Outcome of Lower-Limb Preservation with an Expandable Endoprosthesis After Bone Tumor Resection in Children

Henderson, Eric; Pepper, Andrew M; Marulanda, German A.; Binitie, Odion; Cheong, David; Letson, G. Douglas

doi:10.2106/jbjs.i.01575

Cited by 65 publications

(60 citation statements)

References 54 publications

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“…To the best of our knowledge there are no published data regarding revision-free implant survival of expandable total femur replacements. Failure rates between 60% [30] and 66% [10] were reported compared with 90% in our series. However overall implant survival in those two studies was equal to our overall implant survival rate.…”

Section: Discussionsupporting

confidence: 42%

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Total Femur Replacement After Tumor Resection: Limb Salvage Usually Achieved But Complications and Failures are Common

Sevelda

Schuh

Hofstaetter

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Primary bone or soft tissue tumors of the femur sometimes present with severe and extensive bone destruction, leaving few limb-salvage options other than total femur replacement. However, there are few data available regarding total femur replacement and, in particular, regarding implant failures. Questions/purposes We asked: (1) What are the revisionfree and overall implant survival rates of conventional total femur replacements in patients treated for sarcoma of the femur or soft tissues? (2) What are the revision-free and overall implant survival rates of expandable total femur replacements in skeletally immature patients? (3) Using the comprehensive International Society of Limb Salvage failure-mode classification, what types of complications occur with conventional and expandable total femur replacements? Patients and Methods Our retrospective, single-center cohort study was based on data prospectively collected for 50 patients who received a total femur replacement after tumor resection for indications other than carcinoma or metastatic disease. Of the 50 patients, six (12%) were lost to followup before 6 months. Ten of the remaining 44 patients received expandable implants. The mean followup was 57 months (range, 1-280 months) and 172 months (range, 43-289 months) for patients who underwent conventional and expandable total femur replacements, respectively. For implant survival, competing risk analyses were used. Results At 5 years, revision-free implant survival of conventional total femur replacements was 48% (95% CI, 0.37-0.73), and overall implant survival was 97% (95% CI, 0.004-0.20). Five-year revision-free implant survival of expandable total femur replacements was 30% (95% CI, 0.47-1.00) and overall implant survival was 100%. With

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Section: Discussionsupporting

confidence: 42%

“…Reported infection rates range from 20% [11,30] to 33% [10] and aseptic loosening in 20% [30]. No dislocations of the hip with extendable total femur replacements have been reported to our knowledge.…”

Section: Discussionmentioning

confidence: 86%

Total Femur Replacement After Tumor Resection: Limb Salvage Usually Achieved But Complications and Failures are Common

Sevelda

Schuh

Hofstaetter

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…The introduction of less-invasive expandable prostheses is purported to allow for implant expansion without further surgical interventions and without use of general anesthesia, making this type of reconstruction increasingly popular in the treatment of skeletally immature children with malignant bone tumors of the extremities [6,11,12,15,17,26,27]. However, we found that use of a particular expandable prosthesis was associated with many complications, resulting in failure of the prosthesis, inability to achieve Expandable = mini-invasive mechanically expandable prosthesis; Noninvasive expand = noninvasive expandable prosthesis; bone = segmental massive bone allograft; DAIR = débridement, antibiotics, and implant retention; EPD = epiphysiodesis; MSTS = Musculoskeletal Tumor Society; *= did not undergo lengthening.…”

Section: Discussionmentioning

confidence: 99%

Are Complications Associated With the Repiphysis® Expandable Distal Femoral Prosthesis Acceptable for Its Continued Use?

Staals

Colangeli

Alì

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Reconstruction of the distal femur after resection for malignant bone tumors in skeletally immature children is challenging. The use of megaprostheses has become increasingly popular in this patient group since the introduction of custom-made, expandable devices that do not require surgery for lengthening, such as the Repiphysis 1 Limb Salvage System. Early reports on the device were positive but more recently, a high complication rate and associated bone loss have been reported. Questions/purposes We asked: (1) what are the clinical outcomes using the Musculoskeletal Tumor Society (MSTS) scoring system after 5-year minimum followup in patients treated with this prosthesis at one center; (2) what are the problems and complications associated with the lengthening procedures of this implant; and (3) what are the specific concerns associated with revision of this implant? Methods At our institute, between 2002 and 2007, the Repiphysis 1 expandable prosthesis was implanted in 15 children (mean age, 8 years; range, 6-11 years) after distal femoral resection for malignant bone tumors. During this time, the general indication for use of this implant was resection of the distal femur for localized malignant bone tumors in pediatric patients. Alternative techniques used for this indication were modular prosthetic reconstruction, massive (osteoarticular or intercalary) allograft reconstruction, or rotationplasty. Age and tumor extension were the main factors to decide on the surgical indication. Of the 15 patients who had this prosthesis implanted during reconstruction surgery, five died with the implant in situ or underwent amputation before 5 years followup and the remaining 10 were evaluated at a minimum of 5 years (mean, 104 months; range, 78-140 months). No patients were lost to followup. These 10 patients were long-term survivors and underwent the lengthening program. They were included in our study analysis. The first seven lengthening procedures were attempted in an outpatient setting; however, owing to pain and burning sensations experienced by the patients, the procedures failed to achieve the desired lengthening. Therefore, other procedures were performed with the patients under general anesthesia. We reviewed clinical data at index surgery for all 15 patients. We further analyzed the lengthening procedures, implant survival, radiographic and functional results, for the 10 long-term survivors. Functional results were assessed according to the MSTS scoring system.

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“…Limb salvage surgery has replaced amputation as the first-line treatment for primary bone sarcoma of the distal femur [11,12]. This transition has been achieved without adversely affecting survival, primarily owing to improvements of chemotherapy [11,12].…”

Section: Discussionmentioning

confidence: 99%

“…This transition has been achieved without adversely affecting survival, primarily owing to improvements of chemotherapy [11,12]. However, the complication rate after prosthetic replacement remains high.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of Kyocera Modular Limb Salvage system after resection of bone sarcoma of the distal part of the femur: the Japanese Musculoskeletal Oncology Group study

Nakamura¹,

Matsumine²,

Uchida³

et al. 2013

International Orthopaedics (SICOT)

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Purpose The Japanese Musculoskeletal Oncology Group have developed an original prosthesis called the Kyocera Modular Limb Salvage system (KMLS system). This prosthesis has a semi-rotating hinge joint and is particularly designed for people with an Asian body type. The metallic parts of the prosthesis are made entirely of titanium alloy. The purpose of this study is to evaluate the clinical outcomes of treatment using this system following tumour resection of primary bone sarcoma of the distal femur. Methods Between 2002 and 2010, 82 patients with primary bone sarcomas of the distal femur were treated. Seventeen patients underwent stem cementation, while 65 patients were treated with cementless prostheses. The mean follow-up period after surgery was 61 months. Results Complications were observed in 28 of the 82 patients. Forty-one complications occurred in these 28 patients. Thirteen prostheses (16 %) required revision surgery due to complications, including five cases of stem breakage, three deep infections, three cases of aseptic loosening, one case of displacement of the shaft cap and one case of breakage of the tibial tray. The five-year overall prosthetic survival rate was 80.0 %. Four of the 82 patients underwent subsequent amputation due to local recurrence. The five-year limb salvage rate was 94.5 %. The mean function score according to the scoring system of the Musculoskeletal Tumour Society was 21.8 points (72.5 %).

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Outcome of Lower-Limb Preservation with an Expandable Endoprosthesis After Bone Tumor Resection in Children

Cited by 65 publications

References 54 publications

Total Femur Replacement After Tumor Resection: Limb Salvage Usually Achieved But Complications and Failures are Common

Total Femur Replacement After Tumor Resection: Limb Salvage Usually Achieved But Complications and Failures are Common

Are Complications Associated With the Repiphysis® Expandable Distal Femoral Prosthesis Acceptable for Its Continued Use?

Clinical outcomes of Kyocera Modular Limb Salvage system after resection of bone sarcoma of the distal part of the femur: the Japanese Musculoskeletal Oncology Group study

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