Reconstruction After Tumor Resection in the Growing Child

Groundland, John; Binitie, Odion

doi:10.1016/j.ocl.2015.08.027

Cited by 25 publications

(22 citation statements)

References 69 publications

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“…Limb salvage in skeletally immature children is challenging, with the greatest difficulty associated with resection of the open physis. Sacrifice of major growth plates during resection and fixed‐length reconstruction of a limb in a skeletally immature child with osteosarcoma usually result in significant limb‐length inequality as growth progress.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical options have shifted from amputation to limb salvage. Reconstruction strategies for this specific population include rotationplasty, megaprosthesis implantation with expandable mechanism or fixed length, allograft, and staged distraction osteogenesis. Rotationplasty and expandable endoprosthesis have been successfully used to treat skeletally immature patients with osteosarcoma of the distal femur.…”

Section: Discussionmentioning

confidence: 99%

“…To address LLD following limb salvage surgery, expandable prostheses have been developed. However, besides the high complication rate, up to 50% of patients who have expandable prosthesis reconstruction do not undergo further lengthening procedures due to oncological failures or overestimation of expected LLD. In addition, small degrees of LLD up to 2.2 cm can be well compensated by mechanism of pelvic obliquity, and the children usually have a normal gait.…”

Section: Discussionmentioning

confidence: 99%

“…A high complication rate of the extendable prosthesis has been highlighted in some studies. An average 50% revision rate is reported for non‐invasive expandable endoprostheses.…”

Section: Discussionmentioning

confidence: 99%

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Limb Salvage Using Non‐hinged Endoprosthesis and Staged Correction of Leg‐length Discrepancy for Children with Distal Femoral Malignant Tumors

Yang

et al. 2019

Orthopaedic Surgery

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ObjectiveLimb salvage in pediatric patients remains a challenge. We describe a staged strategy. The procedure includes: (i) tumor removal and non‐hinged static endoprosthesis reconstruction; (ii) leg length discrepancy (LLD) correction by shoe lift or distraction osteogenesis; and (iii) maturity reconstruction by regular endoprosthesis. The aim of the study was to investigate the results of non‐hinged static megaprosthesis reconstruction and staged LLD correction in the treatment of malignant tumors in the distal femur in children.MethodsNon‐hinged megaprostheses were implanted in 12 pediatric patients with osteosarcoma in the distal femur. The prosthesis consists of a femoral component with constrained condylar knee (CCK) design, and a tibial component with a small‐diameter press‐fit stem and derotation fins. A posterior stabilizing polyethylene component is fixed on the tibial component. The cases were prospectively followed up with focus on the growth rate of adjacent uninvolved bone in the salvaged limb, joint stability, knee stability, function outcome, length discrepancy, and surgery‐related complications.ResultsThere were five girls and seven boys included in the study, with an average age at the time of primary surgery of 10.0 years (range, 8–12 years). All the tumors were located in the distal femur. The average follow up was 76.3 months (range, 24–139 months). The Ligament Augmentation and Reconstruction System (LARS) ligament was used in two patients to enhance the soft tissue reattachment and reconstruct medial collateral ligament (MCL). Ten patients were alive at the final follow‐up and two had died of lung metastases. Expected LLD was 6.7 cm (range, 3.0–13.2 cm) at initial surgery. At the final follow‐up, nine patients reached skeletal maturity and the actual LLD at the femur was 5.3 cm (range, 3.0–10.1 cm), excluding 1 cm correction at initial surgery by endoprosthesis. The proximal tibia physis showed an average of 86.7% (range, 56.5%–100%) growth of the contralateral side. The mean reduction in tibial length was 1.2 cm (range, 0.5–4.7 cm). Six patients received distraction osteogenesis at a mean length of 5.4 cm (range, 3.0–9.1 cm). Range of knee movement was between 85° and 125°, with an average of 102.5°. The Musculoskeletal Tumor Society 93 score of patients alive was 80.6 (range, 60–90).ConclusionNon‐hinged static megaprosthesis followed by LLD correction with shoe lift or staged distraction osteogenesis appears to be an alternative option to treat children with malignant bone tumors around the knee.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…A high complication rate of the extendable prosthesis has been highlighted in some studies. An average 50% revision rate is reported for non‐invasive expandable endoprostheses.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Limb Salvage Using Non‐hinged Endoprosthesis and Staged Correction of Leg‐length Discrepancy for Children with Distal Femoral Malignant Tumors

Yang

et al. 2019

Orthopaedic Surgery

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“…In third-world countries, where chemotherapy lacks funding and amputation has negative perceptions, it can be used as a tool to educate patients [32]. In skeletally immature patients prognostic estimates can help guide whether a patient is suitable for a growing prosthesis, an invasive growing prosthesis, allograft reconstruction, or conventional limb salvage with an endoprosthesis [20,39]. A hypothetical example would be where the clinician decides to neglect the growth potential of a child who has a poor prognosis and opts for an endoprosthesis that will provide short-term function and quality of life.…”

Section: Discussionmentioning

confidence: 99%

Can a Bayesian Belief Network Be Used to Estimate 1-year Survival in Patients With Bone Sarcomas?

Nandra

Parry

Forsberg

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Bone sarcomas are difficult to treat requiring multidisciplinary input to strategize management. An evidence-based survival prediction can be a powerful adjunctive to clinicians in this scenario. We believe the short-term predictions can be used to evaluate services, with 1-year mortality already being a quality indicator. Mortality predictors also can be incorporated in clinical trials, for example, to identify patients who are least likely to experience the side effects of experimental toxic chemotherapeutic agents.

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