scholarly journals Double Endoprosthesis in the Management of Refractory Metastatic Primary Bone Tumors in Children and Young Adults

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Anna Raciborska ◽  
Iwona Malesza ◽  
Katarzyna Bilska ◽  
Tomasz Koziński ◽  
Bartosz Pachuta
Keyword(s):  
Limb Salvage ◽  
Bone Tumors ◽  
Salvage Surgery ◽  
Young Patients ◽  
Limb Salvage Surgery ◽  
First Line ◽  
Musculoskeletal Tumor Society ◽  
Custom Made ◽  
Second Surgery ◽  
The Impact

Background. Although not all children can be cured yet, much more emphasis is placed on the quality of life during and after cancer treatment. In the case of recurrence, mutilating treatment is still the prevalent option. In our study, we explored the role of limb salvage surgery for young patients with metastatic malignant bone tumors after endoprosthesis reconstruction during the first line of treatment and evaluated the impact of the local control modality in disease control and functional outcomes. Materials and Methods. Eleven patients with bone tumor treated between 2007 and 2018 were included in this study. Both during primary treatment and during recurrence, limb salvage surgery was performed using a modular or expandable custom-made replacement system. Peri- and postoperative care for both surgeries were similar. All patients were given chemotherapy before and after both surgeries, according to the oncological guidelines. Results. Seven patients (63.6%) are alive with a median follow-up of 6.5 years from diagnosis. None had local recurrence. Five-year estimates of event-free survival and overall survival were 36.27% and 79.55%, respectively. Median time between the first and second surgery was 2.7 years. Three patients presented with postoperative complications following both surgeries and required resurgical intervention. Three months following the second surgery, the Musculoskeletal Tumor Society Scale (MSTS) scores were 15–27 points (21 points on average—60%). Conclusions. Limb salvage surgery is feasible and offers good chance of cure with a reasonable rate of complications and good function in patients with recurrent bone sarcoma after endoprosthesis reconstruction during the first line of treatment.

scholarly journals 3D-Printed Connector for Revision Limb Salvage Surgery in Long Bones Previously Using Customized Implants

Metals ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 707
Author(s):  
Jong-Woong Park ◽  
Hyun-Guy Kang ◽  
June-Hyuk Kim ◽  
Han-Soo Kim
Keyword(s):  
Limb Salvage ◽  
Salvage Surgery ◽  
Revisional Surgery ◽  
Limb Salvage Surgery ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Proximal Ulna ◽  
Custom Made ◽  
Orthopedic Oncology ◽  
3D Printed

In orthopedic oncology, revisional surgery due to mechanical failure or local recurrence is not uncommon following limb salvage surgery using an endoprosthesis. However, due to the lack of clinical experience in limb salvage surgery using 3D-printed custom-made implants, there have been no reports of revision limb salvage surgery using a 3D-printed implant. Herein, we present two cases of representative revision limb salvage surgeries that utilized another 3D-printed custom-made implant while retaining the previous 3D-printed custom-made implant. A 3D-printed connector implant was used to connect the previous 3D-printed implant to the proximal ulna of a 40-year-old man and to the femur of a 69-year-old woman. The connector bodies for the two junctions of the previous implant and the remaining host bone were designed for the most functional position or angle by twisting or tilting. Using the previous 3D-printed implant as a taper, the 3D-printed connector was used to encase the outside of the previous implant. The gap between the previous implant and the new one was subsequently filled with bone cement. For both the upper and lower extremities, the 3D-printed connector showed stable reconstruction and excellent functional outcomes (Musculoskeletal Tumor Society scores of 87% and 100%, respectively) in the short-term follow-up. To retain the previous 3D-printed implant during revision limb salvage surgery, an additional 3D-printed implant may be a feasible surgical option.

Limb salvage surgery for malignant bone tumors of the extremities in children and adolescents

2009 ◽  
Vol 8 (11) ◽  
pp. 631-637 ◽  
Author(s):  
Zhen Wang ◽  
Zheng Guo ◽  
Xiangdong Li ◽  
Luyu Huang ◽  
Qiang Ji ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Limb Salvage ◽  
Bone Tumors ◽  
Salvage Surgery ◽  
Limb Salvage Surgery ◽  
Malignant Bone Tumors

Influence of Chemotherapy on Perioperative Complications in Limb-Salvage Surgery for Bone Tumors

Limb Salvage ◽  
1991 ◽  
pp. 497-507
Author(s):  
D. J. McDonald ◽  
R. Capanna ◽  
F. Gherlinzoni ◽  
M. Campanacci ◽  
A. Ferruzzi ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Bone Tumors ◽  
Salvage Surgery ◽  
Perioperative Complications ◽  
Limb Salvage Surgery

Does neo-adjuvant chemotherapy increase the risk of infection after limb salvage surgery for bone tumors?

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 20532-20532
Author(s):  
S. Sankaranarayanan ◽  
V. Sokolovskiy ◽  
V. Voloshin ◽  
M. Aliev ◽  
V. Zubikov ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Limb Salvage ◽  
Bone Tumors ◽  
Salvage Surgery ◽  
Limb Salvage Surgery ◽  
Team Approach ◽  
Group A ◽  
Neo Adjuvant Chemotherapy ◽  
Group B

20532 Background: Neo-adjuvant chemotherapy is commonly used to eradicate the micro metastases and to prepare the patient for limb-salvage surgery. It helps the surgeon to get good oncological margin intraoperatively. Methods: Between the period of 1992 - 2005, 321 patients underwent limb salvage surgery for bone tumors at the Department of General Oncology (Bone & Soft tissue tumors), N. N. Blokhin Russian Cancer Research Center & Moscow Regional Clinical Research Institute, Moscow, Russian Federation. 230/321 patients (Group A) received neo-adjuvant chemotherapy. The course of chemotherapy ranges from 2 to 11 cycles. 95/321 patients (Group B) did not receive neo-adjuvant chemotherapy. The histological diagnoses were: 155 - High grade osteosarcoma, 38 - Giant cell tumor, 36 - Malignant fibrous histiocytoma, 29 - Chondrosarcoma, 25 - Periosteal osteosarcoma, 21 - Metastasis from other organs and 17 - Ewing's tumor. Results: In Group A, 27 patients (11.7%) and in Group B, 7 (7.3%) had infection of endoprosthetic bed. Suppression of the immune system by chemotherapeutic agents is the main reason for the higher incidence of infection in Group A. All the 27 patients in Group A and 2 patients in Group B had revisional endoprosthetic replacement. In group A 7/27 and in Group B none of the 7 patients died of post operative infection. The follow-up ranged from 1 - 13 years (mean follow-up 6 years). Discussion: In our opinion, it has a major disadvantage, i.e. it increases the risk of postoperative infection. How best to combine this drug is still unknown. In the future, therapy for bone tumors should be enhanced by advances in pharmacology, immunology, and molecular genetics that will lead to more efficacious, specific and less toxic treatments. An interdisciplinary team approach is needed in order to advance the goal of local tumor control, limb salvage with optimum extremity function, minimal morbidity and improved long term survival. No significant financial relationships to disclose.

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.

scholarly journals Accuracy of Bony Resection Under Computer Assisted Navigation Compared with Free-Hand Cutting for Bone Tumors Around the Knee

10.29007/dd82 ◽  
2018 ◽  
Author(s):  
Zhiping Deng ◽  
Bin Li ◽  
Tao Jin ◽  
Qing Zhang ◽  
Lin Hao ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Bone Tumors ◽  
Salvage Surgery ◽  
Control Group ◽  
Computer Assisted ◽  
Limb Salvage Surgery ◽  
Assisted Navigation ◽  
Length Difference ◽  
Operative Specimen ◽  
Navigation Group

INTRODUCTIONBone tumor surgery can be more accurate under the computer assisted navigation. The researches have shown the benefit of margin control in pelvic, joint sparing surgery. The traditional method for bone cutting in limb salvage was by free hand. There was no literature focused on the comparison of cutting accuracy in bone tumors around the knee joint. The aim of this study was to compare the accuracy for bony resection under navigation and by free hand in limb salvage surgery around the knee.MATERIALS AND METHODSThirty-nine cases of bone tumors around the knee joint were resected under navigation (Stryker System) in our department from 2008 Sep to 2017 Nov. All the cases were performed intercalary resection in femur or tibia. The initial aim to use navigation was to make the resection more close to the pre-operative planning. The pre-operative planning was performed with the software OrthoMap at the working station (Stryker Company). The CT and MRI imaging were input to the system. We used intraoperative navigation (Iso-C based) to find the cutting plane and use the jig saw to cut the bone. The post-operative specimen was used for verification and compared with the pre-operative plan. The length difference was defined as specimen length minus planning resection length. The control group included 117 cases of tumors around the knee performed limb salvage surgery when bony cutting was achieved by free hand. This was a non-randomized control study. The method to find the cutting plane was by measuring the length from the joint line to the planned plane by ruler. The length of post-operative specimen by free hand was compared with the surgical plan. The length difference was detected in this control group. Then the differences in two groups were compared and analyzed.RESULTSThe resection lengths in navigation group ranged from 85-282mm and in the free hand group the length ranged from 90-330mm. The length difference between post-operative verification and pre-operative plan was detected. In the navigation group, the length difference was 0.5±2.5mm (range ,-5～5mm), while in the free hand group the length difference was 3.4±9.6mm (range ,-20～29mm), P<0.01. For the absolute value differences analysis, the difference was 2.0±1.6mm and 8.3±6.0mm for navigation and free hand group respectively, P<0.01.DISCUSSIONOur study shows that bone cutting with navigation can be more accurate than freehand cutting. The average length difference was 2.0mm (95% CI, 0.4 to 3.6mm) when compared to average 8.3mm (95% CI, 2.3 to 14.3mm). The accuracy with navigation is similar to the previous researches. Our comparison with free hand group gives the data how accurate the navigation can help surgeon to achieve. The result indicates that computer assisted navigation can make a role in limb salvage surgery if the precise resection is required.

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