Total knee replacement versus osteochondral allograft in proximal tibia bone tumours

Colangeli, Marco; Donati, Davide María; Benedetti, M.G.; Catani, Fabio; Gozzi, E.; Montanari, Eva; Giannini, Sandro

doi:10.1007/s00264-006-0256-y

Cited by 26 publications

(37 citation statements)

References 27 publications

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“…The mean modified HSS Knee score of successful cases increased from 66 pre-operatively to 83 postoperatively. Colangeli et al [31] compared results of 10 patients who underwent total knee modular megaprosthesis and 8 patients who underwent osteochondral allograft transplantation for reconstruction of the knee with proximal tibia bone tumours. When compared to total knee replacement, patients treated with osteochondral allografts had a lower incidence of knee extension lag; higher rate of normal knee pattern during gait; and superior knee extensor strength.…”

Section: Tibiamentioning

confidence: 99%

“…Colangeli et al [31] - Raz et al [29] Young, active patients Post-traumatic; OCD MFC, LFC 58 58 28 21.8 yr 22%…”

Section: Bipolarmentioning

confidence: 99%

“…Graft fragmentation and collapse are the main causes of failure, commonly presenting as new onset of pain, joint effusion, and mechanical symptoms. Failure of allograft transplantation Bakay et al [6] MFC, LFC, T, P, bipolar 33 -----Ghazavi et al [30] MFC, LFC, T, bipolar, P 126 95 71 66 --Langer et al [4] MFC, LFC 60 95 85 ---Gross et al [5] T 65 95 80 ---Jamali et al [35] P, FT 20 -67 ---Colangeli et al [31] T 8 -----Davidson et al [19] MFC, FT 10 -----Emmerson et al [24] MFC, LFC 66 91 76 76 --McCulloch et al [21] MFC, LFC 25 -----Williams et al [8] MFC, LFC 19 -----Pearsall et al [3] MFC, LFC, FT, P 24 -----Muscolo et al [32] T 58 65 65 ---Krych et al [28] MFC, LFC, FT, multiple sites 43 -----Murphy et al [27] MFC, LFC, FT, P, T, multiple sites 43 -----Raz et al [29] MFC, LFC 58 Bakay et al [6] MFC, LFC, T, P, bipolar…”

Section: Risks and Complicationsmentioning

confidence: 99%

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Knee salvage procedures: The indications, techniques and outcomes of large osteochondral allografts

Chui

Jeys

Snow

2015

WJO

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The overall incidence of osteochondral defect in the general population is estimated to be 15 to 30 per 100000 people. These lesions can become symptomatic causing pain, swelling and decreased function of the knee, and may eventually progress to osteoarthritis. In the young and active population, partial or total knee arthroplasty (TKA) is rarely the treatment of choice due to risk of early failure. Osteochondral allograft transplantation has been demonstrated to be a safe and effective treatment of large osteochondral and chondral defects of the knee in appropriately selected patients. The treatment reduces pain, improves function and is a viable limb salvage procedure for patients, especially young and active patients for whom TKA is not recommended. Either large dowels generated with commercially available equipment or free hand shell allografts can be implanted in more posterior lesions. Current recommendations for fresh allografts stored at 4C advise implantation within 21-28 d of procurement for optimum chondrocyte viability, following screening and testing protocols. Higher rates of successful allograft transplantation are observed in younger patients, unipolar lesions, normal or corrected malalignment, and defects that are treated within 12 mo of symptom onset. Patients with bipolar lesions, uncorrectable malalignment, advanced osteoarthritis, and those over 40 tend to have less favourable outcomes. Core tip:Osteochondral allograft transplantation has been demonstrated to be a safe and effective treatment of large osteochondral and chondral defects of the knee in appropriately selected patients. The treatment reduces pain, improves function and is a viable limb salvage procedure for patients, especially young and active patients for whom total knee arthroplasty is not recommended. Current recommendations for fresh allografts stored at 4C advise implantation within 21-28 d of procurement for optimum chondrocyte viability, following screening and testing protocols. Higher rates of successful allograft transplantation are observed in younger patients, unipolar lesions, normal or corrected malalignment, and defects that are treated within 12 mo of symptom onset.

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Section: Tibiamentioning

confidence: 99%

“…Colangeli et al [31] - Raz et al [29] Young, active patients Post-traumatic; OCD MFC, LFC 58 58 28 21.8 yr 22%…”

Section: Bipolarmentioning

confidence: 99%

Section: Risks and Complicationsmentioning

confidence: 99%

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Knee salvage procedures: The indications, techniques and outcomes of large osteochondral allografts

Chui

Jeys

Snow

2015

WJO

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“…Because tumors of the proximal tibia are relatively rare, our study group was relatively small [13,22,32]. Thus, we were unable to include a control group in which another surgical technique could have been used [12,40,41]. For the purpose of clarity, we chose to report our results using the Blackburne-Peel Index [6] (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Tumor mega-endoprostheses are an attractive option with good functional outcomes because they are versatile, allow immediate weightbearing, and may be more cost effective [12,41]. However, since tendinous tissue does not grow naturally to metal, controversy remains regarding reconstruction techniques for the extensor mechanism [3,5,9,14,20,24,27,[37][38][39][40][41].…”

Section: Introductionmentioning

confidence: 99%

Extensor Function After Medial Gastrocnemius Flap Reconstruction of the Proximal Tibia

Jentzsch

Erschbamer

Seeli

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Reconstruction of the extensor mechanism after resection of the proximal tibia is challenging, and several methods are available. A medial gastrocnemius flap commonly is used, although it may be associated with an extensor lag. This problem also is encountered, although perhaps to a lesser extent, with other techniques for reconstruction of the extensor apparatus. It is not known how such lag develops with time and how it correlates with functional outcome. Questions/purposes We therefore (1) assessed patellar height with time, (2) correlated patellar height with function using the Musculoskeletal Tumor Society (MSTS) score, and (3) correlated patellar height with range of motion (ROM) after medial gastrocnemius flap reconstruction. Methods Sixteen patients underwent tumor endoprosthesis implantation and extensor apparatus reconstruction between 1997 and 2009 using a medial gastrocnemius flap after sarcoma resection of the proximal tibia. These patients represented 100% of the population for whom we performed extensor mechanism reconstructions during that time. The minimum followup was 2 years (mean, 5 years; range, 2-11 years). Fourteen patients were alive at the time of this study. We used the Blackburne-Peel Index to follow patellar height radiographically with time. Functional outcomes were assessed retrospectively using the MSTS, and ROM was evaluated through active extensor lag and flexion. Results Eleven patients had patella alta develop, whereby the maximal patellar height was reached after a mean of 2 years and then stabilized. More normal patellar height was associated with better functional scores, a smaller extensor lag, but less flexion; the mean extensor lag (and flexion) of patients with patella alta was 17°(and 94°) compared with only 4°(and 77°) without. Conclusions In our patients patella alta evolved during the first 2 postoperative years. Patella alta is associated with extensor lag, greater flexion, and worse MSTS scores.

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Predictors of soft‐tissue complications and deep infection in allograft reconstruction of the proximal tibia

Lozano-Calderón

Swaim

Federico

et al. 2016

Journal of Surgical Oncology

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Soft-tissue complications are prevalent in allograft reconstruction of the proximal tibia. Prevention is important as these may progress to deep infection. Careful attention to nutritional (BMI) and immunological status may help in patient selection for allograft reconstruction. If allograft reconstruction is opted for, efforts should focus on optimization of these factors as they proved to be independent predictors of subsequent deep infection. J. Surg. Oncol. 2016;113:811-817. © 2016 Wiley Periodicals, Inc.

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Total knee replacement versus osteochondral allograft in proximal tibia bone tumours

Cited by 26 publications

References 27 publications

Knee salvage procedures: The indications, techniques and outcomes of large osteochondral allografts

Knee salvage procedures: The indications, techniques and outcomes of large osteochondral allografts

Extensor Function After Medial Gastrocnemius Flap Reconstruction of the Proximal Tibia

Predictors of soft‐tissue complications and deep infection in allograft reconstruction of the proximal tibia

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