The results of total humeral replacement following excision for primary bone tumour

Puri, Ajay; Gulia, Ashish

doi:10.1302/0301-620x.94b9.29697

Cited by 29 publications

(33 citation statements)

References 27 publications

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“…It has been well established that survival decreases in cases of secondary osteosarcoma and those that have metastasis at presentation 4. Our results for these pelvic tumors are comparable to those achieved for our extremity lesions thus belying the fact that appropriately treated pelvic lesions have a dismal prognosis 2021…”

Section: Discussionsupporting

confidence: 84%

Outcome of surgical resection of pelvic osteosarcoma

Puri

Gulia

Pruthi

2014

IJOO

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Background:The aim of the following study is to evaluate the morbidity, oncologic results and functional outcome in nonmetastatic patients with primary osteosarcoma of the pelvis treated with surgical resection.Materials and Methods:Twelve cases of nonmetastatic osteosarcoma of pelvis were operated as part of their multimodality treatment regime between November 2003 and May 2011. There were 5 males and 7 females with a median age of 22 years (range 8-39 years). Ten patients underwent limb sparing resections while 2 had a hindquarter amputation. All 10 cases of limb sparing surgery included resection of the acetabulum. A pseudarthrosis was carried out in 7 cases. Extracorporeal radiation therapy and reimplantation of the bone followed by fixation with plates was used in 1 case and an ischiofemoral arthrodesis was carried out in 2 cases.Results:Surgical margins were free in 11 patients. Seven patients had a poor histological response to chemotherapy while 4 patients had a good response to chemotherapy. In the patient reconstructed with radiated auto bone graft, the histological response to chemotherapy could not be assessed. Surgery related complications were seen in 8 out of 12 patients (67%). Three of these patients (25%) required additional surgical intervention for their complications. All patients were available for followup. The median followup of survivors was 56 months (range 24-102 months). Four patients (33%) developed a local recurrence. At 5 years, overall survival was 67%. Patients with a good response to chemotherapy had a better overall survival when compared with patients with a poor response to chemotherapy. The mean Musculoskeletal Tumor Society functional score was 22 (range12-27).Conclusions:Though complex and challenging, surgery provides good local control and oncologic outcomes with acceptable function in patients with osteosarcoma of the pelvis treated with appropriate surgical resection as part of their multimodality treatment.

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Section: Discussionsupporting

confidence: 84%

Outcome of surgical resection of pelvic osteosarcoma

Puri

Gulia

Pruthi

2014

IJOO

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“…[1][2][3][4][5]17,18 Most, however, involve reconstruction after intra-articular resection. Suspected intra-articular extension of the tumour cannot always be proven macro-and/or microscopically, resulting in possible over-treatment in some patients.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] The survival rate of the prostheses has increased, principally because of lower mechanical failure rates, despite prolonged survival of patients, many of whom are young and active with high demands on the implant. 5,6 Although most tumours around the knee can be treated using intra-articular surgery, extra-articular resection is necessary in some patients owing to infiltration of the joint by tumour, or iatrogenic contamination of the joint as a result of an inappropriate technique used for biopsy.…”

mentioning

confidence: 99%

Endoprosthetic replacement after extra-articular resection of bone and soft-tissue tumours around the knee

Hardes

Henrichs

Gosheger

et al. 2013

The Bone & Joint Journal

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We evaluated the clinical results and complications after extra-articular resection of the distal femur and/or proximal tibia and reconstruction with a tumour endoprosthesis (MUTARS) in 59 patients (mean age 33 years (11 to 74)) with malignant bone or soft-tissue tumours. According to a Kaplan-Meier analysis, limb survival was 76% (95% confidence interval (CI) 64.1 to 88.5) after a mean follow-up of 4.7 years (one month to 17 years). Peri-prosthetic infection was the most common indication for subsequent amputation (eight patients). Survival of the prosthesis without revision was 48% (95% CI 34.8 to 62.0) at two years and 25% (95% CI 11.1 to 39.9) at five years post-operatively. Failure of the prosthesis was due to deep infection in 22 patients (37%), aseptic loosening in ten patients (17%), and peri-prosthetic fracture in six patients (10%). Wear of the bearings made a minor revision necessary in 12 patients (20%). The mean Musculoskeletal Tumor Society score was 23 (10 to 29). An extensor lag > 10° was noted in ten patients (17%). These results suggest that limb salvage after extra-articular resection with a tumour prosthesis can achieve good functional results in most patients, although the rates of complications and subsequent amputation are higher than in patients treated with intra-articular resection.

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“…These prostheses are now routinely being used even for total bone resections and total femur and total humerus replacements are not uncommon. 13 14 …”

Section: Introductionmentioning

confidence: 99%

Limb salvage: When, where, and how?

Puri

2015

IJOO

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From an era where amputation was the only option to the current day function preserving resections and complex reconstructions has been a major advance in the treatment of musculoskeletal sarcomas. The objectives of extremity reconstruction after oncologic resection include providing skeletal stability where necessary, adequate wound coverage to allow early subsequent adjuvant therapy, optimising the aesthetic outcome and preservation of functional capability with early return to function. This article highlights the concepts of surgical margins in oncology, discusses the principles governing safe surgical resection in these tumors and summarises the current modalities and recent developments relevant to reconstruction after limb salvage. The rationale of choice of a particular resection modality and the unique challenges of reconstruction in skeletally immature individuals are also discussed. Striking the right balance between adequate resection, while yet retaining or reconstructing tissue for acceptable function and cosmesis is a difficult task. Complications are not uncommon and patients and their families need to be counseled regarding the potential setbacks that may occur in the course of their eventual road to recovery, Limb salvage entails a well orchestrated effort involving various specialties and better outcomes are likely to be achieved with centralization of expertise at regional centers.

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The results of total humeral replacement following excision for primary bone tumour

Cited by 29 publications

References 27 publications

Outcome of surgical resection of pelvic osteosarcoma

Outcome of surgical resection of pelvic osteosarcoma

Endoprosthetic replacement after extra-articular resection of bone and soft-tissue tumours around the knee

Limb salvage: When, where, and how?

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