Rotationplasty After Failed Limb-Sparing Tumor Surgery

Brigman, Brian E.; Kumagai, S; McGuire, Michael H.

doi:10.1097/01.blo.0000093887.12372.3d

Cited by 12 publications

(4 citation statements)

References 12 publications

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“…Large humeral or femoral segments can be reconstructed with endoprosthesis of new prosthetic materials [17,18]. We performed more endoprosthesis (27%) than osteosynthesis (17%), as these are beneficial for selected patients with metastatic tumors and bone loss, what we and others have shown before [19-22]. A wide resection (R0) could, on the first sight, significantly improve survival (p = 0.0123) in comparison to R1 or R2 resection.…”

Section: Discussionmentioning

confidence: 98%

Analysis of orthopedic surgery of bone metastases in breast cancer patients

Wegener

Schlemmer

Stemmler

et al. 2012

BMC Musculoskelet Disord

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BackgroundBreast cancer is the most common malignancy and the second leading cause of death in women. Because bone metastases are a common finding in patients with breast cancer, they are of major clinical concern.MethodsIn 115 consecutive patients with bone metastases secondary to breast cancer, 132 surgical procedures were performed. Medical records and imaging procedures were reviewed for age, treatment of the primary tumor, clinical symptoms, surgical treatment, complications, and survival.ResultsThe overall survival of patients with metastatic breast cancer was dependent on the site and the amount of the metastases. Age was not a prognostic factor for survival. If the result of the orthopaedic surgery was a wide resection (R0) survival was significantly better than in the R1 (marginal resection – tumor resection in sane tissue) or R2 (intralesional resection) situation. Concerning the orthopaedic procedures there was no survival difference.ConclusionIn conclusion a wide (R0) resection and the absence of pathological fracture and visceral metastases were predictive for longer survival in univariate analysis. Age and the type of orthopaedic surgery had no impact on survival in multivariate analysis. The resection margins lost significance. The standard of care for patients with metastatic breast cancer to the bone requires a multidisciplinary approach.

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Section: Discussionmentioning

confidence: 98%

Analysis of orthopedic surgery of bone metastases in breast cancer patients

Wegener

Schlemmer

Stemmler

et al. 2012

BMC Musculoskelet Disord

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“…Several authors have reported using rotationplasty as a successful treatment option for a failed limb salvage procedure, albeit with higher complication rates than primary rotationplasty [5,15]. The only patient in our cohort who did not have osteosarcoma underwent rotationplasty after failure of the primary resection for synovial sarcoma.…”

Section: Discussionmentioning

confidence: 75%

Vascular Management in Rotationplasty

Mahoney

Hartman

Simon

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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The Van Nes rotationplasty is a useful limbpreserving procedure for skeletally immature patients with distal femoral or proximal tibial malignancy. The vascular supply to the lower limb either must be maintained and rotated or transected and reanastomosed. We asked whether there would be any difference in the ankle brachial index or complication rate for the two methods of vascular management. Vessels were resected with the tumor in seven patients and preserved and rotated in nine patients. One amputation occurred in the group in which the vessels were preserved. Four patients died secondary to metastatic disease diagnosed preoperatively. The most recent ankle brachial indices were 0.96 and 0.82 for the posterior tibial and dorsalis pedis arteries, respectively, in the reconstructed group. The ankle brachial indices were 0.98 and 0.96 for the posterior tibial and dorsalis pedis arteries, respectively, in the rotated group. Outcomes appear similar using both methods of vascular management and one should not hesitate to perform an en bloc resection when there is a question of vascular involvement. Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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“…However, the patient should always be aware that a conversion in the setting of infection carries a significant risk of thigh amputation 7, 8. Rotationplasty should be considered in selected patients for whom an amputation is being considered after failed limb salvage surgery 21. Rotationplasty allows the patient to actively control the knee, which results in coordinated gait pattern, which is similar to the gait of the able‐bodied population, and better than in subjects with above‐knee amputation and also with knee arthrodesis 22–29.…”

Section: Discussionmentioning

confidence: 99%