Distally Based Pedicled Fibula Flap for Reconstruction of Infected Charcot’s Midtarsal Collapse—Diabetic Rocker Bottom Foot

Abstract Introduction and Methods Diabetic rocker bottom foot with secondary infection exacts the expertise of a reconstructive surgeon to salvage the foot. The author selected 28 diabetic patients with secondarily infected Charcot’s degenerated rocker bottom feet and reconstructed their feet using distally based pedicled fibula flap. Reconstruction was done in a staged manner. Stage 1 surgery involved external fixation following debridement. In stage 2, struts were activated for distraction and arthroereisis. In stage 3, the distally based pedicled fibula was used for reconstruction and beaming of the arches. Results In this retrospective study, the author analyzed the outcome of all 28 patients using the Musculoskeletal Tumor Society Rating (MSTSR) score. The average MSTSR score was 27.536 in an average follow-up of 30.5 months. The limb salvage rate with the author’s procedure was 96.4% (p = 0.045). Conclusion Author’s protocol for the staged reconstruction and salvage of the infected diabetic rocker bottom foot, using the pedicled fibula flap, will be a new addendum in the reconstructive armamentarium of the orthoplastic approach.

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Custom-Made 3D-Printed Implants as Novel Approach to Reconstructive Surgery after Oncologic Resection in Pediatric Patients

Journal of Clinical Medicine ◽

10.3390/jcm10051056 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1056

Author(s):

Giovanni Beltrami ◽

Gabriele Ristori ◽

Anna Maria Nucci ◽

Alberto Galeotti ◽

Angela Tamburini ◽

...

Keyword(s):

Pediatric Patients ◽

Soft Tissues ◽

Lower Limbs ◽

Host Bone ◽

Limb Salvage Surgery ◽

Musculoskeletal Tumor ◽

Musculoskeletal Tumor Society ◽

Custom Made ◽

3D Printed

Recently, custom-made 3D-printed prostheses have been introduced for limb salvage surgery in adult patients, but their use has not been described in pediatric patients. A series of 11 pediatric patients (mean age 10.8 years; range 2–13) with skeletal tumors treated with custom-made implants for the reconstruction of bony defects is described. Patients were followed up every 3 months. Functional results were evaluated by the Musculoskeletal Tumor Society Score (MSTS) for upper and lower limbs. The mean follow-up was 25.7 months (range 14–44). Three patients died after a mean of 19.3 months postoperatively—two because of disease progression and the other from a previous malignancy. Three patients experienced complications related to soft tissues. One patient required device removal, debridement, and antibiotic pearls for postoperative infection. Partial osseointegration between grafts and host bone was observed within a mean of 4 months. At the final follow-up, mean MSTS score was 75%. 3D prostheses may yield biological advantages due to possible integration with the host bone and also through the use of vascularized flaps. Further research is warranted.

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Clinical outcome of operative treatment in 18 cases of giant cell tumors of bones

Journal of Chitwan Medical College ◽

10.3126/jcmc.v10i2.29677 ◽

2020 ◽

Vol 10 (2) ◽

pp. 67-71

Author(s):

Suresh Pandey

Keyword(s):

Clinical Outcome ◽

Giant Cell ◽

De Novo ◽

Excellent Result ◽

Giant Cell Tumors ◽

Musculoskeletal Tumor ◽

Musculoskeletal Tumor Society ◽

Non Union ◽

Proximal Fibula

Background: Giant Cell Tumor of the bone (GCTB) has got variable outcome after the different methods of surgical treatment depending upon the site and grade of lesion and extent of tumor removal. This retrospective prospective analysis of operatively treated cases of GCTB of different sites aimed to highlight the clinical outcome. Methods: This was a prospective observational study of 18 cases of GCTB; proximal tibia (n=6), distal femur (n=5), distal radius (n=4), proximal femur (n=1), proximal fibula (n=1) and anterior arc of first rib (n=1) treated with different operative management with mean follow up of 53.61 months. Functional outcome with Musculoskeletal Tumor Society Score (MSTS), recurrence and complications were analyzed with at least 24 months of follow up. Results: There were 10 females and 8 males with average age at presentation 27.3 years (range 15-38). Average duration of symptom was 4.72 months. 2 were cases of recurrence previously operated and 16 were de novo cases. Mean MSTS was 84.27% with good to excellent result in 88%. There were no non-union, graft failure, metastasis, prosthetic failure or wound infection till at least 24 months of follow up in any of the cases. Conclusions: Extended curettage or reconstruction with auto graft in grade I and II tumor or endoprosthesis in higher grade or recurrence of GCTB can give good to excellent functional result in majority of the cases.

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Reconstruction with Custom Unicondylar Hemiarthroplasty following Tumor Resection: A Case Series and Review of the Literature

The Journal of Knee Surgery ◽

10.1055/s-0039-1688556 ◽

2019 ◽

Vol 33 (08) ◽

pp. 818-824

Author(s):

Joseph A. Ippolito ◽

Megan L. Campbell ◽

Brianna L. Siracuse ◽

Joseph Benevenia

Keyword(s):

Distal Femur ◽

Weight Bearing ◽

Tumor Resection ◽

Case Series ◽

Full Weight Bearing ◽

Musculoskeletal Tumor ◽

Musculoskeletal Tumor Society ◽

Optimal Function ◽

Tumor Involvement

AbstractFor patients with tumors of the distal femur, options for limb salvage include tumor resection followed by reconstruction. While reconstruction commonly involves a distal femoral replacement, careful selection of patients with tumor involvement limited to a single condyle may be candidates for reconstruction with distal femur hemiarthroplasty. In these procedures, resection spares considerably more native anatomy. Three consecutive patients who underwent resection and reconstruction at the distal femur with custom unicondylar hemiarthroplasty are presented in this case series at a mean follow-up of 45 months (range, 26–78). In two cases, prostheses were utilized as a secondary procedure after failure of initial reconstruction. In one case, the custom prosthesis was utilized as the primary method of reconstruction. Mean Musculoskeletal Tumor Society disease-specific scores were 26.7 (range, 25–28). All patients achieved a return to full weight bearing, activities of daily living, and functional range of motion. In appropriately selected patients with tumors of the distal femur, reconstruction with custom unicondylar hemiarthroplasty provides benefits including optimal function postoperatively via preservation of tumor-free bone and ligamentous structures. Additionally, maintenance of greater bone stock may confer benefits to patients with pathology at a high likelihood for recurrence and need for subsequent procedures.

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Long-term outcomes of an extracorporeal irradiated autograft for limb salvage operations in musculoskeletal tumours

The Bone & Joint Journal ◽

10.1302/0301-620x.101b9.bjj-2019-0090.r1 ◽

2019 ◽

Vol 101-B (9) ◽

pp. 1151-1159 ◽

Cited By ~ 3

Author(s):

N. Oike ◽

H. Kawashima ◽

A. Ogose ◽

H. Hatano ◽

T. Ariizumi ◽

...

Keyword(s):

Deep Infection ◽

Long Term Outcomes ◽

En Bloc ◽

Musculoskeletal Tumor ◽

Musculoskeletal Tumor Society ◽

Initial Surgery ◽

Common Diagnosis ◽

The Mean

Aims We analyzed the long-term outcomes of patients observed over ten years after resection en bloc and reconstruction with extracorporeal irradiated autografts Patients and Methods This retrospective study included 27 patients who underwent resection en bloc and reimplantation of an extracorporeal irradiated autograft. The mean patient age and follow-up period were 31.7 years (9 to 59) and 16.6 years (10.3 to 24.3), respectively. The most common diagnosis was osteosarcoma (n = 10), followed by chondrosarcoma (n = 6). The femur (n = 13) was the most frequently involved site, followed by the tibia (n = 7). There were inlay grafts in five patients, intercalary grafts in 15 patients, and osteoarticular grafts in seven patients. Functional outcome was evaluated with the Musculoskeletal Tumor Society (MSTS) scoring system. Results There were no recurrences in the irradiated autograft and the autograft survived in 24 patients (88.9%). Major complications included nonunion (n = 9), subchondral bone collapse (n = 4), and deep infection (n = 4). Although 34 revision procedures were performed, 25 (73.5%) and four (11.8%) of these were performed less than five years and ten years after the initial surgery, respectively. The mean MSTS score at the last follow-up was 84.3% (33% to 100%). Conclusion Considering long-term outcomes, extracorporeal irradiated autograft is an effective method of reconstruction for malignant musculoskeletal tumours Cite this article: Bone Joint J 2019;101-B:1151–1159

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Functional and oncologic outcomes after excision of proximal femur primary bone tumors using a cost-effective indigenous prosthesis.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e23500 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e23500-e23500

Author(s):

Ashish Gulia ◽

Sri Harsha ◽

Srinath Gupta ◽

Ajay Puri

Keyword(s):

Proximal Femur ◽

Malignant Tumors ◽

Weight Bearing ◽

Distant Recurrence ◽

Oncologic Outcomes ◽

Implant Survival ◽

Musculoskeletal Tumor ◽

Musculoskeletal Tumor Society ◽

Early Return

e23500 Background: Proximal femur endoprosthetic replacement(PFER) has become aprimary treatment option for aggressive benign and malignant tumors of proximal femur allowing early return to weight bearing and improvement in functional status. We present our experience in these cases with respect to oncological outcomes, functional outcomes and implant survival. Methods: All cases were retrieved from our prospectively maintained surgical database. 98 patients(35 males and 63 females) with a mean age of 29 years(10– 69 years)were operated between August 2006 and September 2017. Median followup was 49 months(1 - 160 months).The diagnosis included osteosarcoma(18), Ewing’s sarcoma(38), chondrosarcoma(32), and GCT(8) synovial sarcoma (2) .They were evaluated by Musculoskeletal Tumor Society score, recurrence free survival, patient survival, and implant survival. Results: Mean resection length is 18.5cm (8 – 35cm). 8 patients underwent revision surgery,7 for mechanical (3 for aseptic loosening, 4 for dislocations and for implant failures), 1 for non mechanicalcause (infection) and 2 patients underwent amputation for local recurrence. One patient had dislocation recently for whom revision is adbvised. At last follow-up, out of 98 cases 6 were lost to follow up, 32 patients had died(28 due to disease and 4 due to other causes) and 60 are alive. There were 3 only local recurrences(3 alive-1 external hemipelvectomy, 1 excision, 1 definitive chemo radiation), 9 had both local and distant recurrence (1 alive – hip disarticulation for local, definitive cheomoradiation for distant recurrence), and 26 had distant recurrences(6 alive - 3 pulmonary metastetectomy,1 nodal metastasis, 1 lung metastasis and 1 bone metastasis treated with definitive cheomoradiation) . The 5year OS, LRFS,DRFS were 68.3,85.7,61.5% respectively. The mean Musculoskeletal Tumor Society score was 26(22 – 28). The implant survival was 87.4% at 5 years. Conclusions: The use of a PFER in the treatment of primary tumours of bone is oncologically safe and gives consistent and predictable results with low rates of complication. We found that low cost indigenous prosthesis (one fourth the cost of imported prosthesis) fare equivalent to existing imported prosthesis. This can immensely helpful in offering limb salvage in resource constraint settings.

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Chondroblastoma of the Femoral Head: A Case Series and Literature Review

The Journal of Hip Surgery ◽

10.1055/s-0039-1681021 ◽

2019 ◽

Vol 03 (01) ◽

pp. 002-007

Author(s):

Tyler Hoskins ◽

Laura Sonnylal ◽

Ian O'Connor ◽

Jay Patel ◽

Kimona Issa ◽

...

Keyword(s):

Femoral Head ◽

Case Series ◽

Bone Destruction ◽

Treatment Method ◽

Musculoskeletal Tumor ◽

Musculoskeletal Tumor Society ◽

Local Bone ◽

Primary Investigator ◽

Proper Diagnosis

AbstractChondroblastoma is a rare bone tumor predominantly affecting patients during the first and second decades of life. The purpose of this case series is to assist clinicians in establishing a proper diagnosis and treatment method for patients presenting with chondroblastoma of the femoral head. Symptoms of this tumor in the hip joint can be nonspecific, resulting in the critical delay of a proper diagnosis. Due to the aggressive nature of this tumor, an early diagnosis is vital to prevent significant local bone destruction and the potential loss of a mobile hip. The authors present a series of three adolescent patients treated by the primary investigator between 2014 and 2017 for chondroblastoma of the femoral head to help illustrate several diagnostic and treatment principles and considerations for clinicians. The mean Musculoskeletal Tumor Society score at the latest follow-up was 26 points (range: 25–27). No local recurrence was reported in any patient and all individuals have returned to preoperative function, and are participating in daily activities and sports.

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Clinical outcomes of frozen autograft reconstruction for the treatment of primary bone sarcoma in adolescents and young adults

Scientific Reports ◽

10.1038/s41598-021-96162-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yoshihiro Araki ◽

Norio Yamamoto ◽

Katsuhiro Hayashi ◽

Akihiko Takeuchi ◽

Shinji Miwa ◽

...

Keyword(s):

Young Adults ◽

Clinical Outcomes ◽

Bone Sarcoma ◽

Adolescents And Young Adults ◽

Appendicular Skeleton ◽

Musculoskeletal Tumor ◽

Musculoskeletal Tumor Society ◽

Primary Bone Sarcoma ◽

Primary Bone

AbstractAge affects the clinical outcomes of cancer treatment, including those for bone sarcoma. Successful reconstruction using frozen autograft after excision of bone sarcoma has been reported; however, little is known about the clinical outcomes of frozen autograft reconstruction according to age. The purpose was to evaluate the clinical outcomes of the frozen autograft reconstruction focusing on skeletally mature adolescents and young adults (AYAs) that was 15 to 39 years of age. A total of 37 AYA patients with primary bone sarcoma on the appendicular skeleton were enrolled in this study. The mean follow-up period was 89 months. The graft survival (GS), overall survival (OS), recurrence-free survival (RFS), complications and the function were retrospectively evaluated using medical records. The 10-year GS, OS, and RFS rates were 76%, 84%, and 79%, respectively. Bone union was achieved with a rate of 94% within 1 year after surgery, and nonunion (n = 1) and fracture (n = 2) were infrequently observed. Graft removal was performed in 7 cases, and the most common reason for the removal was infection (n = 5). The Musculoskeletal Tumor Society score was excellent in 23 cases of the available 29 cases. Frozen autograft reconstruction for AYAs showed excellent clinical outcomes, although the long-term follow-up is required.

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Long-term follow-up of all-polyethylene tibial components when used for oncological endoprosthetic reconstruction

The Bone & Joint Journal ◽

10.1302/0301-620x.102b2.bjj-2019-0535.r1 ◽

2020 ◽

Vol 102-B (2) ◽

pp. 170-176 ◽

Cited By ~ 1

Author(s):

Nicholas M. Bernthal ◽

Zachary D. C. Burke ◽

Vishal Hegde ◽

Alexander Upfill-Brown ◽

Clark J. Chen ◽

...

Keyword(s):

Risk Factor ◽

Tibial Component ◽

Significant Risk ◽

Mechanical Failure ◽

Endoprosthetic Reconstruction ◽

Musculoskeletal Tumor ◽

Musculoskeletal Tumor Society ◽

Msts Score

Aims We aimed to examine the long-term mechanical survivorship, describe the modes of all-cause failure, and identify risk factors for mechanical failure of all-polyethylene tibial components in endoprosthetic reconstruction. Methods This is a retrospective database review of consecutive endoprosthetic reconstructions performed for oncological indications between 1980 and 2019. Patients with all-polyethylene tibial components were isolated and analyzed for revision for mechanical failure. Outcomes included survival of the all-polyethylene tibial component, revision surgery categorized according to the Henderson Failure Mode Classification, and complications and functional outcome, as assessed by the Musculoskeletal Tumor Society (MSTS) score at the final follow-up. Results A total of 278 patients were identified with 289 all-polyethylene tibial components. Mechanical survival was 98.4%, 91.1%, and 85.2% at five, ten and 15 years, respectively. A total of 15 mechanical failures were identified at the final follow-up. Of the 13 all-polyethylene tibial components used for revision of a previous tibial component, five (38.5%) failed mechanically. Younger patients (< 18 years vs > 18 years; p = 0.005) and those used as revision components (p < 0.001) had significantly increased rates of failure. Multivariate logistic regression modelling showed revision status to be a positive risk factor for failure (odds ratio (OR) 19.498, 95% confidence interval (CI) 4.598 to 82.676) and increasing age was a negative risk factor for failure (OR 0.927, 95% CI 0.872 to 0.987). Age-stratified risk analysis showed that age > 24 years was no longer a statistically significant risk factor for failure. The final mean MSTS score for all patients was 89% (8.5% to 100.0%). Conclusion The long-term mechanical survivorship of all-polyethylene tibial components when used for tumour endoprostheses was excellent. Tumour surgeons should consider using these components for their durability and the secondary benefits of reduced cost and ease of removal and revision. However, caution should be taken when using all-polyethylene tibial components in the revision setting as a significantly higher rate of mechanical failure was seen in this group of patients. Cite this article: Bone Joint J. 2020;102-B(2):170–176

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A newly revised pivot knee prosthesis for peri-knee malignant bone destruction tumor management

10.21203/rs.3.rs-24068/v1 ◽

2020 ◽

Author(s):

jie tan ◽

Qingyi Zhang ◽

Wu Wu ◽

Yaxing Li ◽

Kai Huang ◽

...

Keyword(s):

Knee Prosthesis ◽

Good Condition ◽

Bone Destruction ◽

Operation Time ◽

Good Alternative ◽

Tumor Stage ◽

Knee Score ◽

Musculoskeletal Tumor ◽

Musculoskeletal Tumor Society

Abstract BackgroundThis study evaluated the effectiveness of a newly revised pivot knee prosthesis in patients with peri-knee malignant bone destruction tumors.MethodsMedical records of patients who were admitted to our hospital from January 2014 to February 2020 and underwent the newly revised pivot knee prosthesis operations were retrospectively collected and analyzed. Visual analogue scale (VAS), hospital special surgery (HSS) knee score, American knee society knee score (KSS), and ROM for pre-operation, discharge, and last follow-up were applied to assess the effectiveness of this surgery. Meanwhile, the results of musculoskeletal tumor society system (MTSS) and radiographs were observed and analyzed at last follow-up.ResultsThe average operation time was 174.0 ± 35.5 min, and intraoperative bleeding volume was 271.2 ± 127.3 ml. The follow-up time was 33.8 ± 14.9 months. The scores of VAS, HSS, and KSS at pre-operation, discharging, and last follow-up were all comparable (p༜0.05), ROM was only comparable between discharging and last follow-up (p༜0.05), while ROM between preoperative and discharging had no significance (p༞0.05). MTSS at last follow-up was22.6 ± 2.4. All patients were alive with their prosthesis in good condition except for one patient who underwent revision surgery for misalignment of prosthesis and two patients who died of systemic metastasis.ConclusionThe newly revised pivot knee prosthesis is a good alternative limb-salvage strategy for patients who suffered from bone destruction tumors, although patient tumor stage and health condition should be fully assessed before surgery to reduce the mortality rate of patients who are not eligible.

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Extensor Carpi Ulnaris Tenodesis Versus No Stabilization After Wide Resection of Distal Ulna Giant Cell Tumors

Hand ◽

10.1177/1558944717743598 ◽

2017 ◽

Vol 14 (2) ◽

pp. 242-248 ◽

Cited By ~ 1

Author(s):

Ioannis D. Papanastassiou ◽

Olga D. Savvidou ◽

George D. Chloros ◽

Panayiotis D. Megaloikonomos ◽

Vasileios A. Kontogeorgakos ◽

...

Keyword(s):

Functional Outcome ◽

Grip Strength ◽

Giant Cell ◽

Wide Resection ◽

Giant Cell Tumors ◽

Distal Ulna ◽

Musculoskeletal Tumor ◽

Musculoskeletal Tumor Society ◽

Extensor Carpi Ulnaris

Background: The necessity of stabilizing the residual ulnar stump after distal ulna tumor resection remains controversial. The authors retrospectively compared the outcome of patients who underwent wide resection of distal ulna giant cell tumors (GCTs) and reconstruction with tenodesis of the extensor carpi ulnaris (ECU) or without reconstruction. Methods: Between 2007 and 2015, 9 patients (6 females, 3 males; mean age, 36.8 years; range, 24-65 years) who underwent distal ulna resection for GCT of bone were retrospectively reviewed. The mean resection length was 8.1 cm. Five patients had no reconstruction, whereas 4 patients had stabilization of the ulnar stump using ECU tenodesis. With a mean follow-up of 3.6 years (2-9 years), the functional outcome using the quick Disability of Arm, Shoulder and Hand (DASH) score; Musculoskeletal Tumor Society score and grip strength; as well as the oncological outcome were evaluated. Results: Musculoskeletal Tumor Society functional scores were more than 24 in 7 patients and 20 to 24 in 2 patients (mean, 27.6 or 92%). Quick DASH scores ranged from 0 to 27.3 (mean, 11.1). In both groups, similar scores were observed ( P > .5). No patient had instability or pain related to the stump. There was no ulnar translation or subluxation of the radiocarpal joint. Grip strength in the operated hand, controlled for handedness, was 11% less than in the contralateral hand, although there was no difference between groups ( P > .4). All patients were disease-free at the latest follow-up. Conclusions: The distal ulna may be widely resected with or without stabilization of the residual ulnar stump, yielding satisfactory local disease control and functional outcome.

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