Comparison of reconstructive techniques after acetabular resection for pelvic chondrosarcoma

2021 ◽  
Vol 103-B (2) ◽  
pp. 391-397
Author(s):  
Matthew T. Houdek ◽  
Jay S. Wunder ◽  
Matthew P. Abdel ◽  
Anthony M. Griffin ◽  
Mario Hevesi ◽  
...  
Keyword(s):  
Tumour Volume ◽  
High Rate ◽  
Acetabular Reconstruction ◽  
Level Of Evidence ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Msts Score ◽  
Saddle Prosthesis ◽  
The Mean

Aims Hip reconstruction after resection of a periacetabular chondrosarcoma is complex and associated with a high rate of complications. Previous reports have compared no reconstruction with historical techniques that are no longer used. The aim of this study was to compare the results of tantalum acetabular reconstruction to both historical techniques and no reconstruction. Methods We reviewed 66 patients (45 males and 21 females) with a mean age of 53 years (24 to 81) who had undergone acetabular resection for chondrosarcoma. A total of 36 patients (54%) underwent acetabular reconstruction, most commonly with a saddle prosthesis (n = 13; 36%) or a tantalum total hip arthroplasty (THA) (n = 10; 28%). Mean follow-up was nine years (SD 4). Results There was no difference in the mean age (p = 0.63), sex (p = 0.110), tumour volume (p = 0.646), or type of resection carried out (p > 0.05) between patients with and without reconstruction. Of the original 66 patients, 61 (92%) were ambulant at final follow-up. There was no difference in the proportion of patients who could walk in the reconstruction and 'no reconstruction' groups (p = 0.649). There was no difference in the mean Musculoskeletal Tumor Society (MSTS) score between patients who were reconstructed and those who were not (61% vs 56%; p = 0.378). Patients with a tantalum THA had a significantly (p = 0.015) higher mean MSTS score (78%) than those who were reconstructed with a saddle prosthesis (47%) or who had not been reconstructed (56%). Patients who had undergone reconstruction were more likely to have complications (81% vs 53%; p = 0.033). Conclusion Reconstruction after resection of the acetabulum is technically demanding. In selected cases, reconstruction is of benefit, especially when reconstruction is by tantalum THA; however, the follow-up for these patients remains mid-term. When not feasible, patients with no reconstruction have an acceptable functional outcome. Level of Evidence: Level III Therapeutic. Cite this article: Bone Joint J 2021;103-B(2):391–397.

10 Years Follow up of Chondroblastoma Treated with Intralesional Curettage: A Retrospective Study

2020 ◽  
Author(s):  
Lei Yang ◽  
Panyi Yang ◽  
Daoxi Wang ◽  
Xiaodong Yang ◽  
Lang Li ◽  
...  
Keyword(s):  
Bone Grafting ◽  
Case Series ◽  
Primary Treatment ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Intralesional Curettage ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
The Mean

Abstract Introduction: Chondroblastoma is a rare benign tumor mainly occurred in epiphyses and apophyses of long bones, and usually affects the young people. The primary treatment for chondroblastoma is intralesional curettage. The aim of this study was to evaluate the clinical and radiologic results of patients suffering chondroblastoma treated with intralesional curettage, electrocauterization of the cavity and bone grafting. Patients and Methods: From January 2000 to January 2010, 15 patients with chondroblastoma were treated with intralesional curettage and electrocauterization of the cavity, among which14 patients received bone grafting. After operation, patients were immobilized with splint for 4 weeks and followed up for at least 10 years. The recurrence was examined by clinical manifestation and X ray. The clinical outcome included complications and the Musculoskeletal Tumor Society Score (MSTS).Results: Totally, 15 patients with chondroblastoma were enrolled in our study, including 9 males and 6 females, with a mean age of 13 years old (range from 8 to 21 years). The most common chief compliant were pain and limited joint motion, others including local swelling and increased skin temperature. The mean duration of symptom was 5 months (range from 2-14 months). Tumors mostly affected the proximal humerus (7/15), distal femur (4/15), proximal femur (1/15), proximal tibia (2/15) and femoral head (1/15). Eight patients were undiagnosed or misdiagnosed before operation, only 7 patients with a consideration of chondroblastoma. With a mean follow up of 12years (range from 10-16 years) , two patients had complications of upper limb shortening and1 patient suffered re-operation due to tumor recurrence. The mean postoperative MSTS score was 28.1 (range, 24 to 30) points, which was significantly higher than the preoperative score of 17.6 (range, 12 to 21) points.Conclusion: Thorough curettage with electrocauterization and bone grafting has a good functional outcome in the treatment of chondroblastoma, but still has a low risk of recurrence and complications.Level of Evidence: Level IV, retrospective case series.

scholarly journals Reduction and Association of the Scaphoid and Lunate: A Functional and Radiographical Outcome Study

2018 ◽  
Vol 08 (01) ◽  
pp. 037-042
Author(s):  
William Aibinder ◽  
Ali Izadpanah ◽  
Bassem Elhassan
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
High Rate ◽  
Salvage Procedure ◽  
Level Of Evidence ◽  
Long Term Follow Up ◽  
The Mean ◽  
Ligament Disruption

Background Management of scapholunate (SL) ligament disruption is a challenging problem. The reduction and association of the scaphoid and lunate (RASL) procedure has been described with varying results. This study assessed the outcomes of the RASL procedure. Purpose The objective of this study was to assess the outcomes of patients undergoing the RASL procedure at our institution in regard to pain relief, range of motion, radiographic and functional outcomes, complications, and reoperations. Materials and Methods Twelve patients with symptomatic chronic SL instability underwent the RASL procedure. The mean age was 35 years. The mean time from injury to surgery was 40 weeks. The mean follow-up was 89 months. Outcomes included visual analog score for pain, wrist range of motion, grip strength, and Mayo Wrist Scores. Preoperative and postoperative radiographs were reviewed. Results Pain scores improved in 10 wrists. Range of motion and grip strength worsened. The average Mayo Wrist Score was 63.3. The mean SL diastasis and angle improved, but seven wrists developed progressive degenerative changes, with two requiring a salvage procedure. Symptomatic progressive screw lucency occurred in eight wrists requiring screw removal. Conclusion The RASL procedure can improve SL widening but has a high rate of early failure and reoperation. Following reoperation, long-term follow-up demonstrates reasonable long-term durability in some cases. Level of Evidence This is a Level IV, therapeutic case study.

Results of Arthroscopic Medial Retinacular Release for Treatment of Medial Subluxation of the Patella

2007 ◽  
Vol 35 (7) ◽  
pp. 1180-1187 ◽  
Author(s):  
Brian D. Shannon ◽  
James S. Keene
Keyword(s):  
Rating Scale ◽  
Case Series ◽  
High Rate ◽  
Lateral Release ◽  
Level Of Evidence ◽  
Patellar Subluxation ◽  
Subluxation Of The Patella ◽  
The Mean ◽  
Medial Release

Background Medial subluxation of the patella is a rare, disabling condition that has iatrogenic and traumatic causation. To date, only open reconstructions have been reported for operative treatment of this condition, but these procedures have a high rate of complications, revisions, and subsequent surgery. This is the first study to present the results of arthroscopic medial retinacular release for treatment of this problem. Hypothesis Arthroscopic release will alleviate painful medial patellar subluxation. Study Design Case series; Level of evidence, 4. Methods Nine knees (7 patients) with painful, recurrent medial subluxation of the patella that occurred spontaneously (2 knees) or after a lateral release (5 knees) or an injury (2 knees) were treated with an arthroscopic medial retinacular release. The retinaculum was released 2 cm medial to the superior pole of the patella down to the anteromedial portal. At a mean follow-up of 2.7 years (range, 1-8 years), all knees were evaluated, and the results were graded according to the Merchant and Mercer rating scale. Results The mean age of the patients was 25 years (range, 15-38 years), and the mean duration of the subluxations before surgery was 28 months (range, 6-48 months). In all 7 patients (9 knees), the medial release relieved their medial subluxation and knee pain, and there were 6 excellent and 3 good results. There were no complications or further realignment surgery needed after this procedure. Conclusion An arthroscopic medial retinacular release will successfully treat painful medial subluxation of the patella.

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

Long-Term Follow-up of Arthroscopic Treatment of Lateral Epicondylitis

2008 ◽  
Vol 36 (2) ◽  
pp. 254-260 ◽  
Author(s):  
Champ L. Baker ◽  
Champ L. Baker
Keyword(s):  
Case Series ◽  
Lateral Epicondylitis ◽  
Operative Management ◽  
High Rate ◽  
Functional Score ◽  
Level Of Evidence ◽  
Long Term Follow Up ◽  
The Mean

Background In a previously published report of the authors’ arthroscopic technique of operative management of recalcitrant lateral epicondylitis, they demonstrated short-term success with the procedure in their patients. Hypothesis Arthroscopic management of patients with lateral epicondylitis can produce clinical improvement and have successful long-term outcomes. Study Design Case series; Level of evidence, 4. Methods Forty patients (42 elbows) with lateral epicondylitis who had not responded to nonoperative management were treated with arthroscopic resection of pathologic tissue. Thirty of these patients (30 elbows) were located for extended follow-up. At a mean follow-up of 130 months (range, 106–173 months), patients were asked to use a numeric scale to rate their elbow pain from 0 (no pain) to 10 (severe pain). Patients were also asked to rate their elbows according to the functional portion of the Mayo Clinic Elbow Performance Index. Results The mean pain score at rest was 0; with activities of daily living, 1.0; and with work or sports, 1.9. The mean functional score was 11.7 out of a possible 12 points. No patient required further surgery or repeat injections after surgery. One patient continued to wear a counterforce brace with heavy activities. Twenty-three patients (77%) stated they were “much better,” 6 patients (20%) stated they were “better,” and 1 patient (3%) stated he was the same. Twenty-six patients (87%) were satisfied, and 28 patients (93%) stated they would have the surgery again if needed. Conclusion Arthroscopic removal of pathologic tendinosis tissue is a reliable treatment for recalcitrant lateral epicondylitis. The early high rate of success in patients was maintained at long-term follow-up.

scholarly journals Long-term follow-up of all-polyethylene tibial components when used for oncological endoprosthetic reconstruction

2020 ◽  
Vol 102-B (2) ◽  
pp. 170-176 ◽  
Author(s):  
Nicholas M. Bernthal ◽  
Zachary D. C. Burke ◽  
Vishal Hegde ◽  
Alexander Upfill-Brown ◽  
Clark J. Chen ◽  
...  
Keyword(s):  
Risk Factor ◽  
Tibial Component ◽  
Significant Risk ◽  
Mechanical Failure ◽  
Endoprosthetic Reconstruction ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Msts Score

Aims We aimed to examine the long-term mechanical survivorship, describe the modes of all-cause failure, and identify risk factors for mechanical failure of all-polyethylene tibial components in endoprosthetic reconstruction. Methods This is a retrospective database review of consecutive endoprosthetic reconstructions performed for oncological indications between 1980 and 2019. Patients with all-polyethylene tibial components were isolated and analyzed for revision for mechanical failure. Outcomes included survival of the all-polyethylene tibial component, revision surgery categorized according to the Henderson Failure Mode Classification, and complications and functional outcome, as assessed by the Musculoskeletal Tumor Society (MSTS) score at the final follow-up. Results A total of 278 patients were identified with 289 all-polyethylene tibial components. Mechanical survival was 98.4%, 91.1%, and 85.2% at five, ten and 15 years, respectively. A total of 15 mechanical failures were identified at the final follow-up. Of the 13 all-polyethylene tibial components used for revision of a previous tibial component, five (38.5%) failed mechanically. Younger patients (< 18 years vs > 18 years; p = 0.005) and those used as revision components (p < 0.001) had significantly increased rates of failure. Multivariate logistic regression modelling showed revision status to be a positive risk factor for failure (odds ratio (OR) 19.498, 95% confidence interval (CI) 4.598 to 82.676) and increasing age was a negative risk factor for failure (OR 0.927, 95% CI 0.872 to 0.987). Age-stratified risk analysis showed that age > 24 years was no longer a statistically significant risk factor for failure. The final mean MSTS score for all patients was 89% (8.5% to 100.0%). Conclusion The long-term mechanical survivorship of all-polyethylene tibial components when used for tumour endoprostheses was excellent. Tumour surgeons should consider using these components for their durability and the secondary benefits of reduced cost and ease of removal and revision. However, caution should be taken when using all-polyethylene tibial components in the revision setting as a significantly higher rate of mechanical failure was seen in this group of patients. Cite this article: Bone Joint J. 2020;102-B(2):170–176

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 Outcomes of Tumor Resection and Reconstruction by Megaprosthesis around Knee: Our Experience

2021 ◽  
Vol 11 (3) ◽  
Author(s):  
Bikram Kesari Kar ◽  
Mukund Madhav Ojha ◽  
Sandeep Kumar Yadav ◽  
Alok Chandra Agrawal ◽  
Harshal Sakale
Keyword(s):  
Local Recurrence ◽  
Limb Salvage ◽  
Lower Limbs ◽  
Implant Failure ◽  
Limb Salvage Surgery ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Prosthetic Reconstruction ◽  
Msts Score

Introduction: In this modern era, limb reconstructive surgeries have become a standardized procedure for malignant tumor of lower limbs. We performed limb salvage surgeries for tumor around the knee with en bloc resection and subsequent reconstruction with a megaprosthesis. Methods: A total of six cases of malignant and locally aggressive tumor around the knee were operated on from 2017 to 2018, with resection and mega prosthetic reconstruction. Interpretation of functional outcome after surgery was performed with musculoskeletal tumor society (MSTS) score. Complications such as infection, local recurrence of tumor, implant failure, and distant metastases were evaluated during each follow-up. Results: Postoperatively, one patient developed superficial infection; one local recurrence with metastasis and the rest cases were uneventful. Patients were regularly followed for atleast1 year, and none of them developed any sign of deep infection, implant failure,or loosening. At the beginning of treatment, the average MSTS score was 8.83, which showed a significant increment to 25.83 after 12 months of follow-up. Conclusion: Albeit few cases were operated on, we draw this inference from our short-term experience that mega prosthesis acts as a boon to orthopedic surgeons in musculoskeletal tumor management, thereby uplifting the quality of life of patients even during terminal care. Keywords: Limb salvage surgery, osteosarcoma, giant cell tumor, megaprosthesis.

Sauve-Kapandji Remains a Viable Option for Distal Radioulnar Joint Dysfunction

Hand ◽  
2020 ◽  
pp. 155894472096672
Author(s):  
Nicholas Munaretto ◽  
William Aibinder ◽  
Steven Moran ◽  
Marco Rizzo
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Distal Radioulnar Joint ◽  
High Rate ◽  
Wrist Flexion ◽  
Level Of Evidence ◽  
Radioulnar Joint ◽  
Major Complications ◽  
The Mean

Introduction Dysfunction of the distal radioulnar joint (DRUJ) can be significantly debilitating. The Sauve-Kapandji (S-K) procedure can be indicated to address multiple etiologies of DRUJ dysfunction. The purpose of this study was to review our institution’s results performing the S-K procedure for DRUJ dysfunction in terms of clinical and radiographic outcomes, as well as complications and reoperations. Methods A retrospective review of S-K procedures performed at 2 institutions between 1998 and 2017 with a minimum of 1-year follow-up was performed. Preoperative and postoperative visual analog scale (VAS) pain, grip strength, and wrist range of motion were reviewed. Radiographs were reviewed for DRUJ healing, carpal translation, and radiocarpal degenerative changes. Results The cohort included 35 patients. The mean age was 51 years. The mean follow-up was 49.5 months. The postoperative range of motion was unchanged in regard to pronation, supination, and wrist extension. There was a decrease in wrist flexion from 43 degrees to 34 degrees. Successful union was noted in 100% of the wrists. There was 1 case (2.8%) of progressive ulnar translation and 4 major complications (11.3%). Conclusion The S-K procedure has several theoretical benefits compared to other procedures for DRUJ dysfunction with results of this study demonstrating excellent pain relief, improved postoperative grip strength, retained wrist pronation, supination, and extension, high rate of successful arthrodesis and low rate of major complications. Level of Evidence Level IV

scholarly journals The Neoadjuvant Chemotherapy and Expandable Prosthesis Reconstruction to Treat Osteosarcoma Around the Knee in Child

2020 ◽  
Author(s):  
Jiajia Cheng ◽  
Junqi Huang ◽  
Wenzhi Bi ◽  
Gang Han ◽  
Jinpeng Jia ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Limb Salvage ◽  
Growth Period ◽  
Functional Results ◽  
Limb Salvage Surgery ◽  
High Survival ◽  
Level Of Evidence ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society

Abstract Background: To investigate: (1) what are the prognosis in patients treated with this chemotherapy scheme and limb salvage; (2) what are the clinical outcomes of expandable endoprosthesis reconstruction in child?Methods: From January 2009 to December 2014, we retropected 29 skeletally immature kids ( mean age, 10.5 years; range, 6-15 years) with osteosarcoma around knee. Of the 29 patients who underwent neoadjuvant chemotherapy and limb salvage surgery, this expandable prosthesis was implanted to reconstruct. These 29 patients were included in our retrospection. No patients were missed during follow-up. The evaluation index involved follow-up time, complication, functional results, lengthening procedures. The survivorship and recurrence were assessed by SPSS software. The function was assessed by Musculoskeletal Tumor Society (MSTS) scoring system.Results: A mean of follow-up time was 8.9 years (range, 6-12years). The overall 5-year survival was 89.1% based on Kaplan-Meier. Relapse suffered in three patients and one underwent amputation. Lung metastasis developed in one patient. At six months after operation, patients had a mean MSTS score of 27 points (range, 24-29). Two patients underwent revision surgery--one for implant infection and one for aseptic loosening.Conclusions: Chemotherapy scheme and limb salvage could achieved high survival rate. Use of this expandable prosthesis was associated with good function and low complication. The character of expandability could be a method to overcome discrepancy in the growth period.Level of Evidence Level IV, therapeutic study.

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