Gait Outcomes Following Proximal Tibial Tumor Resection and Endoprosthetic Reconstruction

2021 ◽  
Author(s):  
Eileen G. Fowler ◽  
Jeffrey J. Eckardt ◽  
Andy Vuong ◽  
Marcia B. Greenberg ◽  
Kent Yamaguchi ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Endoprosthetic Reconstruction

Internal Hemipelvectomy for Musculoskeletal Tumors—Indications and Options for Reconstruction

2011 ◽  
Vol 07 (02) ◽  
pp. 123
Author(s):  
Adam J Schwartz ◽  
Jeffrey J Eckardt ◽  
Christopher P Beauchamp ◽  
◽  
◽  
...  
Keyword(s):  
Tumor Resection ◽  
Functional Method ◽  
Endoprosthetic Reconstruction ◽  
Primary Tumors ◽  
Internal Hemipelvectomy ◽  
Musculoskeletal Tumors ◽  
Risks And Benefits ◽  
Bony Pelvis ◽  
Metastatic Lesions ◽  
Reconstruction Methods

Resection of all or part of the bony pelvis is commonly referred to as internal hemipelvectomy. This procedure is a common treatment for various localized primary tumors of the hemipelvis, and rarely for metastatic lesions. Options for reconstruction following tumor resection include allograft, allograft-prosthetic composite (APC), and endoprosthetic reconstruction. An alternative method of limb salvage following resection of the hemipelvis is resection arthroplasty. Controversy exists among musculoskeletal oncologists regarding the most durable and functional method of reconstruction. As primary musculoskeletal tumors involving the pelvis are rare, there are few well-designed studies from which to draw definitive conclusions. The purpose of this paper is to review the indications for internal hemipelvectomy and to examine the risks and benefits of the available reconstruction methods.

scholarly journals Modular Endoprostheses for Nonneoplastic Conditions: Midterm Complications and Survival

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Marco De Gori ◽  
Guido Scoccianti ◽  
Filippo Frenos ◽  
Leonardo Bettini ◽  
Filippo Familiari ◽  
...  
Keyword(s):  
Survival Rate ◽  
Bone Loss ◽  
Tumor Resection ◽  
Viable Option ◽  
Endoprosthetic Reconstruction ◽  
Index Procedure ◽  
Free Survival ◽  
Severe Bone Loss ◽  
Significant Difference

The use of modular endoprostheses is a viable option to manage both tumor resection and severe bone loss due to nonneoplastic conditions such as fracture sequelae, failed osteoarticular grafts, arthroplasty revisions, and periprosthetic fractures. We sought to investigate both midterm complications and failures occurred in 87 patients who underwent a megaprosthetic reconstruction in a nonneoplastic setting. After a mean follow-up of 58 (1–167) months, overall failure-free survival was 91.5% at 1 year, 80% at 2 years, 71.6% at 5 years, and 69.1% at 5 and 10 years. There was no significant difference in the survival rate according to the diagnosis at the index procedure (p=0.921), nor to the reconstruction site (p=0.402). The use of megaprostheses in a postneoplastic setting did not affect survival rate in comparison with endoprosthetic reconstruction of pure nonneoplastic conditions (p=0.851). Perimegaprosthetic infection was the leading complication, occurring in 10 (11.5%) patients and implying a megaprosthetic revision in all but one case. Physicians should consider these results when discussing with patients desired outcomes of endoprosthetic reconstructions of a nonneoplastic disease.

scholarly journals Endoprosthetic Reconstruction in Limb Salvage for Malignant Bone Tumours in Children

2021 ◽  
Vol 2 (2) ◽  
pp. 4-8
Author(s):  
Sagar Tontanahal ◽  
Gahukamble Abhay Deodas ◽  
Deeptiman James ◽  
Anand Kurian ◽  
Thomas Palocaren
Keyword(s):  
Limb Salvage ◽  
Bone Tumors ◽  
Rapid Development ◽  
Tumor Resection ◽  
Limb Salvage Surgery ◽  
Endoprosthetic Reconstruction ◽  
Malignant Bone Tumors ◽  
Musculoskeletal Tumor Society ◽  
Prosthetic Reconstruction ◽  
Malignant Bone Tumours

Background: The management of malignant bone tumors in children has come a long way in the past few decades. The transition from amputation to limb salvage has been made possible due to the rapid development in the diagnosis and the oncological management of these malignant tumors. However, there exist significant reservations regarding endoprosthetic reconstruction in children. Material and methods: A mini-review was conducted of articles detailing the use of prosthetic reconstruction following tumor resection in children. The data regarding complications and functional outcomes following surgery were collected and presented. Results: The studies reviewed reported a 5-year survival rate between 60 – 70 %. Uniform across the studies was the need for multiple surgeries when endoprosthesis was used for limb reconstruction, ranging between 2.8 – 3.5 surgeries. The most common complication noted across the studies was related to soft tissue problems such as joint instability followed by structural failure of the prosthesis. Infections were noted with a frequency of 10 – 15 %. Studies showed successful management of limb length discrepancy with expandible prosthesis. Musculoskeletal Tumor Society (MSTS) score used to evaluate the functional outcome showed satisfactory outcomes. Conclusion: Limb salvage surgery, with recent advances in technique and prosthesis design, is an attractive option in children with extremity malignant bone tumors. In recent time, endoprosthetic reconstruction of extremities have yielded good functional results and are well accepted by the child and the parents. The purpose of this mini-review is to shed some light on the use of endoprosthetic reconstruction in children following tumor resection with its potential benefits and drawbacks.

Expandable Endoprosthetic Reconstruction of the Skeletally Immature After Malignant Bone Tumor Resection

1993 ◽  
Vol &NA; (297) ◽  
pp. 188???202 ◽  
Author(s):  
JEFFREY J. ECKARDT ◽  
MARC R. SAFRAN ◽  
FREDERICK R. EILBER ◽  
GERALD ROSEN ◽  
J. MICHAEL KABO
Keyword(s):  
Bone Tumor ◽  
Tumor Resection ◽  
Malignant Bone Tumor ◽  
Skeletally Immature ◽  
Endoprosthetic Reconstruction ◽  
Bone Tumor Resection

scholarly journals LUMiC® Endoprosthetic Reconstruction After Periacetabular Tumor Resection: Short-term Results

2016 ◽  
Vol 475 (3) ◽  
pp. 686-695 ◽  
Author(s):  
Michaël P. A. Bus ◽  
Andrzej Szafranski ◽  
Simen Sellevold ◽  
Tomasz Goryn ◽  
Paul C. Jutte ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Endoprosthetic Reconstruction ◽  
Short Term

scholarly journals Surgical drainage after limb salvage surgery and endoprosthetic reconstruction: is 30 mL/day critical?

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jiayong Liu ◽  
Zhengfu Fan ◽  
Marc El Beaino ◽  
Valerae O. Lewis ◽  
Bryan S. Moon ◽  
...  
Keyword(s):  
Preoperative Chemotherapy ◽  
Lower Limb ◽  
Cox Regression ◽  
Tumor Resection ◽  
Limb Salvage Surgery ◽  
Endoprosthetic Reconstruction ◽  
Drain Removal ◽  
Cause Of Failure ◽  
Segmental Bone ◽  
Surgical Drain

Abstract Background Periprosthetic infection is a major cause of failure after segmental endoprosthetic reconstruction. The purpose of this study is to determine whether certain aspects of drain output affect infection risk, particularly the 30 mL/day criterion for removal. Methods Two hundred and ninety-five patients underwent segmental bone resection and lower limb endoprosthetic reconstruction at one institution. Data on surgical drain management and occurrence of infection were obtained from a retrospective review of patients’ charts and radiographs. Univariate and multivariate Cox regression analyses were performed to identify factors associated with infection. Results Thirty-one of 295 patients (10.5%) developed infection at a median time of 13 months (range 1–108 months). Staphylococcus aureus was the most common organism and was responsible for the majority of cases developing within 1 year of surgery. Mean output at the time of drain removal was 72 mL/day. Ten of 88 patients (11.3%) with ≤ 30 mL/day drainage and 21 of 207 patients (10.1%) with > 30 mL/day drainage developed infection (p = 0.84). In multivariate analysis, independent predictive factors for infection included sarcoma diagnosis (HR 4.13, 95% CI 1.4–12.2, p = 0.01) and preoperative chemotherapy (HR 3.29, 95% CI 1.1–9.6, p = 0.03). Conclusion Waiting until drain output is < 30 mL/day before drain removal is not associated with decreased risk of infection for segmental endoprostheses of the lower limb after tumor resection. Sarcoma diagnosis and preoperative chemotherapy were independent predictors of infection.

scholarly journals Prophylactic Antibiotic Regimens In Tumor Surgery (PARITY): a multi-center randomized controlled study comparing alternative antibiotic regimens in patients undergoing tumor resections with endoprosthetic replacements—a statistical analysis plan

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Patricia Schneider ◽  
◽  
Diane Heels-Ansdell ◽  
Lehana Thabane ◽  
Michelle Ghert
Keyword(s):  
Statistical Analysis ◽  
Lower Extremity ◽  
Controlled Trial ◽  
Tumor Resection ◽  
Prophylactic Antibiotic ◽  
Statistical Analysis Plan ◽  
Controlled Study ◽  
Tumor Surgery ◽  
Endoprosthetic Reconstruction ◽  
Randomized Controlled

Abstract Background Limb salvage with endoprosthetic reconstruction is the current standard practice for the surgical management of lower extremity bone tumors in skeletally mature patients and typically includes tumor resection followed by the functional limb reconstruction with modular metallic and polyethylene endoprosthetic implants. However, owing to the complexity and length of these procedures, as well as the immunocompromised nature of patients treated with chemotherapy, the risk of surgical site infection (SSI) is high. The primary research objective of the Prophylactic Antibiotic Regimens In Tumor Surgery (PARITY) trial is to assess whether a 5-day regimen of post-operative antibiotics decreases the risk of SSI at 1 year post-operatively compared to a 1-day regimen. This article describes the statistical analysis plan for the PARITY trial. Methods/design The PARITY trial is an ongoing multi-center, blinded parallel two-arm randomized controlled trial (RCT) of 600 participants who have been diagnosed with a primary bone tumor, a soft tissue sarcoma that has invaded the bone or oligometastatic bone disease of the femur or tibia that requires surgical resection and endoprosthetic reconstruction. This article describes the overall analysis principles, including how participants will be included in each analysis, the presentation of results, adjustments for covariates, the primary and secondary outcomes, and their respective analyses. Additionally, we will present the planned sensitivity and sub-group analyses. Discussion Our prior work has demonstrated (1) high rates of SSI after the treatment of lower extremity tumors by surgical excision and endoprosthetic reconstruction, (2) highly varied opinion and practice among orthopedic oncologists with respect to prophylactic antibiotic regimens, (3) an absence of applicable RCT evidence, (4) extensive support from international investigators to participate in a RCT, and (5) the feasibility of conducting a definitive RCT to evaluate a 5-day regimen of post-operative antibiotics in comparison with a 1-day regimen. Trial registration ClinicalTrials.gov NCT01479283. Registered on 24 November 2011

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