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.

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

2020 ◽  
Author(s):  
Zhiqiang Zhao ◽  
Qinglin Jin ◽  
Xianbiao Xie ◽  
Yongqian Wang ◽  
Tiao Lin ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Preliminary Report ◽  
Young Patients ◽  
Bone Sarcoma ◽  
Postoperative Management ◽  
Functional Score ◽  
Leg Length ◽  
Reconstruction Strategy ◽  
Distal Joint ◽  
Vascularized Bone

Abstract Background At present, amputation was widely adopted for young patients when limb salvage is deemed risky with several surgical strategy such as rotationplasty. However, leg length discrepancies and unfavorable cosmetic results is an indispensable complication of this strategy. The purpose of this study is to demonstrate a novel reconstruction strategy and evaluate the early clinical and functional outcomes of the strategy. Methods Plastic lengthening amputation 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. Six pairs of patients matched for age, sex, location, pathologic 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 MSTS were used to describe and quantitatively grade limb functional outcomes after amputation. The complications and functional outcomes of the two procedures were compared. Results Twelve patients with osteosarcoma or Ewing sarcoma in either the femur or tibia were included in the study. Six patients underwent plastic lengthening amputations, three of whom also underwent vascular anastomosis. All 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 but was 19.50 ± 7.87 in the traditional amputation group. Conclusions Plastic lengthening amputations with vascularized autografts could preserve one additional distal joint and improve the function of the amputated limb in selected bone sarcoma patients. MSTS analysis also indicated that the patients would have better functional outcomes with plastic lengthening amputation than with traditional amputation.

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.

scholarly journals Effectiveness of Clavicula Pro Humero Reconstruction for Elderly Patients: Report of Two Cases

2016 ◽  
Vol 2016 ◽  
pp. 1-6
Author(s):  
Sho Okimatsu ◽  
Hiroto Kamoda ◽  
Tsukasa Yonemoto ◽  
Shintaro Iwata ◽  
Takeshi Ishii
Keyword(s):  
Elderly Patients ◽  
Proximal Humerus ◽  
Young Patients ◽  
Distal Humerus ◽  
Wide Resection ◽  
Functional Score ◽  
Positive Outcomes ◽  
Postoperative Results ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society

Clavicula pro humero (CPH) reconstruction is a method that is used after proximal humeral excision. During CPH reconstruction, the ipsilateral clavicle is rotated downward and connected to the preserved distal humerus by using plates and screws. This method is frequently used for reconstruction surgeries involving young patients and has positive outcomes. In this study, we describe two cases of CPH reconstruction that were performed on elderly individuals after wide resection of the proximal humerus; postoperative results from these surgeries were satisfactory. The average Musculoskeletal Tumor Society (MSTS) functional score after surgery was 68.5%, indicating that CPH reconstruction is suitable for not only younger but also elderly patients, particularly those over the age of 65 years.

scholarly journals Pedicle frozen autograft-prosthesis composite reconstructions for malignant bone tumors of the proximal femur

2020 ◽  
Author(s):  
gang xu ◽  
Shinji Miwa ◽  
Norio Yamamoto ◽  
Katsuhiro Hayashi ◽  
Akihiko Takeuchi ◽  
...  
Keyword(s):  
Proximal Femur ◽  
Functional Outcomes ◽  
Bone Tumors ◽  
Functional Score ◽  
Malignant Bone Tumors ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Biological Reconstruction ◽  
The Mean

Abstract Background Limb salvage surgery is becoming increasingly popular after tumor resection in the lower extremity. Biological reconstruction and use of megaprosthesis are main methods for malignant bone tumors of the proximal femur, which remain controversial due to short- and long-term complication in the proximal femur. Tumor-bearing bone treated by liquid nitrogen is one of biological reconstruction. This study aimed to evaluate the mid- and long-term functional outcomes and complications in patients treated with frozen autograft–prosthesis composite (FAPC) reconstructions in the proximal femur. Methods This retrospective study included 19 patients (10 women, 9 men) with malignant tumors of the proximal femur who underwent tumor-wide resection and FAPC reconstruction (mean age, 46 years; range, 9-77 years). The mean follow-up period of 69 months (range, 9-179 month). Functional outcomes, oncological outcomes and complications were evaluated by Musculoskeletal Tumor Society score, clinical and radiological examinations. Results The overall survival rate was 68.4%, and the mean Musculoskeletal Tumor Society functional score was 26.4 points (88%). FAPC survival rates were 100% and 50% at 5 and 10 years, respectively. Five of the 19 patients (26%) had complications: 2 required prosthesis removal and 2 developed a deep infection around acetabular. Wear of the acetabulum occurred in 2 cases, while disease recurrence was occurred in 1 case. There were no cases of greater trochanter avulsion, obvious absorption around frozen bone, prosthesis loosening or leg length discrepancy. Conclusions Due to without femoral osteotomy, this technique features satisfactory functional outcome and provide biomechanical stability that is comparable to those of other methods of biological reconstruction or megaprosthesis.

scholarly journals Pedicle frozen autograft-prosthesis composite reconstructions for malignant bone tumors of the proximal femur

2020 ◽  
Author(s):  
gang xu ◽  
Shinji Miwa ◽  
Norio Yamamoto ◽  
Katsuhiro Hayashi ◽  
Akihiko Takeuchi ◽  
...  
Keyword(s):  
Proximal Femur ◽  
Functional Outcomes ◽  
Bone Tumors ◽  
Functional Score ◽  
Malignant Bone Tumors ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Biological Reconstruction ◽  
The Mean

Abstract Background Limb salvage surgery is becoming increasingly popular after tumor resection in the lower extremity. Biological reconstruction and use of megaprosthesis are main methods for malignant bone tumors of the proximal femur, which remain controversial due to short- and long-term complication in the proximal femur. Tumor-bearing bone treated by liquid nitrogen is one of biological reconstruction. This study aimed to evaluate the mid- and long-term functional outcomes and complications in patients treated with frozen autograft–prosthesis composite (FAPC) reconstructions in the proximal femur. Methods This retrospective study included 19 patients (10 women, 9 men) with malignant tumors of the proximal femur who underwent tumor-wide resection and FAPC reconstruction (mean age, 46 years; range, 9-77 years). The mean follow-up period of 69 months (range, 9-179 month). Functional outcomes, oncological outcomes and complications were evaluated by Musculoskeletal Tumor Society score, clinical and radiological examinations. Results The overall survival rate was 68.4%, and the mean Musculoskeletal Tumor Society functional score was 26.4 points (88%). FAPC survival rates were 100% and 50% at 5 and 10 years, respectively. Five of the 19 patients (26%) had complications: 2 required prosthesis removal and 2 developed a deep infection around acetabular. Wear of the acetabulum occurred in 2 cases, while disease recurrence was occurred in 1 case. There were no cases of greater trochanter avulsion, obvious absorption around frozen bone, prosthesis loosening or leg length discrepancy. Conclusions Due to without femoral osteotomy, this technique features satisfactory functional outcome and provide biomechanical stability that is comparable to those of other methods of biological reconstruction or megaprosthesis.

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

3D Printing Guide Plate for Accurate Hemicortical Bone Resection in Low-Grade Bone Sarcoma

2020 ◽  
Author(s):  
Hongwei Wu ◽  
Xian'an Li ◽  
Shuo Yang ◽  
Jie Bu ◽  
Xuezheng Xu ◽  
...  
Keyword(s):  
3D Printing ◽  
Bone Sarcoma ◽  
Long Bone ◽  
Low Grade ◽  
Joint Function ◽  
Bone Resection ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Guide Plate ◽  
Post Operation

Abstract Background: Surgical resection and reconstruction for low grade bone sarcoma in the metaphysis of the long bone remains challenging. We hypothesize that 3D printing osteotomy guide plate could assist to accurately resect the tumor lesion and save the joint function without higher recurrence rate. Methods: From January 2017 to August 2019, ten patients with low-grade malignant bone tumor in metaphysis of the limbs were treated with hemicortical resection using 3D printing guide plate and biological reconstruction. Results: Four patients were paracorticular osteosarcoma, five cases had highly differentiated chondrosarcoma, and one case was a chondromyxoid fibroma. Two of the cases involved the proximal humerus, while eight cases involved the distal femur. There was neither post-operation infection, internal fixation loosening, nor fracture occurrence in any of the patients. The Musculoskeletal Tumor Society score averaged at 27.1, while the International Society of Limb Salvage imaging score examination averaged 87.8%. Conclusions: Here, we demonstrate that the 3D printing osteotomy guide plate assisted hemicortical bone resection is a beneficial strategy to effectively resect the primary low-grade malignant bone tumors in the metaphysis of long bone and restore excellent joint function.

scholarly journals Surgical Treatment of Radial Head Fractures: Review of Literature.

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Edvin Selmani ◽  
Agron Dogjani
Keyword(s):  
Radial Head ◽  
Functional Outcomes ◽  
Treatment Decision ◽  
Functional Score ◽  
Complication Rates ◽  
Eligibility Criteria ◽  
Radial Head Fractures ◽  
Search Terms ◽  
Functional Scores ◽  
Type 3

The aim of this systematic review was to search for and critically appraise articles directly comparing functional outcomes and complications for fixation (ORIF) versus arthroplasty for comminuted radial head fractures (Mason type 3) in adults. Material and methods: A comprehensive study of Medline, Embase and Cochrane databases using specific search terms and limits was conducted. Strict eligibility criteria were applied to stringently screen resultant articles. Three comparative studies were identified and reviewed. Results: Two studies found significantly better functional scores after replacement compared with ORIF in Mason type 3 fractures. The third study found no significant differences in functional score or range of motion, but did find that grip strength was better after ORIF. Complication rates were too heterogenous for conclusion. Conclusion: Fixation with good reduction may be attempted in unstable Mason type 3 fractures, and arthroplasty may be considered if this is not possible. Further randomised comparative trials are required to clarify the decision-making between fixation and replacement. Functional outcomes and complications were conflicting in the studies included here. Ideally, treatment decision should take into account elbow stability and degree of comminution.

Early Postoperative Pain Predicts 2-Year Functional Outcomes following Knee Arthroplasty

2019 ◽  
Vol 33 (11) ◽  
pp. 1132-1139 ◽  
Author(s):  
Akshay Lakra ◽  
Taylor Murtaugh ◽  
Roshan P. Shah ◽  
H. John Cooper ◽  
Jeffrey A. Geller
Keyword(s):  
Postoperative Pain ◽  
Functional Outcome ◽  
Knee Arthroplasty ◽  
Pain Control ◽  
Functional Outcomes ◽  
Short Form ◽  
Functional Score ◽  
Womac Pain ◽  
Pain Scores ◽  
Functional Scores

AbstractPain control following knee arthroplasty is extremely important to both patients and surgeons to improve the perioperative experience; however, the implication of early pain control on long-term outcomes following knee arthroplasty remains poorly understood. We hypothesized that poor early pain control results in poor functional outcomes 2 years following total (TKA) and unicondylar knee arthroplasty (UKA). This retrospective study reviewed 242 TKA and 162 UKA performed at a single institution by two surgeons. Mean visual analog scale (VAS) pain scores were collected for first 3 postoperative days. Patients were prospectively evaluated using short form (SF-12), the Western Ontario and McMaster University osteoarthritis index (WOMAC), and the Knee Society functional score (KSFS) questionnaires. Pearson's correlation coefficients were calculated between mean VAS pain scores and functional outcome scores at 2 years. In the TKA group, poorly controlled perioperative pain correlated with poorer functional scores at 2 years. There was a significant negative correlation between early mean VAS pain scores (mean, 3.2 ± 2.0) and most 2-year functional outcomes including SF-12 physical score (r = −0.227, p ≤ 0.01), WOMAC pain scores (r = −0.268, p ≤ 0.01), WOMAC stiffness scores (r = −0.224, p < 0.01), WOMAC function score (r = −0.290, p 0.01), and KSFS (r = −0.175, p = 0.031). Better control of early pain was associated with improved functional outcomes at 2 years following TKA. We also found significant negative correlations between preoperative functional scores and early postoperative pain scores. Collectively, using preoperative and early postoperative pain scores, we identified an “at-risk” patient group that manifested an inferior functional outcome at 2 years; these patients may benefit from closer surveillance and a multidisciplinary approach to pain and function to optimize their clinical outcome following knee arthroplasty.

scholarly journals Short-term outcomes of one-stage bilateral total hip arthroplasty in young patients (< 30 years old)

2018 ◽  
Vol 10 (2) ◽  
Author(s):  
Afshin Taheriazam ◽  
Amin Saeidinia
Keyword(s):  
Rheumatoid Arthritis ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Slipped Capital Femoral Epiphysis ◽  
Young Patients ◽  
Harris Hip Score ◽  
Functional Score ◽  
Total Hip ◽  
One Stage ◽  
Functional Scores

Total hip arthroplasty is one of the best treatments for restoring function and activity in young patients with advanced joint diseases. One-Stage Bilateral Total Hip Arthroplasty (BTHA) offers many advantages, which are important to younger patients and diminished costs and time in comparison with sequential THA. There is currently much concern about the safety of this procedure. The current study was designed to provide more information regarding THA in patients aged 30 years old or younger. Between April 2010 and September 2015, arthroplasty procedures were performed on 180 patients at the surgical centers of Erfan and Milad, Tehran, Iran. The patients that were entered in the study included those with bilateral hip involvement of Avascular Necrosis (AVN), Rheumatoid Arthritis (RA), Juvenile Rheumatoid Arthritis (JRA), Slipped Capital Femoral Epiphysis (SCFE), and Developmental Dysplasia of the Hip (DDH). The patients underwent one-stage bilateral total hip arthroplasties through the direct lateral approach. Standardized questionnaires were used to obtain mean Postel-Merle d’Aubigné (PMA) score, Oxford Hip Score (OHS), Visual Analogue Scale (VAS) Score, and Modified Harris Hip Score (MHHS), both preoperatively and post-operatively to evaluate functional outcomes. All patients were in the American Society of Anesthesiology (ASA) category 1 or 2. All complications were followed closely for a period of 4.67±0.54 years. From 141 males and 39 females, 84 patients had been recognized as ASA 1, and 96 as ASA 2. Mean age of patients was 27.04±2.74 years old (range: 16 to 30). The mean operation time and the average length of hospital stay were 156±23 minutes and 5.20±2.44 days, respectively. Overall, 3 patients developed unilateral temporary peroneal nerve palsy (1.66%), 2 intraoperative fracture (1.11%), and 2 patients (1.11%) showed deep vein thrombosis. There was no wound infection. Regarding the functional scores in the diagnosis of patients, improvement was better in AVN than, RA, JRA, SCFE, and DDH, respectively. There were significant differences between diagnosis and every functional score, individually (P<0.05). The current results showed that one-stage bilateral THA led to improvement in hip function and stable implant fixation at short to midterm follow up, which suggests the efficacy of one-stage cementless THA in bilateral advanced arthritis in patients younger than 30 years old.

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