scholarly journals Onlay vascularized fibular grafting as a salvage procedure for the management of nonunion after reconstruction of the femur following tumor resection

2018 ◽  
Vol 26 (3) ◽  
pp. 230949901880249
Author(s):  
Jae Hoon Lee ◽  
Chung Soo Han ◽  
Jong Hun Baek
Keyword(s):  
Median Time ◽  
Tumor Resection ◽  
Deep Infection ◽  
Functional Score ◽  
Salvage Procedure ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Fibular Grafting ◽  
Graft Fracture

Purpose: The femur is prone to nonunion after biologic reconstruction following tumor resection, due to high bending forces. Nonunion at the host–graft junction is difficult to treat since the graft is in an avascular state. We aimed to investigate the clinical and radiographic results of an onlay free vascularized fibular grafting (VFG) as a salvage procedure for nonunion management after biologic reconstruction of the femur following bone tumor resection. Methods: We retrospectively reviewed 10 patients (8 men and 2 women, median age: 15.5 years, range: 10–47) who underwent an onlay VFG for nonunion after intercalary reconstruction of the femur using an allograft ( n = 7) or pasteurized autograft ( n = 3), following tumor resection. The median follow-up period after VFG was 85.7 (24.6–163.5) months. Results: The median time to union between the host bone and the VFG osteotomy sites was 3.5 (2.8–4.5) months. The median time to union at the host–graft junctions was 10.6 (6.6–12.7) months. Two postoperative complications requiring revision surgery occurred in two patients: one graft fracture and one deep infection with synchronous graft fracture. Internal fixation was required in the patient with graft fracture. The patient with the infection and synchronous graft fracture was treated using debridement, antibiotics, and an external fixator. The median Musculoskeletal Tumor Society functional score was 88% (60–97%) at the final follow-up. Conclusion: Onlay VFG as a salvage procedure for nonunion of a biologic intercalary reconstruction of the femur after tumor resection is a useful treatment option.

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

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.

scholarly journals Clinical Outcomes of Osteoarticular Extracorporeal Irradiated Autograft for Malignant Bone Tumor

Sarcoma ◽  
2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Satoshi Takenaka ◽  
Nobuhito Araki ◽  
Takafumi Ueda ◽  
Shigeki Kakunaga ◽  
Yoshinori Imura ◽  
...  
Keyword(s):  
Bone Tumor ◽  
Functional Outcomes ◽  
Tumor Resection ◽  
Radiographic Evaluation ◽  
Functional Score ◽  
Operation Technique ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Radiographic Score ◽  
Radiographic Changes

Background and Objectives. Osteoarticular extracorporeal irradiated autograft is an alternative operation technique to prosthetic devices or allografts for reconstruction after resection of bone malignancies. The aim of this study is to assess the complications, radiographic changes, and functional outcomes of osteoarticular ECIA. Methods. We retrospectively reviewed 33 patients who underwent osteoarticular ECIA after bone tumor resection from 1988 to 2014. We investigated complications, radiographic changes by the International Society of Limb Salvage graft evaluation criteria, and functional outcomes according to the Musculoskeletal Tumor Society scoring system. Results. Fifteen patients were reoperated upon due to infection (n = 9), protruding fixation implant (n = 4), or fracture of the grafted bone (n = 2). The average radiographic evaluation score was 66.4%, and the median functional score was 23 (77%). The radiographic score for the proximal humerus or proximal tibia was lower than that for the other locations. The functional score was not different among the autograft sites but was related to the radiographic score. Conclusion. Although osteoarticular ECIA is one of the reasonable surgical options for patients with tumors for which reliable prostheses are not available, we do not recommend osteoarticular ECIA as a routine procedure because of high complication rate.

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

2019 ◽  
Vol 101-B (9) ◽  
pp. 1151-1159 ◽  
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

The long-term results of extendable endoprostheses of the humerus in children after the resection of a bone sarcoma

2020 ◽  
Vol 102-B (1) ◽  
pp. 64-71
Author(s):  
Yusuke Tsuda ◽  
Tomohiro Fujiwara ◽  
Jonathan D. Stevenson ◽  
Michael C. Parry ◽  
Roger Tillman ◽  
...  
Keyword(s):  
Bone Sarcoma ◽  
Long Term Results ◽  
Functional Score ◽  
Endoprosthetic Replacement ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Initial Surgery ◽  
The Mean

Aims The purpose of this study was to report the long-term results of extendable endoprostheses of the humerus in children after the resection of a bone sarcoma. Methods A total of 35 consecutive patients treated with extendable endoprosthetic replacement of the humerus in children were included. There were 17 boys and 18 girls in the series with a median age at the time of initial surgery of nine years (interquartile range (IQR) 7 to 11). Results The median follow-up time was 10.6 years (IQR 3.9 to 20.4). The overall implant survival at ten years was 75%. Complications occurred in 13 patients (37%). Subluxation at the proximal humerus occurred in 19 patients (54%) but only six (17%) were symptomatic. Subluxation was seen more commonly in children under the age of nine years (86%) than in those aged nine years or more (33%) (p = 0.002). Implant failure occurred in nine patients (26%): the most common cause was aseptic loosening (four patients, 11%). Lengthening of the implant was carried out in 23 patients (66%). At final follow up, three patients had a limb that was shortened by 5 cm or more. The mean Musculoskeletal Tumor Society (MSTS) functional score was 79% (73% to 90%). Conclusion Extendable endoprosthetic replacement is a reliable method of reconstructing humerus after excision of a bone sarcoma. Children who are less than nine years old have a high risk of subluxation. Cite this article: Bone Joint J 2020;102-B(1):64–71

scholarly journals Analysis of the curative effect of limb salvage therapy in patients with soft tissue sarcoma who underwent extensive resection combined with skin flap transplantation

2021 ◽  
Vol 5 (1) ◽  
pp. 3-7
Author(s):  
Wei-na Wu ◽  
Hai-ying Cao ◽  
Zhen Feng
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Skin Flap ◽  
Tumor Resection ◽  
Tumor Control ◽  
Soft Tissue Coverage ◽  
Musculoskeletal Tumor ◽  
Extensive Resection ◽  
Musculoskeletal Tumor Society

Purpose: Patients who were diagnosed with soft tissue sarcoma (STS) of limbs and met the indications for amputation because of no effective soft tissue coverage after extensive tumor resection were treated with skin flap transplantation and therapeutic courses were observed.  Methods: A total of 23 patients, pathologically diagnosed as soft tissue sarcoma from January 2011 to June 2015 and whose effective soft tissue coverage was not guaranteed due to extensive tumor resections were included. They underwent extensive tumor excision and skin flap grafting. The postoperative follow-up, tumor control and functional recovery was evaluated as per the Musculoskeletal Tumor Society (MSTS) score.  Results: The follow-up time was from 8 to 60 months, with an average follow-up of 39.69 months. Of the 23 patients, 10(43.47%) died of tumor metastasis from 8th to 23rd months after surgery. In these 10 cases, 2 cases (8.70%) subsequently underwent amputation because of local tumor recurrence. The remaining 13 patients are recurrence free till date of follow up. The MSTS limb function score at 3 months after surgery of all patients were 7-28 points, with an average of 22.56 points, and the excellent and fair scores are observed in 91.30% of patients.  Conclusion: For patients who cannot achieve effective soft tissue coverage after extensive resection of soft tissue sarcoma and meet the indications of amputation can have limb preservation by extensive tumor resection combined with skin flap transplantation with a good functional results 

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

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.

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

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.

scholarly journals Plastic lengthening amputation with vascularized bone grafts in children with bone sarcoma: a preliminary report

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Zhiqiang Zhao ◽  
Qinglin Jin ◽  
Xianbiao Xie ◽  
Yongqian Wang ◽  
Tiao Lin ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Young Patients ◽  
Bone Sarcoma ◽  
Postoperative Management ◽  
Functional Score ◽  
Leg Length ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Functional Scores ◽  
Distal Joint

Abstract Background At present, amputation was widely adopted for young patients when limb salvage was deemed risky with several surgical strategy such as rotationplasty. However, leg length discrepancies and unfavorable cosmetic results were indispensable complication of this strategy. The purpose of this study was to propose a novel reconstruction strategy and evaluate the early clinical and functional outcomes of the strategy. Methods Plastic lengthening amputation (PLA) has been developed by lengthening the stump to preserve one additional distal joint for fixing the artificial limb well. The surgical technique and postoperative management were documented, and the functional outcomes were compared with those of traditional amputation (TA). Six pairs of patients matched for age, sex, location, pathological type, and final prosthesis underwent individually designed plastic lengthening amputation with vascularized autografts or traditional amputation between January 2005 and December 2007. All patients were followed, and the locomotor index and the musculoskeletal tumor society score (MSTS) were used to describe and quantitatively grade limb functional outcomes after amputation. The complications and functional outcomes of the patients taken two kinds of procedures were compared. Results Twelve patients with osteosarcoma or Ewing’s sarcoma of either the femur or tibia were included in the study. Six patients underwent plastic lengthening amputations, three of whom also underwent vascular anastomosis. Patients were followed for an average of 48.17 months; bone healing required an average of 3.3 months. No local recurrence was found. The average postoperative locomotor index functional score of the affected limb was 32.67 ± 5.89 in the plastic lengthening amputation group while was 19.50 ± 7.87 in the traditional amputation group. The MSTS functional scores were 22.67 ± 1.33 and 24.17 ± 1.45 at 6 and 12 months for patients in PLA group while 17.00 ± 1.549 and 17.83 ± 1.64 at 6 and 12 months for patients in TA group. Conclusions Plastic lengthening amputations with vascularized autografts could preserve the knee joint to improve the function of the amputated limb in selected bone sarcoma patients.

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

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.

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

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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