Outcome after reconstruction of proximal femoral tumors: A systematic review

Janssen, Stein J.; Langerhuizen, David W. G.; Schwab, Joseph H.; Bramer, Jos A. M.

doi:10.1002/jso.25297

Cited by 30 publications

(21 citation statements)

References 54 publications

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“…Oncologic resection of the proximal femur presents several challenges to the orthopedic oncology surgeon 3‐9 . Resection of the femoral head, neck, intertrochanteric region, and variable portions of the proximal diaphysis of the femur carries consequences that the surgeon must address.…”

Section: Introductionmentioning

confidence: 99%

“…Oncologic resection of the proximal femur presents several challenges to the orthopedic oncology surgeon. [3][4][5][6][7][8][9] Resection of the femoral head, neck, intertrochanteric region, and variable portions of the proximal diaphysis of the femur carries consequences that the surgeon must address. In a proximal femur resection, the entirety of the joint capsule is detached from the intertrochanteric line; the attachments of the hip abductors and hip flexors are removed from the greater and lesser trochanters, respectively; and, depending on the length of resection, the gluteal sling may be detached from its insertion as well.…”

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confidence: 99%

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Is osseous reattachment of the greater trochanter necessary compared to soft‐tissue‐only abductor repair in proximal femoral megaprosthesis reconstruction?

Groundland

Jones

et al. 2021

Journal of Surgical Oncology

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Background One of the challenges to surgical reconstruction following oncologic proximal femur resection is reliable re‐establishment of the abductor mechanism. Surgical and functional outcomes following re‐approximation of the abductor mechanism to a metallic endoprosthetic after tumor resection of the proximal femur have not been well established in the literature. Methods A retrospective review was performed, inclusive of patients who received a proximal femur replacement with a metallic endoprosthesis following tumor resection. Patients were divided into two groups: (1) those that received an abductor repair involving a trochanteric osteotomy and osseous fixation of the greater trochanter/abductor mechanism to the endoprosthesis, and (2) those that did not have a trochanteric osteotomy and therefore had an abductor repair consisting of only soft tissue reattachment to the endoprosthesis. The two groups were assessed for demographic characteristics, diagnosis, surgical outcomes including rates of complication and failure, radiographic evidence of trochanteric failure, and functional outcomes. Descriptive statistics, comparative statistics, and logistic regression analyses were performed to discern differences between the two study groups. Results Fifty‐three patients were included in the analysis, 29 had abductor reconstructions involving reattachment of the greater trochanter to the metallic endoprosthesis and 24 had soft tissue reconstruction of the abductor mechanism without bony fixation. There were no differences between the two groups for demographic data, cancer diagnosis, follow up, or survivorship. Radiographic evidence of trochanteric dissociation from the endoprosthesis was observed in 45% of osteotomy cases. Only 10% of patients in the trochanter osteotomy group and 38% of the soft tissue only group were able to resume a normal, non‐Trendelenburg gait at final postoperative visit (p = .024). Need for an assistive ambulatory device was seen in 83% and 67% of the osteotomy and soft‐tissue‐only patients, respectively (p = .21). Conclusion Re‐establishing the abductor mechanism following proximal femur oncologic resection remains a challenge to orthopedic oncologists. Even when possible, salvage of the greater trochanter for reattachment to the endoprosthesis did not lead to improved function in this series, when compared to a similar cohort that received a soft‐tissue‐only abductor repair. Abductor mechanism reconstruction with a greater trochanteric osteotomy and subsequent fixation to the proximal femur endoprosthesis had a high rate of radiographic failure. Additionally, reattachment of the greater trochanter to the proximal femur endoprosthesis demonstrated no improvement in Trendelenburg gait or reliance on an assistive ambulatory device when compared to a soft‐tissue‐only abductor repair.

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Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

Is osseous reattachment of the greater trochanter necessary compared to soft‐tissue‐only abductor repair in proximal femoral megaprosthesis reconstruction?

Groundland

Jones

et al. 2021

Journal of Surgical Oncology

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“…This reconstruction can be a proximal femoral endoprosthesis (tumor prosthesis) or an allograft-prosthesis combination. Reasons such as early loading on extremity, costeffectiveness, and easy availability have made arthroplasty the primary option in limb salvage surgery [13][14][15].…”

Section: Discussionmentioning

confidence: 99%

The Effectiveness of Tranexamic Acid in Patients With Proximal Femoral Tumor Resection Prosthesis

Atalay¹,

Yapar²,

Ulucaköy³

et al. 2020

Cureus

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Aim: The aim of this study is to evaluate the risk of thromboembolic events and amount of postoperative blood loss and transfusion in patients who received preoperative tranexamic acid (TXA) administration in proximal femoral resection and endoprosthesis of proximal femur malignant lesion. Methods: In this study, the data of 46 patients who underwent extensive resection and proximal femoral tumor prosthesis for proximal femoral bone malignancies were retrospectively reviewed. Patients were divided into two groups according to preoperative 15 mg/kg bolus intravenous administration of TXA. These patients were compared in terms of postoperative blood loss, postoperative bleeding, and transfusion requirements. Results: There were 46 patients (18 female, 28 male) with a mean age of 60.7±14.7 (19-89) years. Fifteen patients (32.6%) were treated with iv TXA. In the TXA group (46.7%), there was a statistically significant decrease in the need for transfusion compared to the patient group (93.5%) without TXA (p=0.001). Postoperative 24th hour, 48th hour,and total drainage blood loss values were found to be significantly lower in the TXA group (p=0.047, p=0.015, and p=0.019, respectively). There was no thromboembolic event observed. Conclusion: Because of proximal femoral malignancy, extensive tumor resection and preoperative bolus 15 mg/kg TXA administration in proximal femoral prosthesis surgery significantly decreased the amount of postoperative bleeding and transfusion requirement without increasing the risk of thromboembolic event. Level of Evidence: Level III-retrospective comparative study.

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“…Также в профилактике вывиха эндопротеза стоит отметить немаловажную роль правильного пространственного позиционирования компонентов эндопротеза и оптимального восстановления длины конечности [14,15].…”

Section: Discussionunclassified

The Long-Term Results of Hip Arthroplasty in Patients with Proximal Femur Tumors

Микайлов¹,

Тихилов

Пташников

et al. 2020

Traumatology and Orthopedics of Russia

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Relevance. The development of the modern principles of combined tumor treatment has significantly improved the survival of the patients. For these patients, the organ-preserving surgerybecomes now the mainstream tactics. For the restoration of the lower limb support ability and the hip function, the hip arthroplasty is now the most used type of surgery. Purpose of the study. The purpose of this work was to evaluate the long-term results of hip arthroplasty in the patients with extensive proximal femur defects caused by tumors and tumor-like lesions. Materials and Methods. The data on 126 patients with proximal femur tumors, undergone the surgical treatment in 2000-2013, were collected and summarized. The average age of the patients was 53.8 years (26-74), 94 women (74.6%), and 32 men (25.4%). There were 16 primary malignant bone tumors (12.7%), 10 benign aggressive (7.9%); 92 metastatic (73%), and 8 tumor-like lesions (6.4%). The average follow-up after the surgery was 72.6 months. The complications classification and analysis were performed according to the criteria of the International Society of Limb Salvage 2014 (ISOLS 2014). For the assessment of the functional result, patients were divided into 4 groups. In this context, the following indicators were taken into account: whether the acetabular component or the bipolar head were used, and the method of the soft tissues fixation to the femoral component of the endoprosthesis. Functional outcome was evaluated using the international Musculoskeletal Tumor Society (MSTS) scoring system at 3, 6, and 12 months. Results. The total number of complications, identified during the observation period from 2000 to 2018, was 26 (20.6%). The oncological complications, represented by local recurrence, were detected on average after 11.5 months. The total number of local recurrences is 6 (4.7%) which amounted to 23% in the structure of all complications. Dislocations of the endoprosthesis became the most frequent complication-13 (10.3%) observations, 50% in the structure of all complications. Only one patient with aseptic instability of the femoral component was identified over the entire follow-up period. There were 4 (3.1%) patients with complications due to the destruction of metal constructions. All of them had an endoprosthesis stem fracture. The average period of onset of these complications was 122.5 months. Prosthetic joint infection was observed in 2 (1.6%) patients (7.2% of all complications), on the 14th and 31st days. The patient with the latter onset of infection underwent a twostaged revision arthroplasty. Functional result by the MSTS scale: 3 months-74.8%, 6 months-79%, 12 months-81.8%. In the patients under investigation, 5-, 10-, and 15-year survival for aggressive benign tumors and tumorlike lesions was 95%, 84%, 62%; for malignant primary tumors-88%, 65%, 24%; for secondary bone lesions-55%, 43%, 12%, respectively. Conclusion. The use of a bipolar head made it possible to reduce the likelihood of an endoprosthesis dislocation. The fixation of the preserved...

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Outcome after reconstruction of proximal femoral tumors: A systematic review

Cited by 30 publications

References 54 publications

Is osseous reattachment of the greater trochanter necessary compared to soft‐tissue‐only abductor repair in proximal femoral megaprosthesis reconstruction?

Is osseous reattachment of the greater trochanter necessary compared to soft‐tissue‐only abductor repair in proximal femoral megaprosthesis reconstruction?

The Effectiveness of Tranexamic Acid in Patients With Proximal Femoral Tumor Resection Prosthesis

The Long-Term Results of Hip Arthroplasty in Patients with Proximal Femur Tumors

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