Radiological and clinical outcomes using induced membrane technique combined with bone marrow concentrate in the treatment of chronic osteomyelitis of immature patients

Shen, Jie; Sun, Dong; Yu, Shengpeng; Fu, Jingshu; Wang, Xiaohua

doi:10.1302/2046-3758.101.bjr-2020-0229.r1

Cited by 10 publications

(14 citation statements)

References 35 publications

(20 reference statements)

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“…Establishing the best surgical option in treating musculoskeletal neoplastic and non-neoplastic conditions is ongoing. [17][18][19][20][21][22][23] Our comparison of rAPC reconstruction with osteoarticular allograft reconstruction in treating distal femoral tumours in children revealed knee stability and functional outcomes were statistically significantly better in the rAPC group, while the ROM in the knee was statistically significantly better in the osteoarticular allograft group. These findings were clinically relevant.…”

Section: Discussionmentioning

confidence: 76%

A comparison of osteoarticular allografts and allograft-prosthesis composites for reconstruction of the distal femur after resection of a bone tumour in childhood

Jamshidi

Bagherifard

Mirzaei

2022

The Bone & Joint Journal

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Aims Osteoarticular reconstruction of the distal femur in childhood has the advantage of preserving the tibial physis. However, due to the small size of the distal femur, matching the host bone with an osteoarticular allograft is challenging. In this study, we compared the outcomes and complications of a resurfaced allograft-prosthesis composite (rAPC) with those of an osteoarticular allograft to reconstruct the distal femur in children. Methods A retrospective analysis of 33 skeletally immature children with a malignant tumour of the distal femur, who underwent resection and reconstruction with a rAPC (n = 15) or osteoarticular allograft (n = 18), was conducted. The median age of the patients was ten years (interquartile range (IQR) 9 to 11) in the osteoarticular allograft group and nine years (IQR 8 to 10) in the rAPC group (p = 0.781). The median follow-up of the patients was seven years (IQR 4 to 8) in the osteoarticular allograft group and six years (IQR 3 to 7) in the rAPC group (p = 0.483). Limb function was evaluated using the Musculoskeletal Tumor Society (MSTS) score. Results At final follow-up, the knee was unstable in 9/18 patients (50%) in the osteoarticular allograft group and 2/15 patients (13%) in the rAPC group (p = 0.026). The median range of motion (ROM) of the knee was 117° (IQR 115° to 120°) in the osteoarticular allograft group and 100° (IQR 95° to 105°) in the rAPC group (p < 0.001). The median MSTS score was 25 (IQR 23 to 26) in the osteoarticular allograft group and 28 (IQR 26 to 29) in the rAPC group (p = 0.007). Osteoarthritic change was detected in 11/18 patients (61%) in the osteoarticular allograft group and in 4/15 (26%) patients in the rAPC group (p = 0.048). Conclusion In our series, a resurfaced allograft-prosthesis composite provided better knee stability and function, with a lower rate of osteoarthritis; an osteoarticular allograft was associated with better knee ROM. Cite this article: Bone Joint J 2022;104-B(10):1174–1179.

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Section: Discussionmentioning

confidence: 76%

A comparison of osteoarticular allografts and allograft-prosthesis composites for reconstruction of the distal femur after resection of a bone tumour in childhood

Jamshidi

Bagherifard

Mirzaei

2022

The Bone & Joint Journal

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“…Some studies reported the volume of bone defects rather than their length. 21,36,58 Study and patient characteristics are summarized in Table I. Surgical parameters.…”

Section: Resultsmentioning

confidence: 99%

“…77 However, our multivariate analysis did not reach that conclusion, which is significantly different from the clinical effects reported in previous studies. 58,78 Masquelet even believed that adding BMP-7 leads to a poor prognosis of infected bone defects. 3 Age is a recognized factor affecting bone healing.…”

Section: Discussionmentioning

confidence: 99%

Treatment of infected bone defects with the induced membrane technique

Shen,

Wei,

Wang

et al. 2023

Bone Joint Res

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AimsThis study aimed to evaluate the effectiveness of the induced membrane technique for treating infected bone defects, and to explore the factors that might affect patient outcomes.MethodsA comprehensive search was performed in PubMed, Embase, and the Cochrane Central Register of Controlled Trials databases between 1 January 2000 and 31 October 2021. Studies with a minimum sample size of five patients with infected bone defects treated with the induced membrane technique were included. Factors associated with nonunion, infection recurrence, and additional procedures were identified using logistic regression analysis on individual patient data.ResultsAfter the screening, 44 studies were included with 1,079 patients and 1,083 segments of infected bone defects treated with the induced membrane technique. The mean defect size was 6.8 cm (0.5 to 30). After the index second stage procedure, 85% (797/942) of segments achieved union, and 92% (999/1,083) of segments achieved final healing. The multivariate analysis with data from 296 patients suggested that older age was associated with higher nonunion risk. Patients with external fixation in the second stage had a significantly higher risk of developing nonunion, increasing the need for additional procedures. The autografts harvested from the femur reamer-irrigator-aspirator increased nonunion, infection recurrence, and additional procedure rates.ConclusionThe induced membrane technique is an effective technique for treating infected bone defects. Internal fixation during the second stage might effectively promote bone healing and reduce additional procedures without increasing infection recurrence. Future studies should standardize individual patient data prospectively to facilitate research on the affected patient outcomes.Cite this article: Bone Joint Res 2023;12(9):546–558.

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“…Their results showed that BTP was even more effective in osteogenesis than bone graft. Shen et al [ 30 ] used bone marrow concentrator–modified allograft or bone marrow aspirate–mixed allograft to improve the osteogenic ability of allograft. In this study, allograft bone was added as an alternative graft material to increase the graft volume.…”

Section: Discussionmentioning

confidence: 99%

Clinical effects of early debridement, internal fixation, and Masquelet technique for childhood chronic haematogenous osteomyelitis of long bones

Shi¹,

Yang²,

Song³

et al. 2023

J Orthop Surg Res

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Background Childhood chronic haematogenous osteomyelitis (CCHOM) is a severe condition in paediatric patients. The optimal timing of debridement and the subsequent method of bone reconstruction in CCHOM patients remain controversial. The purpose of this study was to assess the treatment efficacy of Masquelet technique with early debridement and internal fixation in CCHOM of long bones. Methods Between January 2016 and January 2021, a total of 21 patients (18 males, 3 females) with CCHOM of long bone were included. The mean age was 10.4 years (range, 2–18 years). All cases were treated by a two-stage surgical protocol of Masquelet technique. In the first stage, aggressive debridement, sequestrectomy, and inducing membrane by bone cement spacer were performed after definite diagnosis. In the second stage, cement spacer was removed, and autologous and allogeneic bone was grafted. Internal fixation was used for the first and/or second stage depending on stability requirements. The patients’ clinical and imaging results were retrospectively analysed. Results The mean follow-up was 31.7 months (range, 21–61 months). None of the patients experienced recurrence of infection. Radiographic bone union time was 4.3 months (range, 2.5–11 months). Five cases underwent re-operation due to complications such as bone resorption or refracture. By the last follow-up visit, bones had healed and all of the patients had resumed daily living and sports activities. Conclusion The Masquelet technique with early debridement and internal fixation is a viable surgical method for the management of large long bone defects of CCHOM patients.

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Radiological and clinical outcomes using induced membrane technique combined with bone marrow concentrate in the treatment of chronic osteomyelitis of immature patients

Cited by 10 publications

References 35 publications

A comparison of osteoarticular allografts and allograft-prosthesis composites for reconstruction of the distal femur after resection of a bone tumour in childhood

A comparison of osteoarticular allografts and allograft-prosthesis composites for reconstruction of the distal femur after resection of a bone tumour in childhood

Treatment of infected bone defects with the induced membrane technique

Clinical effects of early debridement, internal fixation, and Masquelet technique for childhood chronic haematogenous osteomyelitis of long bones

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