Endoprosthetic Proximal Femoral Hemiarthroplasty Versus Total Hip Endoprosthetic Reconstruction After Proximal Femoral Resections in Young Adults

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohamed Abdel Rahman Mostafa ◽  
Sherif Ishak Azmy ◽  
Kyrillos Magdy Rashid
Keyword(s):  
Limb Salvage ◽  
Proximal Femur ◽  
Meta Analysis ◽  
Case Control ◽  
Endoprosthetic Reconstruction ◽  
Total Hip ◽  
Search Results ◽  
Bone Sarcomas ◽  
Primary Bone

Abstract Background Metastatic tumors are the most common malignant lesion of the proximal femur, with carcinomas being the most frequent. The proximal femur and midfemur are common sites for primary bone sarcomas; approximately16% of Ewing's sarcomas, 13% chondrosarcomas and 10% of osteosarcomas develop at these locations. The major aim in the management of patients who have bone malignancies is prolonging their survival. Primary bone sarcomas that require surgical resection can be treated by either amputation or limb salvage. Most studies which compared both approaches reported that limb salvage had no adverse effect on patients’ survival on long-term. Objective This is a systematic review of literature with meta-analysis study that compare the functional outcomes and complications of the methods; proximal femoral hemi versus total arthroplasty after proximal femur resection followed by endoprosthetic reconstruction and provide recommendations by the best available evidence. Methods We included Randomized control trails (RCTs), including cluster RCTs, controlled (non-randomized) clinical trials or cluster trials, prospective and retrospective comparative cohort studies, and case-control or nested case-control studies and controlled clinical trials. We excluded cross-sectional studies, case reports, review articles, letters to the editor, meeting abstracts, and technique papers. Search results conducted to systematic review management software and manually screened for eligibility were included. Critical appraisal checklist was used to assess the search results based on the inclusion/exclusion criteria. Results Twenty-three studies are included. Quality appraisal demonstrated that all but one study is retrospective. The pooled results from the meta-analysis showed that the rate of aseptic loosening was only 2% when reconstruction occurs with endoprosthetic proximal femoral hemiarthroplasty. There was unimportant heterogeneity in the included studies. The rate of conversion to total hip arthroplasty (THA) is 4.6% to 8% of oncological patients. The rate of periprosthetic fracture was only 1% Conclusion Proximal femoral endoprosthesis has definitive benefits in the treatment of primary or metastatic tumors affecting the proximal femur. The implants tend to improve the function and quality of life of patients with metastatic disease and high-grade localized disease. It also provides them with a relatively pain-free limb with good functional capacity. With continuing advances in the surgical and oncological fields, there is a great potential for curative limb salvage surgery in the long term. Reconstruction with endoprosthetic Proximal femoral hemiarthroplasty after proximal femoral resection in young adults can confer additional stability with a reduced dislocation rates and systemic complications as compared to total hip arthroplasty.

Does robotic-assisted surgery improve outcomes of total hip arthroplasty compared to manual technique? A systematic review and meta-analysis

2021 ◽  
pp. postgradmedj-2021-141135
Author(s):  
Vishal Kumar ◽  
Sandeep Patel ◽  
Vishnu Baburaj ◽  
Rajesh Kumar Rajnish ◽  
Sameer Aggarwal
Keyword(s):  
Systematic Review ◽  
Total Hip Arthroplasty ◽  
Clinical Outcomes ◽  
Hip Arthroplasty ◽  
Meta Analysis ◽  
Operating Time ◽  
Limb Length ◽  
Robot Assisted ◽  
Total Hip

BackgroundRobot-assisted total hip arthroplasty (THA) is an emerging technology that claims to position implants with very high accuracy. However, there is currently limited data in literature on whether this improved accuracy leads to better long-term clinical outcomes. This systematic review compares the outcomes of THA done with the help of robotic assistance (RA) to those done with conventional manual techniques (MTs).MethodsFour electronic databases were searched for eligible articles that directly compared robot-assisted THA to manual THA and had data on the radiological or clinical outcomes of both. Data on various outcome parameters were collected. Meta-analysis was conducted using a random-effects model with 95% CIs.ResultsA total of 17 articles were found eligible for inclusion, and 3600 cases were analysed. Mean operating time in the RA group was significantly longer than in the MT group. RA resulted in significantly more acetabular cups being placed inside Lewinnek’s and Callanan’s safe zones (p<0.001) and had significantly reduced limb length discrepancy compared with MT. There were no statistically significant differences in the two groups in terms of incidence of perioperative complications, need for revision surgery and long-term functional outcome.ConclusionRA leads to highly accurate implant placement and leads to significantly reduced limb length discrepancies. However, the authors do not recommend robot-assisted techniques for routine THAs due to lack of adequate long-term follow-up data, prolonged surgical times and no significant differences in the rate of complications and implant survivorship compared with conventional MTs.

Limb salvage surgery for primary bone sarcoma of the lower extremities: Long-term consequences of endoprosthetic reconstructions

1998 ◽  
Vol 5 (5) ◽  
pp. 423-436 ◽  
Author(s):  
S. John Ham ◽  
Heimen Schraffordt Koops ◽  
René P. H. Veth ◽  
Jim R. van Horn ◽  
Willemina M. Molenaar ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Salvage Surgery ◽  
Lower Extremities ◽  
Bone Sarcoma ◽  
Limb Salvage Surgery ◽  
Primary Bone Sarcoma ◽  
Primary Bone ◽  
Long Term Consequences

Oncologic and clinical outcomes in pelvic primary bone sarcomas treated with limb salvage surgery

2015 ◽  
Vol 99 (3) ◽  
pp. 237-242 ◽  
Author(s):  
G. L. Farfalli ◽  
J. I. Albergo ◽  
L. E. Ritacco ◽  
M. A. Ayerza ◽  
D. L. Muscolo ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Limb Salvage ◽  
Salvage Surgery ◽  
Limb Salvage Surgery ◽  
Bone Sarcomas ◽  
Primary Bone

scholarly journals Does Robotic-Assisted Surgery improve outcomes of total hip arthroplasty compared to manual technique? A protocol for systematic review and meta-analysis

2021 ◽  
Author(s):  
Vishal Kumar ◽  
Sandeep Patel ◽  
Vishnu Baburaj ◽  
Rajesh Kumar Rajnish ◽  
Sameer Aggarwal
Keyword(s):  
Systematic Review ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Meta Analysis ◽  
Robot Assisted ◽  
Total Hip ◽  
Radiographic Outcomes ◽  
Increase In Accuracy ◽  
High Degree

AbstractBackgroundRobot-assisted total hip arthroplasty (THA) is an emerging technology that claims to position THA components with a very high degree of accuracy. It is unclear if this increase in accuracy leads to improved long-term functional outcomes of the patient.ObjectivesThis systematic review aims to compare robot-assisted THA to those done using conventional manual techniques, in terms of both short-term radiographic outcomes, as well as long-term clinical outcomes.MethodsThis systematic review will be conducted according to the PRISMA guidelines. A literature search will be conducted on the electronic databases of PubMed, Embase, Scopus, and Ovid with a pre-determined search strategy. A manual bibliography search of included studies will also be done. Original articles in English that directly compare robot-assisted THA to manual THA will be included. Data on outcomes will be extracted from included studies and analysis carried out with the help of appropriate software.

scholarly journals Long-Term Nightshift Work and Breast Cancer Risk: An Updated Systematic Review and Meta-Analysis with Special Attention to Menopausal Status and to Recent Nightshift Work

Cancers ◽  
2021 ◽  
Vol 13 (23) ◽  
pp. 5952
Author(s):  
Christine Schwarz ◽  
Ana María Pedraza-Flechas ◽  
Roberto Pastor-Barriuso ◽  
Virginia Lope ◽  
Nerea Fernández de Larrea ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Menopausal Status ◽  
Case Control ◽  
Risk Exposure ◽  
Newcastle Ottawa Scale ◽  
Meta Analyses ◽  
Nested Case Control ◽  
Ottawa Scale

This systematic review discusses long-term NSW and female BC risk, with special attention to differences between pre- and postmenopausal BC, to test the association with recent NSW. The review follows PRISMA guidelines (Prospero registry: CRD42018102515). We searched PubMed, Embase, and WOS for case–control, nested case–control, and cohort studies addressing long-term NSW (≥15 years) as risk exposure and female BC as outcome until 31 December 2020. Risk of bias was evaluated with the Newcastle–Ottawa scale. Eighteen studies were finally included (eight cohorts; five nested case–control; five case–control). We performed meta-analyses on long-term NSW and BC risk; overall and by menopausal status; a subanalysis on recent long-term NSW, based on studies involving predominantly women below retirement age; and a dose–response meta-analysis on NSW duration. The pooled estimate for long-term NSW and BC was 1.13 (95%CI = 1.01–1.27; 18 studies, I2 = 56.8%, p = 0.002). BC risk increased 4.7% per 10 years of NSW (95%CI = 0.94–1.09; 16 studies, I2 = 33.4%, p = 0.008). The pooled estimate for premenopausal BC was 1.27 (95%CI = 0.96–1.68; six studies, I2 = 32.0%, p = 0.196) and for postmenopausal BC 1.05 (95%CI = 0.90–1.24,I2 = 52.4%; seven studies, p = 0.050). For recent long-term exposure, the pooled estimate was 1.23 (95%CI = 1.06–1.42; 15 studies; I2 = 48.4%, p = 0.018). Our results indicate that long-term NSW increases the risk for BC and that menopausal status and time since exposure might be relevant.

scholarly journals THE APPLICATION OF EXPANDABLE ENDOPROSTHETIC RECONSTRUCTION FOR LIMB SALVAGE SURGERY IN THE SKELETALLY IMMATURE PATIENTS

2001 ◽  
Vol 13 (03) ◽  
pp. 141-147 ◽  
Author(s):  
RONG-SEN YANG
Keyword(s):  
Limb Salvage ◽  
Salvage Surgery ◽  
Limb Length Discrepancy ◽  
Limb Length ◽  
Limb Salvage Surgery ◽  
Skeletally Immature ◽  
Endoprosthetic Reconstruction ◽  
Term Survival ◽  
Length Discrepancy ◽  
Primary Bone

The development of new image techniques enables the early detection of bone tumors in the extremities in the past two decades. In addition, new advance of adjuvant therapy improves the long-term survival of patients with primary bone malignancies. Since the primary bone malignancy frequently occurs at the metaphysis of long bones of pediatric patients in the first and second decade, many patients have to face the late problems of limb length discrepancy after the limb salvage operation. Since the inevitable limb length discrepancy will interfere the functional outcomes and cosmetic appearance, the reconstruction of limb defect after limb salvage remains a challenge. Several options of reconstruction are available for these patients, including resection arthrodesis, rotationplasty, osteochondral allograft reconstruction, and endoprosthetic reconstruction. All these methods are difficult to address the limb length discrepancy. The development of expandable endoprosthetic reconstruction makes limb-salvage surgery feasible in the skeletally immature and provides another choice of solution. This article presents the current status of custom-expandable endoprosthetic reconstruction in the skeletally immature patients after wide resection of primary bone malignancies in the extremity. The surgical options, complications and functional results will be emphasized. Basically these expandable endoprostheses can be classified according to the expansion design. Recent reports demonstrated that the results of expandable prosthesis in the growing children are rather acceptable. Some patients can regain the equal limb length after expansion of the prosthesis. However these patients have to take several expansion procedures for the equality of limb length during the growing period. A rather high complication rate of either endoprosthesis-related or disease-associated still needs to be settled in the near future. These include mechanical failure of the expansion mechanism, extensive metallosis, aseptic loosening, fatigue fracture, flexion contracture, local recurrence, delayed wound healing, fat embolism, local overgrowth of counterpart bone, nerve palsy, infection, and bone fracture. Some patients even require an amputation even after expandable endoprosthesis reconstruction because of difficult reconstruction or severe functional impairment. However, with regard to difficult rehabilitation for patients under 8 years, amputation or alternative options need to be considered. A comprehensive discussion with the parents and patient about the detailed treatment protocol is needed before performing reconstruction using expandable endoprosthesis.

Prophylactic efficacy on periprosthetic bone loss in calcar region after total hip arthroplasty of antiosteoporotic drugs: a network meta-analysis of randomised controlled studies

2020 ◽  
pp. postgradmedj-2019-137120
Author(s):  
Xi Chen ◽  
Yu Shen ◽  
Chenyi Ye ◽  
Yishake Mumingjiang ◽  
Jinwei Lu ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Bone Loss ◽  
Hip Arthroplasty ◽  
Meta Analysis ◽  
Residual Effect ◽  
Periprosthetic Bone ◽  
Prophylactic Efficacy ◽  
Total Hip ◽  
Periprosthetic Bone Loss

ObjectivesThe aim of this study was to evaluate the effect of antiosteoporotic drugs on preventing periprosthetic bone loss in calcar 6 and 12 months after total hip arthroplasty.MethodsThe network meta-analysis was conducted guided by the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guideline. A systematic literature search was conducted and 21 studies that enrolled a total of 955 patients with 9 antiosteoporotic drugs met the inclusion criteria. Network meta-analysis and conventional meta-analysis were carried out for calculating standard mean difference (SMD) and the surface under cumulative ranking curve (SUCRA) of the bone mineral density (BMD) in calcar (Gruen zone 7) as well as bone turnover markers (BTMs) including bone-specific alkaline phosphatase (BSAP) and collagen type I cross-linked N telopeptide (NTX) at 6 and 12 months between different antiosteoporotic drugs.ResultsAt 6 months after total hip arthroplasty, zoledronate (SUCRA=86.4%), risedronate (SUCRA=51.3%) and etidronate (SUCRA=44.5%) were effective in retaining BMD in calcar; zoledronate was significantly more effective than etidronate (SMD=0.65, 95% CI 0.03 to 1.27). Teriparatide (SUCRA=84.5%), denosumab (SUCRA=82.5%), zoledronate (SUCRA=69.2%), alendronate+alfacalcidol (SUCRA=66.2%) and etidronate (SUCRA=51.5%) were the top five drugs in retaining BMD in calcar at 12 months after total hip arthroplasty and the efficacy were comparable. After simultaneously excluding studies in which the prosthesis were cement and the drug dosages as well as treatment durations were inconsistent with those in treating osteoporosis, the above results were robust with the exception that alendronate showed significant efficacy compared with placebo (SMD=1.22, 95% CI 0.46 to 1.99) and was comparable with those effective drugs at 12 months. Long-term residual effect was corroborated only in etidronate, alendronate and zoledronate from previous studies. BTMs were significantly decreased as early as 6 months (SMD of BSAP −0.49, 95% CI −0.84 to −0.13; SMD of NTX −0.93, 95% CI −1.21 to −0.64) and sustained until 12 months (SMD of BSAP −0.27, 95% CI −0.50 to −0.03; SMD of NTX −0.84, 95% CI −1.11 to −0.56) during the prophylaxis.ConclusionsAntiosteoporotic drugs showed prophylactic efficacy on periprosthetic bone loss after total hip arthroplasty in calcar, the effectiveness varied. Zoledronate was the best recommendation due to its optimal efficacy both within 6 and 12 months as well as its residual effect in the long term. BTMs could be used as indicators for monitoring through the treatment. More head-to-head clinical trials are needed to confirm those findings.

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