Proximal Tibia Reconstruction After Bone Tumor Resection: Are Survivorship and Outcomes of Endoprosthetic Replacement and Osteoarticular Allograft Similar?

Albergo, José I.; Gaston, Czar Louie; Aponte-Tinao, Luis A.; Ayerza, Miguel A.; Múscolo, D. Luis; Farfalli, Germán L.; Jeys, Lee; Carter, Simon R.; Tillman, R. M.; Abudu, A.; Grimer, R. J.

doi:10.1007/s11999-016-4843-y

Cited by 83 publications

(74 citation statements)

References 28 publications

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“…Whether it is preferable to perform reconstruction of large segmental bone defects after tumor resections including joints with allografts or with massive endoprostheses is still unsolved. All-over results are comparable, however there are differences with regard to causes of failure [3] Proximal tibia reconstruction after bone tumor resection with osteoarticular allografts yielded similar failures compared to endoprosthetic replacement, favouring allograft reconstructions in younger patients to achieve better extensor mechanism function [4].…”

Section: Discussionmentioning

confidence: 97%

“…Toy et al [2] and Verbeek et al [3] addressed problems encountered in femoral osteoarticular allografts and complications in revision to total hip replacement (THA) or total knee replacement (TKA); 61% of THA/TKA respectively in retained allografts had complications, mostly structural failures (periprosthetic fractures/allograft fractures [3]). A study comparing outcome of proximal tibia reconstructions with either osteoarticular allografts or endoprosthetic replacement showed separate advantages, however not significantly different overall failure rates (at 10 years 44% for endoprostheses and 32% for allografts [4]).…”

Section: Introductionmentioning

confidence: 97%

“…[4]. Failures of osteoarticular allografts are primarily caused by fractures and degeneration of the articular cartilage.In the presented two index cases (1 and 2), fractures of the allografts were ad-dressed by osteosynthesis and/or replacement respectively.…”

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confidence: 99%

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Salvage of Failed Osteoarticular Tibia Allografts with Knee Arthroplasties

Exner¹,

Schai²,

Bühler³

et al. 2020

OJO

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Background: Limb preservation in musculoskeletal tumor surgery has largely replaced amputation. Biologic reconstructions are now performed as preferred choice; if not feasible options are "megaprostheses", allografts or composites. Endoprosthetic reconstructions usually provide immediate function, but fail at long term. Osteochondral allografts allow for one-to-one restoration and have potential for incorporation; however degeneration of the cartilage requiring revision almost inevitably will occur. In most cases, revision is then done by endoprosthetic replacement. Aim: In our patients, resurfacing of retained allografts failed. Problems encountered are presented and solutions proposed. Case Presentation: Resurfacing over retained allografts in the 2 index cases has resulted in failures related to fractures and instability. Revision with massive constrained endoprostheses was needed. Based on the experience with these failures, primary endoprosthetic replacement anchored in vital bone in a following case resulted in stable function. Conclusion: Knee replacement for advanced degeneration of the osteochondral allograft apparently needs choosing increased femoro-tibial constraint systems and stem extensions anchored to vital host bone.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 97%

See 1 more Smart Citation

Salvage of Failed Osteoarticular Tibia Allografts with Knee Arthroplasties

Exner¹,

Schai²,

Bühler³

et al. 2020

OJO

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“…In this issue of CORR 1 , we are proud to publish the award winner for the best paper from Latin America in 2016, a large and comprehensive comparison of endoprosthetic reconstruction and osteoarticular allograft after tumor resections of the proximal tibia [1]. With patients from two major tumor centers in Argentina and nearly 400 patients, I expect this paper by Albergo and colleagues to be as definitive a look at this topic as we are likely to see.…”

mentioning

confidence: 99%

Editorial: Bringing CORR's Global Readers the Best in Orthopaedic Research from China and Latin America

Leopold

2017

Clinical Orthopaedics &Amp; Related Research

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“…1 Survival depends greatly on the type and stage of cancer, but with a combination of local and systemic treatment, cure rates range from 85% among patients with stage I disease to 10% to 20% for patients with stage IV disease. 2 However, the cure has a cost: the same life-saving surgery, radiation, and anthracycline chemotherapy used to treat cancer often comes with the loss of fertility, early and late cardiotoxicity, and orthopedic problems. These outcomes include loss of spermatogenesis and premature ovarian failure; acute cardiomyopathy during chemotherapy and late cardiomyopathy in subsequent decades; infections and complications of limb-salvage surgery; and death.…”

mentioning

confidence: 99%

Fertility, Cardiac, and Orthopedic Challenges in Survivors of Adult and Childhood Sarcoma

Lipshultz

Holt

Ramasamy

et al. 2017

American Society of Clinical Oncology Educational Book

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The combination of cisplatin, doxorubicin, and methotrexate was established as the standard backbone of contemporary osteosarcoma therapy in 1986. Since then, however, further improving the survival of patients with osteosarcoma has been challenging-30% to 40% of patients with osteosarcoma still die of this disease. In addition, these patients often experience loss of fertility at a young age, short- and long-term treatment-related cardiotoxicity, and adverse orthopedic effects from surgical resection of the tumor or endoprosthetic reconstructions. Cancer treatment often markedly increases the risk of infertility later in life, causing many patients substantial distress and regret. Sperm banking and oocyte cryopreservation are standard of care and should be available to all at-risk patients. Newer techniques, such as autologous gonadal tissue transplant for prepubertal children, are being developed, and newer systemic agents have infertility risk profiles that remain undefined and warrant further study. Cost and access remain barriers to these options. The late effects of anthracycline-induced cardiotoxicity are also increasingly a problem for these patients. These effects are often progressive and can be disabling. Adding dexrazoxane to doxorubicin therapy significantly reduces the risk for most adverse cardiac outcomes without compromising the efficacy of induction chemotherapy. Limb salvage surgery remains the standard of care for treatment in the majority of patients with extremity sarcomas. Modular metal prostheses and allograft reconstructions comprised the majority of surgical procedures for limb salvage surgery. The most common mechanism of failure of these implants is infection and mechanical failure of the implant.

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Proximal Tibia Reconstruction After Bone Tumor Resection: Are Survivorship and Outcomes of Endoprosthetic Replacement and Osteoarticular Allograft Similar?

Abstract: Level III, therapeutic study.

Cited by 83 publications

References 28 publications

Salvage of Failed Osteoarticular Tibia Allografts with Knee Arthroplasties

Salvage of Failed Osteoarticular Tibia Allografts with Knee Arthroplasties

Editorial: Bringing CORR's Global Readers the Best in Orthopaedic Research from China and Latin America

Fertility, Cardiac, and Orthopedic Challenges in Survivors of Adult and Childhood Sarcoma

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