Massive allografts in the treatment of osteosarcoma and Ewing sarcoma in children and adolescents.

101

120

Background Resection of diaphyseal bone tumors for local tumor control and stabilization often results in an intercalary skeletal defect and presents a reconstructive challenge for orthopaedic surgeons. Although many options for reconstruction have been described, relatively few studies report on the functional outcomes and complications of patients treated with modular intercalary endoprostheses. Questions/purposes The objectives of this study were to examine clinical outcomes after reconstruction with a modular intercalary endoprosthesis with a specific focus on (1) the rate of complication or failure; (2) differences in complication rates by anatomic site; (3) functional results as assessed by the Musculoskeletal Tumor Society System (MSTS); and (4) differences in complication rate between patients treated with cemented versus noncemented fixation. Methods We conducted a retrospective chart review of patients treated with a modular intercalary endoprosthesis from three musculoskeletal oncology centers from 2008 to 2013. The indication for use of this intercalary endoprosthesis was segmental bone loss from aggressive or malignant tumor with sparing of the joint above and below and deemed unsuitable for biologic reconstruction. No other implant was used for this indication during this period. During this period, 41 patients received a total of 44 intercalary implants, which included 18 (40%) humeri, 5 (11%) tibiae, and 21 (48%) femora. There were 27 (66%) men and 14 (34%) women with a mean age of 63 years (range, 18-91 years). Eight patients (20%) had primary bone tumors and 33 (80%) had metastatic lesions. Thirtyfive (85%) patients were being operated on as an initial treatment and six (15%) for revision of a previous reconstruction. Twenty-nine (66%) procedures had cemented stem fixation and 15 (34%) were treated with noncemented fixation. The overall mean followup was 14 months (range, 1-51 months). Patients with primary tumors had a mean followup of 19 months (range, 4-48 months) and patients One or more of the authors (JB) has received funding from the Musculoskeletal Transplant Foundation and has also received fees from Merete Inc (Berlin, Germany) and Implant Cast (Buxtehude, Germany) outside of the submitted work and holds several patents and licensing fees with CreOsso LLC (Montclair, NJ, USA with metastatic disease had a mean followup of 11 months (range, 1-51 months). Causes of implant failure were categorized according to Henderson et al. [19] into five types as follows: Type I (soft tissue failure), Type II (aseptic loosening), Type III (structural failure), Type IV (infection), and Type V (tumor progression). At 2 years of followup, 38 (93%) of these patients were accounted for with three (7%) lost to followup. MSTS functional assessment was available for 39 of 41 patients (95%). Results At latest followup of these 41 patients, 14 (34%) patients were dead of disease, two patients (5%) dead of other causes, seven (17%) are continuously disease-free, one (2%) shows no evidence of disease, a...

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Outcomes of a Modular Intercalary Endoprosthesis as Treatment for Segmental Defects of the Femur, Tibia, and Humerus

Benevenia

Kirchner

Patterson

et al. 2016

101

120

“…The orthopaedic literature describes multiple surgical options for reconstruction after resection of a bone tumor of the distal femur, including custom total knee prosthesis [2, 3, 6-16, 19, 27, 33], osteoarticular allograft [1,20,[25][26][27]30], arthrodesis with intercalary bone grafting [9,32], rotationplasty [10], and ''condyle-sparing'' intercalary allograft [23,24]. Controversy remains concerning the optimal procedure with regard to functional outcome.…”

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

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

“…Different techniques have been proposed to reconstruct such bone defects, including diaphyseal endoprostheses [1,3], allografts [4,16], bone transport [6], and vascularized autograft [7,14]. Restoring original bone anatomy and strength to withstand the rigors of use and growth is challenging.…”

Section: Introductionmentioning

confidence: 99%

Case Report: Reconstruction of a 16-cm Diaphyseal Defect after Ewing's Resection in a Child

Biau

Pannier

Masquelet

et al. 2009

Numerous options exist for intercalary segmental reconstruction after bone tumor resection. We present the extension of a recently developed surgical twostage technique that involves insertion of a cement spacer, induction of a membrane, and reconstruction of the defect with cancellous and cortical bone autograft in a 12-year-old child. The boy was referred to our center for treatment of a right femoral diaphyseal Ewing's sarcoma. The first stage involved resection of the tumor and reconstruction with a locked intramedullary nail and a polymethylmethacrylate cement spacer. Seven months after the initial procedure during which adjuvant chemotherapy was given, the second-stage procedure was performed. The cement was removed and cancellous and cortical bone autograft was grafted in the membrane created around the cement spacer. Touchdown weightbearing was allowed immediately, partial weightbearing was resumed 6 weeks after the operation, and full weightbearing was allowed 4 months later. Successive plain radiographs showed rapid integration of the autograft to the host bone with bone union and cortical reconstitution. The principle of the induced membrane reconstruction seems applicable to intercalary segmental reconstruction after bone tumor resection in children.