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

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.

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

The Journal of Knee Surgery ◽

10.1055/s-0039-1688556 ◽

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.

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Surgical resection and reconstructive techniques using autologous femoral head bone-grafting in treating partial acetabular defects arising from primary pelvic malignant tumors

BMC Cancer ◽

10.1186/s12885-019-6196-x ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Wei Sun ◽

Pengfei Zan ◽

Xiaojun Ma ◽

Yingqi Hua ◽

Jiakang Shen ◽

...

Keyword(s):

Femoral Head ◽

Surgical Resection ◽

Bone Grafting ◽

Malignant Tumors ◽

Functional Evaluation ◽

Musculoskeletal Tumor ◽

Musculoskeletal Tumor Society ◽

Acetabular Defects ◽

Reconstructive Techniques

Abstract Background The aim of this study is to present and evaluate surgical resection and reconstructive techniques using autologous femoral head bone-grafting in treating partial acetabular defects arising from primary pelvic malignant tumors. Methods From January 2009 until January 2015, a total of 20 primary pelvic malignancy cases involving the acetabulum were retrospectively investigated. Surgical resections and reconstructions were conducted based on the type of the tumor with custom osteotomy guides and autologous femoral head bone-grafting. In all cases, prosthesis survival period, complication occurrence, and clinical outcomes data were collected and analyzed. Results Thirteen male and 7 female patients with an average age of 48 years old (range 23-69 years old) were followed for a median of 69 months (range 48-112 months). Of these cases, 17 included chondrosarcomas and 3 additional patients with a malignant giant cell tumor of bone (MBGCT) as proven by pathology. During follow-up, 3 cases of chondrosarcoma recurred (15%), of which two cases received hemi-pelvic amputation, 1 case of MBGCT relapsed and developed pulmonary metastases. Two cases of acetabular prosthesis with an impending dislocation received closed reduction followed by 6 weeks of hip abduction brace fixation. One case of prosthesis loosening was revised. In another case a deep infection occurred with debridement and prosthesis removal. Musculoskeletal Tumor Society 1993 (MSTS-93) score was utilized to conduct functional evaluation: 13 cases were good, 6 were average and one was poor. Conclusion The precision of the osteotomies performed is likely crucial for this type of reconstructive strategy to be successful. The use of custom guides for acetabular osteotomies and femoral head reconstruction can improve functional outcomes with relatively low complications at the intermediate length of follow-up.

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

Journal of Clinical Medicine ◽

10.3390/jcm10051056 ◽

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.

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Comparison of minimally invasive and non-invasive systems in lengthening total femoral prostheses

The Bone & Joint Journal ◽

10.1302/0301-620x.100b12.bjj-2018-0135.r1 ◽

2018 ◽

Vol 100-B (12) ◽

pp. 1640-1646 ◽

Cited By ~ 2

Author(s):

M. R. Medellin ◽

T. Fujiwara ◽

R. Clark ◽

L. M. Jeys

Keyword(s):

Minimally Invasive ◽

Leg Length Discrepancy ◽

Implant Survival ◽

Leg Length ◽

Range Of Movement ◽

Musculoskeletal Tumor Society ◽

Non Invasive ◽

Length Discrepancy ◽

The Mean

AimsThe aim of this study was to describe, analyze, and compare the survival, functional outcome, and complications of minimally invasive (MI) and non-invasive (NI) lengthening total femoral prostheses.Patients and MethodsA total of 24 lengthening total femoral prostheses, 11 MI and 13 NI, were implanted between 1991 and 2016. The characteristics, complications, and functional results were recorded. There were ten female patients and ten male patients. Their mean age at the time of surgery was 11 years (2 to 41). The mean follow-up was 13.2 years (seven months to 29.25 years). A survival analysis was performed, and the failures were classified according to the Modified Henderson System.ResultsThe overall implant survival was 79% at five, ten, and 20 years for MI prostheses, and 84% at five years and 70% at ten years for NI prostheses. At the final follow-up, 13 prostheses did not require further surgery. The overall complication rate was 46%. The mean revision-free implant survival for MI and NI prostheses was 59 months and 49 months, respectively. There were no statistically significant differences in the overall implant survival, revision-free survival, or the distribution of complications between the two types of prosthesis. Infection rates were also comparable in the groups (9% vs 7%; p = 0.902). The rate of leg-length discrepancy was 54% in MI prostheses and 23% in NI prostheses. In those with a MI prosthesis, there was a smaller mean range of movement of the knee (0° to 62° vs 0° to 83°; p = 0.047), the flexion contracture took a longer mean time to resolve after lengthening (3.3 months vs 1.07 months; p < 0.001) and there was a lower mean Musculoskeletal Tumor Society (MSTS) score (24.7 vs 27; p = 0.295).ConclusionThe survival and complications of MI and NI lengthening total femoral prostheses are comparable. However, patients with NI prosthesis have more accurate correction of leg-length discrepancy, a better range of movement of the knee and an improved overall function.

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Intercalary reconstruction of femur after tumour resection: is a vascularized fibular autograft plus allograft a long-lasting solution?

The Bone & Joint Journal ◽

10.1302/0301-620x.100b3.bjj-2017-0283.r2 ◽

2018 ◽

Vol 100-B (3) ◽

pp. 378-386 ◽

Cited By ~ 10

Author(s):

D. A. Campanacci ◽

F. Totti ◽

S. Puccini ◽

G. Beltrami ◽

G. Scoccianti ◽

...

Keyword(s):

Weight Bearing ◽

Young Patients ◽

Bone Tumour ◽

Full Weight Bearing ◽

Tumour Resection ◽

Fibular Graft ◽

Musculoskeletal Tumor Society ◽

Long Term Outcome ◽

The Mean

Aims After intercalary resection of a bone tumour from the femur, reconstruction with a vascularized fibular graft (VFG) and massive allograft is considered a reliable method of treatment. However, little is known about the long-term outcome of this procedure. The aims of this study were to determine whether the morbidity of this procedure was comparable to that of other reconstructive techniques, if it was possible to achieve a satisfactory functional result, and whether biological reconstruction with a VFG and massive allograft could achieve a durable, long-lasting reconstruction. Patients and Methods A total of 23 patients with a mean age of 16 years (five to 40) who had undergone resection of an intercalary bone tumour of the femur and reconstruction with a VFG and allograft were reviewed clinically and radiologically. The mean follow-up was 141 months (24 to 313). The mean length of the fibular graft was 18 cm (12 to 29). Full weight-bearing without a brace was allowed after a mean of 13 months (seven to 26). Results At final follow-up, the mean Musculoskeletal Tumor Society Score of 22 evaluable patients was 94% (73 to 100). Eight major complications, five fractures (21.7%), and three nonunions (13%) were seen in seven patients (30.4%). Revision-free survival was 72.3% at five, ten, and 15 years, with fracture and nonunion needing surgery as failure endpoints. Overall survival, with removal of allograft or amputation as failure endpoints, was 94.4% at five, ten, and 15 years. Discussion There were no complications needing surgical revision after five years had elapsed from surgery, suggesting that the mechanical strength of the implant improves with time, thereby decreasing the risk of complications. In young patients with an intercalary bone tumour of the femur, combining a VFG and massive allograft may result in a reconstruction that lasts a lifetime. Cite this article: Bone Joint J 2018;100-B:378–86.

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

Journal of Chitwan Medical College ◽

10.3126/jcmc.v10i2.29677 ◽

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.

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

The Bone & Joint Journal ◽

10.1302/0301-620x.101b9.bjj-2019-0090.r1 ◽

2019 ◽

Vol 101-B (9) ◽

pp. 1151-1159 ◽

Cited By ~ 3

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

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Preliminary proposal: a classification system for reconstruction with autologous femoral head after periacetabular tumors resection

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02275-y ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Chunzhi Yi ◽

Jiaqian Zheng ◽

Ruoyu Li ◽

Yun Lan ◽

Mincong He ◽

...

Keyword(s):

Femoral Head ◽

Classification System ◽

Malignant Tumors ◽

Type A ◽

Clinical Results ◽

Type B ◽

Musculoskeletal Tumor ◽

Musculoskeletal Tumor Society ◽

Total Incidence ◽

And Function

Abstract Background Although researchers have adopted various methods for the resection and reconstruction of periacetabular tumors, the total incidence rate of complications remains high. Aiming for preserving the acetabulum and reducing the risk of complications, we applied a surgery method using tumor-free autologous femoral head to reconstruct the defective acetabulum after resection of periacetabular tumors followed by performing a conventional total hip arthroplasty (THA). Moreover, we proposed a preliminary classification system for these surgery methods. Methods We retrospectively reviewed 6 patients treated with acetabulum reconstruction combined with autologous femoral head following peri-acetabulum resection between April 2010 and May 2018. All patients were diagnosed as periacetabular tumors including chondrosarcoma (n = 5) and chondroblastoma (n = 1). Clinical data such as age, diagnosis, complications, local recurrence or metastasis, and function (Musculoskeletal Tumor Society 1993, MSTS93) were documented. The average time of follow-up was 62.5 months (range, 17 to 106 months). Results A total of 5 patients survive with average MSTS93 score of 27.8 points (range, 26–30). One patient, suffering from multiple bone metastasis prior treatment, ended up dying. One who had received radiotherapy before surgery had poor incision healing. Further, a classification system was preliminary proposed in 2 patients involving the pubis (type A) and 4 patients involving ischium (type B). Conclusions Based on the results, we preliminary proposed a classification system for reconstruction with autologous femoral head after periacetabular low malignant tumors resection. The clinical results suggested that surgery methods involving pubis (type A) and ischium (Type B) are safe and feasible. However, further researches should be conducted to verify our classification system.

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

The Journal of Hip Surgery ◽

10.1055/s-0039-1681021 ◽

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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