Endoprosthetic reconstruction for large osseous defects after tumor resection

Abstract Destruction of the alveolar bone in the jaws can occur due to periodontitis, trauma or following tumor resection. Common reconstructive therapy can include the use of bone grafts with limited predictability and efficacy. Romosozumab, approved by the FDA in 2019, is a humanized sclerostin-neutralizing antibody (Scl-Ab) indicated in postmenopausal women with osteoporosis at high risk for fracture. Preclinical models show that Scl-Ab administration preserves bone volume during periodontal disease, repairs bone defects surrounding dental implants, and reverses alveolar bone loss following extraction socket remodeling. To date, there are no studies evaluating Scl-Ab to repair osseous defects around teeth or to identify the efficacy of locally-delivered Scl-Ab for targeted drug delivery. In this investigation, the use of systemically-delivered versus low dose locally-delivered Scl-Ab via poly(lactic-co-glycolic) acid (PLGA) microspheres (MSs) was compared at experimentally-created alveolar bone defects in rats. Systemic Scl-Ab administration improved bone regeneration and tended to increase cementogenesis measured by histology and microcomputed tomography, while Scl-Ab delivered by MSs did not result in enhancements in bone or cemental repair compared to MSs alone or control. In conclusion, systemic administration of Scl-Ab promotes bone and cemental regeneration while local, low dose delivery did not heal periodontal osseous defects in this study.

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The evolution of pelvic endoprosthetic reconstruction after tumor resection

Annals of Joint ◽

10.21037/aoj.2019.06.01 ◽

2019 ◽

Vol 4 ◽

pp. 29-29

Author(s):

Tao Ji ◽

Wei Guo

Keyword(s):

Tumor Resection ◽

Endoprosthetic Reconstruction

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Internal Hemipelvectomy for Musculoskeletal Tumors—Indications and Options for Reconstruction

Oncology & Hematology Review (US) ◽

10.17925/ohr.2011.07.2.123 ◽

2011 ◽

Vol 07 (02) ◽

pp. 123

Author(s):

Adam J Schwartz ◽

Jeffrey J Eckardt ◽

Christopher P Beauchamp ◽

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...

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.

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Modular Endoprostheses for Nonneoplastic Conditions: Midterm Complications and Survival

BioMed Research International ◽

10.1155/2016/2606521 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 4

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.

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Endoprosthetic Reconstruction in Limb Salvage for Malignant Bone Tumours in Children

Journal of Orthopedics and Orthopedic Surgery ◽

10.29245/2767-5130/2021/2.1135 ◽

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.

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