumors around the knee: Long‐term clinical outcomes and prognostic factors for failure of biological reconstruction

Wisanuyotin

Paholpak

Sirichativapee

et al. 2021

Asia-Pac J Clncl Oncology

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“…esection of tumours of the femur and tibia around the knee and ankle joints results in large bony defects. [1] While prosthesis offers a reconstructive option, [2] often arthrodesis is an alternative; in case, adequate functional motors cannot be preserved or due to economic constraints (for those patients who cannot afford megaprosthesis). In an immunocompromised patient, the potential for infection and non-union increases if a non-vascularised bone graft is used.…”

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confidence: 99%

Free fibula flap for lower limb salvage after tumour resection

Shankhdhar

Yadav

Puri

et al. 2018

Indian J Plast Surg

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Context: Post-tumour resection lower limb salvage. Aim/Introduction: Resection of tumours of the femur and tibia around the knee and ankle joints results in large bony defects. Often arthrodesis is an alternative; in case, adequate functional motors cannot be preserved or due to economic constraints. Thus, in an immunocompromised patient, the vascularised fibula is the best form of reconstruction. The vascularised fibular flap (pedicled/free) can be used in combination with an allograft. We refer to such a combination reconstruction as ‘allocombo’. The vascularised fibular graft hypertrophies in due course of time, and till that period, the allograft provides the required mechanical strength to allow early ambulation. Subjects and Methods: A retrospective study of 24 cases of vascularised fibular graft for lower limb reconstruction was conducted from February 2003 to March 2014. The average defect size was 15.5 cm and the average length of fibula harvested was 24.35 cm. A total of 19 free fibular flaps and 5 pedicled fibula were done. Mean age was 26 years. Fibula was nestled in the allograft obtained from the tissue bank. Results: The mean follow-up time was 52 months. Free flap success rate was 96%. Successful healing was achieved at 45 ends (97.8%). Radiological evidence of union at osteotomy sites occurred at an average of 6.8 months. Eight patients eventually succumbed to disease. At the final follow-up, the mean Musculoskeletal Tumour Society functional score of the evaluable patients was 26 (range 20–30). Conclusions: Pedicled fibula is a good option if the defect is within 14 cm of the knee joint at the femoral end. The vessels have to curve around the fibular head, thus its removal improves the reach of the pedicle. The flap is easy to harvest with predictable vascular anatomy and it can provide a large amount of vascularised bone and skin paddle. It results in early ambulation, rehabilitation and reduced morbidity. We realised that fixation is easier and chances of vascular injury are less in free as compared to pedicled fibula.

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“…The earliest biologic arthrodeses were performed using external fixation systems, intramedullary devices, and hybrid methods with union rates from 38% to 100% and different complications [1,13,17,19,22,24,32,33,36,45,48]. Vascularized fibulae have been used to augment arthrodesis reconstructions of all types with overall excellent results [29,31,37,46]. Septic knee arthritis and failed, septic TKA often require débri-dement of large volumes of bone, necessitating structural intercalary segments to maintain limb length when arthrodesis is performed [25].…”

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confidence: 99%

“…However, we did not observe a significant difference between failure rates of primary arthrodeses for tumors compared with revision procedures of a prior implant with segmental bone loss. Although success rates of 80% to 100% have been reported after primary, biologic arthrodesis in patients without prior TKA [9,14,19,30,31,37,44], the success rate of arthrodesis performed in patients with an infection at the site of a TKA has been reported to be much lower [8]. However better results in terms of complication rates have been reported using metal implants than biologic reconstruction [2,8,9,11,13,23,33,42,45,47].Whereas Gosheger et al reported no infections in three arthrodeses with the MUTARS 1 implant [16] and Bartlett et al reported one infection in 10 Stanmore implants [3], there were nine infections in our 31 patients.…”

mentioning

confidence: 99%

Is There a Role for Knee Arthrodesis With Modular Endoprostheses for Tumor and Revision of Failed Endoprostheses?

Angelini

Henderson

Trovarelli

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Knee arthrodeses are performed to treat infection after arthroplasty and tumors requiring extensive soft tissue resection. Many techniques have been described, but most have important disadvantages. Currently, endoprosthetic arthrodesis implants are available, but little is known about them. Questions/purposes Our objective was to analyze a series of knee arthrodeses with a modular prosthetic system to evaluate (1) survivorship of the implant, (2) complications, (3) whether survivorship differed between arthrodeses done for primary tumor resection and revision reconstructions, and (4) whether survivorship differed based on the presence of previous infection or the use of a gastrocnemius flap. Methods We present 32 patients with modular knee arthrodeses; arthrodeses were performed in 25 patients with tumors and in seven patients without tumors. There were 14 implants done at the time of tumor resection and 18 for revision of failed implants. Survivorship and complications were analyzed with Kaplan-Meier curves. Log-rank test was used for comparison between primary and revision implants, not infected and previously infected implants, and use or nonuse of a gastrocnemius flap.

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Knee arthrodesis using a vascularised fibular rotatory graft after tumor resection

Cited by 7 publications

References 24 publications

Resection arthrodesis and osteoarticular allografts reconstruction after resection of primary bone tumors around the knee: Long‐term clinical outcomes and prognostic factors for failure of biological reconstruction

Resection arthrodesis and osteoarticular allografts reconstruction after resection of primary bone tumors around the knee: Long‐term clinical outcomes and prognostic factors for failure of biological reconstruction

Free fibula flap for lower limb salvage after tumour resection

Is There a Role for Knee Arthrodesis With Modular Endoprostheses for Tumor and Revision of Failed Endoprostheses?

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