Limb salvage in musculoskeletal oncology

Veth, R.P.H.; Hoesel, René van; Pruszczyński, M; Hoogenhout, J.; Schreuder, Bart H. W.; Wobbes, Theo

doi:10.1016/s1470-2045(03)01114-8

Cited by 82 publications

(69 citation statements)

References 58 publications

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“…The limb salvage procedure should not delay adjuvant therapy; the reconstruction should be permanent and not be associated with a large number of local complications requiring secondary procedures and frequent hospitalizations; and the resulting limb function should approach that obtained by amputation 10 . Optimal surgical margins around a malignant bone tumour are 3 cm of normal bone and 1 cm of normal soft tissue 11 . In most cases, especially those involving young patients, a 3-5 cm "safe" margin in osteosarcoma means loss of the adjacent joint when the tumour is in the metaphysis, usually leading to limb-length discrepancy.…”

Section: Physeal Distractionmentioning

confidence: 99%

Successful Management of a Childhood Osteosarcoma with Epiphysiolysis and Distraction Osteogenesis

et al. 2014

Current Oncology

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An 11-year-old boy presented in 2012 with pain in his right knee during running. He was referred to our orthopedic department after a radiograph showed an abnormal shadow. This patient's past medical history and family history included nothing of note. Physical examination revealed right knee edema and warmth. Serum phosphorus was 1.92 mmol/L (normal: 0.9-1.9 mmol/L), and serum alkaline phosphatase was 186 IU/L (normal: 45-125 mmol/L). Radiography revealed sclerotic changes and a periosteal reaction in the lateral part of the proximal tibia.On magnetic resonance imaging (mri), the lesion had homogeneous low signal intensity on T1-weighted images and heterogeneous high signal intensity on T2-weighted images, which demonstrated full contact between tumour and epiphysis. Angiography showed a tumour stain, and 99m Tc scintigraphy demonstrated increased uptake in the proximal tibia.A puncture biopsy was performed, and the tumour was histologically diagnosed as an osteosarcoma (Figure 1).We administered 2 cycles of preoperative chemotherapy consisting of cisplatin 120 mg/m 2 (day 1), doxorubicin 30 mg/m 2 (days 1-3), and ifosfamide 2 g/m 2 (days 1-5) 4 . Consequently, the chief complaint of pain was relieved, and by angiography and 99m Tc uptake, the tumour stain disappeared. Serum phosphorus and alkaline phosphatase concentrations declined to 1.06 mmol/L and 113 IU/L respectively. The tumour response was judged to be complete.The surgical procedure consisted of two phases:• In phase 1, two pins were inserted into the epiphysis and another two into the diaphysis 10 cm from the tumour. An external monolateral fixator with a 5-cm T-shaped piece for the epiphyseal pins, strong enough for achieving epiphysiolysis, was attached 5 . Distraction began in the operating room and was continued at a rate of 1-1.5 mm ABSTRACTIn an 11-year-old boy with osteosarcoma in the proximal tibia (type iii), 2 cycles of dia chemotherapy (cisplatin, ifosfamide, doxorubicin) were administered preoperatively while epiphysiolysis was performed. Clinical response was determined to be complete by radiography and histopathology. Marginal excision was then performed with preservation of the proximal tibial epiphysis. Metaphyseal reconstruction was performed using distraction osteogenesis. Six cycles of dia chemotherapy were administered postoperatively. Twenty months later, the patient had developed no complications and experienced full bone healing, with no limb discrepancy. In selected adolescent patients with osteosarcoma, in whom the tumour is in full contact with the epiphysis, epiphyseal preservation by epiphysiolysis and reconstruction by distraction osteogenesis can provide an excellent outcome, resulting in a stable reconstruction that functionally restores the native limb.

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Section: Physeal Distractionmentioning

confidence: 99%

Successful Management of a Childhood Osteosarcoma with Epiphysiolysis and Distraction Osteogenesis

et al. 2014

Current Oncology

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“…Autogenous bone graft was initially used as reconstruction with fibula during resection of radius with tumor (7,8). Although there is an opinion that autogenous bone grafts lead to better outcomes compared to allografts, it has been supported by many studies that allografts lead to results as better as autogenous grafts do (8)(9)(10). Lack of donor site mobility, possibility of supply with different lengths and unlimited resource are among recognized advantages of use of allografts.…”

Section: Introductionmentioning

confidence: 99%

Comparison of medium-period outcomes of allografts and autografts used in repair of bone defects in patients who were treated in our department due to skeletal system tumors

Sevimli¹

2017

J Turgut Ozal Med Cent

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Objective: In orthopaedic oncology, reconstruction with autograft or allograft of bone defects which develop following tumor resection or curettage is a commonly used method. Bone generally has the ability to regenerate completely but requires a very small fracture space or some sort of scaffold to do so. Successful results of allografts or autograft in reconstruction of bone defect after tumor resection encouraged its utilization in post-traumatic defects. In this study, prospective representation of clinical and radiological medium-period outcomes of used autgrafts and allografts is aimed. Materials and Methods: 45 patients who were treated, for whom reconstruction was performed by using allograft or autograft following tumor excision or curettage between the years 2005-2015 in Inonu University Faculty of Medicine were included in the study. Patients were evaluated in regard to age, gender, tumor localization and union. Obtained data were analyzed by SPSS software version 15.0 Results: During follow-ups of the patients; union was radiologically observed in an average of 6.1 months in 43 (91%) patients (in 21 autografts it was 5.8 months, in 22 allografts it was 6.5 months). Nonunion occurred in 2 (9%) patients. No statistically significant difference was determined between groups with allografts and autografts (P>0.05). Conclusion: No difference was determined between use of either autogenous or allogenous grafts in segmental or cavitary bone defects, and reconstruction is a method with high success.

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“…Taking osteosarcoma as an example, new generation neoadjuvant chemotherapy reduces lung metastasis, improves the 5-year survival rate, decreases the tumor size, and permits a closer surgical resection margin for the malignant bone tumor. Different kinds of limb salvage procedure provide better overall functional outcomes of extremity and body images as compared to those with amputees without the expense of increased local recurrence and shortening the survival time [1][2][3][4][5][6][7][8][9][10]. showed a 2.5 times higher relative risk of prosthetic failure than the patient death, thus a carefully performed endoprosthetic reconstruction would achieve immediate clinical success.…”

Section: Introductionmentioning

confidence: 99%

“…showed a 2.5 times higher relative risk of prosthetic failure than the patient death, thus a carefully performed endoprosthetic reconstruction would achieve immediate clinical success. Nowadays 70-85% of all malignant tumors are treated by limb salvage without compromise the onclological outcome, especially for those oncologic patients with survival in some doubt [1][2][3][4][5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

“…The distal femur and proximal tibia are common sites of the malignant neoplasm. Thus many options of limb salvage operation around the knee have been developed, including resection-arthrodesis of knee joint, reconstruction of the knee using bone graft (autograft, allograft, allograft/endoprosthetic composite), endoprosthesis reconstruction, Ilizarov leg lengthening technique, and rotationplasty, etc [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. The selection of a proper procedure is determined on individual basis.…”

Section: Introductionmentioning

confidence: 99%

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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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Limb salvage in musculoskeletal oncology

Cited by 82 publications

References 58 publications

Successful Management of a Childhood Osteosarcoma with Epiphysiolysis and Distraction Osteogenesis

Successful Management of a Childhood Osteosarcoma with Epiphysiolysis and Distraction Osteogenesis

Comparison of medium-period outcomes of allografts and autografts used in repair of bone defects in patients who were treated in our department due to skeletal system tumors

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

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