Medium to long‐term results after reconstruction of bone defects at the knee with tumor endoprostheses

Kinkel, Stefan; Lehner, Burkhard; Kleinhans, J.A.; Jakubowitz, Eike; Ewerbeck, Volker; Heisel, Christian

doi:10.1002/jso.21441

Cited by 86 publications

(67 citation statements)

References 20 publications

(77 reference statements)

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“…However, a radiolucent line between the extracortical bone and the shaft of the implant in the Noncollar Group clearly was evident in all cases except one. The importance of osteointegration at the shoulder has been recognized and some experimental studies have investigated methods to enhance extracortical bone formation, including the use of bone morphogenetic proteins [22] and stem cells [9,18].…”

Section: Discussionmentioning

confidence: 99%

Hydroxyapatite-coated Collars Reduce Radiolucent Line Progression in Cemented Distal Femoral Bone Tumor Implants

Coathup

Sanghrajka

Aston

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Aseptic loosening of massive bone tumor implants is a major cause of prosthesis failure. Evidence suggests that an osteointegrated hydroxyapatite (HA)-coated collar would reduce the incidence of aseptic loosening around the cemented intramedullary stem in distal femoral bone tumor prostheses. Because these implants often are used in young patients with a tumor, such treatment might extend the longevity of tumor implants. Questions/purposes We asked whether (1) HA-coated collars were more likely to osteointegrate; (2) HA collars were associated with fewer progressive radiolucent lines around the stem-cement interface; and (3) HA-coated collars were associated with less bone loss at the boneshoulder implant junction? Methods Twenty-two patients were pair-matched to one of two groups-either (1) implants with a HA-coated ingrowth collar (HA Collar Group); or (2) implants without an ingrowth collar (Noncollar Group). Age, sex, and length of followup were similar in both groups. HA-coated collars were developed and used at our institution from 1992 to address the high failure rate attributable to aseptic loosening in patients with massive bone tumor implants. Before this, smooth titanium shafts were used routinely adjacent to bone at the transection site. The minimum followup was 2 years (mean, 7 years; range, 2-12 years). Radiographs obtained throughout the followup period were analyzed and osteointegration at the shaft of the implant quantified. Radiolucent line progression around the cemented stem was semi-quantitatively assessed and cortical bone loss at the bone-shoulder implant junction was measured during the followup period.

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Section: Discussionmentioning

confidence: 99%

Hydroxyapatite-coated Collars Reduce Radiolucent Line Progression in Cemented Distal Femoral Bone Tumor Implants

Coathup

Sanghrajka

Aston

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Perioperative infection is an especially severe problem in patients with sarcoma as it contraindicates or retards postoperative chemotherapy and may have a negative impact on the prognosis in patients requiring such chemotherapy. Some studies have focused on perioperative infections [9,10,14,17,26] and perioperative antibiotic use [2,3,5,15,18,21,25,26,29,30] after tumor endoprosthetic reconstruction. However, appropriate antibiotic use for patients having tumor prosthetic surgery is unknown and remains controversial [5,7,15,18,21,25,29].…”

Section: Discussionmentioning

confidence: 99%

“…Numerous studies [9,10,14,17,26] have reported perioperative (early) infection rates after tumor endoprostheses from 2.6% to 7.4%. However, the criteria of early infection varied from infections occurring within 3 months [10,17], or within 6 months [14], to infections within 1 year after definitive surgery [9]. Without consideration of tumor types and surgical sites, the 1.9% (1/53) perioperative infection rate in our study is lower than the 7.4% early infection rate (within 3 months after surgery) reported in one study [26] with shorter duration of antibiotic use (2 days versus 8 days in our study).…”

Section: Discussionmentioning

confidence: 99%

“…One study of endoprosthetic reconstruction of 78 patients with osteosarcoma reported a 2.6% infection rate [5]. Several additional studies [9,10,14,17,26] have reported rates of perioperative infection from 2.6% to 7.4% for patients undergoing tumor endoprosthetic reconstruction, although they included various kinds of tumors and used various criteria for early (perioperative) infection.…”

Section: Introductionmentioning

confidence: 99%

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Perioperative Infection Rate in Patients with Osteosarcomas Treated with Resection and Prosthetic Reconstruction

Moretti

Ashana

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background The incidence of perioperative infection after segmental tumor endoprosthetic replacement in previous reports varies from a high of 7.4% to a low of 2.6%. Appropriate antibiotic use for this group is unknown and controversial, whereas the relationship of antibiotic use and perioperative infection is unclear. Questions/purposes We determined the incidence of perioperative infection in patients with osteosarcoma treated with segmental prosthetic replacement using a standard perioperative antibiotic regimen and the incidence of late infections and wound complications. Patients and MethodsWe retrospectively reviewed the records of 53 patients with osteosarcoma undergoing segmental prosthetic replacements from 1993 to 2008. There were 30 males and 23 females ranging from 10 to 78 years of age. All patients were given intraoperative antibiotics (intravenous cefazolin), continued for 3 days postoperatively and then given orally for 5 days. Patients who were allergic to penicillin or cefazolin were given vancomycin followed by clindamycin. A perioperative infection was defined as a deep infection within 2 months after prosthetic reconstruction. The minimum followup was 1 year (range, 1-15 years). Results We identified one confirmed perioperative prosthetic infection (1/53; 1.9%) (Enterobacter cloacae and methicillin-resistant Staphylococcus) in a 78-year-old woman after proximal tibial replacement, gastrocnemius flap, and skin graft. Her infection was controlled with débridement, drainage, and intravenous antibiotics. Three patients had late infections, two of which were culture negative. Four patients had wound complications that required further surgery. Conclusion The antibiotic regimen we used is longer than that recommended for patients having routine total joint arthroplasty. Its appropriateness will require comparison with alternate regimens, including those of shorter duration.

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“…Prosthetic reconstruction allows rapid restoration of mobility and weightbearing, but complications have been described in 25-92% of cases [2,3]. A 57% cumulative five-year survival for knee prostheses has been reported [4]. Stress shielding and prosthetic loosening remain major concerns and may require major revision surgery, resulting in further bone loss [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Extracorporeally irradiated autografts for the treatment of bone tumours: tips and tricks

Poffyn

Sys

Mulliez

et al. 2010

International Orthopaedics (SICOT)

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We retrospectively reviewed 107 patients with 108 malignant or locally aggressive bone tumours treated between 1978 and 2009 by extracorporeal irradiation with 300 Gy to eradicate the tumour, and reimplantation of the bone as an orthotopic autograft. Patient subgroups were defined according to resection type. We describe the local recurrence rate, the graft infection rate and the factors affecting graft healing and graft survival. No local recurrences were detected in the irradiated grafts. At fiveyear follow-up, graft healing had occurred in 64% of patients, providing a stable and lasting reconstruction. For various reasons, 11% of grafts were removed, although no single factor was predictive of failure. All patient subgroups had comparable results. Early infection predicted the development of pseudarthrosis. Pelvic reconstructions had a worse graft survival. Rigid fixation and bridging of the graft appeared to be important technical points.

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Medium to long‐term results after reconstruction of bone defects at the knee with tumor endoprostheses

Abstract: Regardless of achieving a low recurrence rate and satisfactory functional results, we found a high complication rate after implantation of a megaprosthesis. This was particularly evident for extraarticular resections and cemented fixation, which should be avoided when possible.

Cited by 86 publications

References 20 publications

Hydroxyapatite-coated Collars Reduce Radiolucent Line Progression in Cemented Distal Femoral Bone Tumor Implants

Hydroxyapatite-coated Collars Reduce Radiolucent Line Progression in Cemented Distal Femoral Bone Tumor Implants

Perioperative Infection Rate in Patients with Osteosarcomas Treated with Resection and Prosthetic Reconstruction

Extracorporeally irradiated autografts for the treatment of bone tumours: tips and tricks

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