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

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.

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

10.21203/rs.3.rs-120042/v1 ◽

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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Cryoablation-aided joint retention surgery for epiphysis involvement in osteosarcoma compared with endoprosthetic replacement

The Bone & Joint Journal ◽

10.1302/0301-620x.103b8.bjj-2020-2528.r2 ◽

2021 ◽

Vol 103-B (8) ◽

pp. 1421-1427

Author(s):

Jing Li ◽

Yajie Lu ◽

Guojing Chen ◽

Minghui Li ◽

Xin Xiao ◽

...

Keyword(s):

Limb Salvage ◽

Salvage Surgery ◽

Joint Arthroplasty ◽

Limb Salvage Surgery ◽

Musculoskeletal Tumor ◽

Musculoskeletal Tumor Society ◽

Clinical Evaluations ◽

Joint Preservation ◽

Msts Score ◽

One Year

Aims We have previously reported cryoablation-assisted joint-sparing surgery for osteosarcoma with epiphyseal involvement. However, it is not clear whether this is a comparable alternative to conventional joint arthroplasty in terms of oncological and functional outcomes. Methods A total of 22 patients who had localized osteosarcoma with epiphyseal involvement around the knee and underwent limb salvage surgery were allocated to joint preservation (JP) group and joint arthroplasty (JA) group. Subjects were followed with radiographs, Musculoskeletal Tumor Society (MSTS) score, and clinical evaluations at one, three, and five years postoperatively. Results Patients in both groups (ten in JP and 12 in JA) did not differ in local recurrence (p ≥ 0.999) and occurrence of metastases (p ≥ 0.999). Overall survival was similar in both groups (p = 0.858). Patients in the JP group had less range of motion (ROM) of the knee (p < 0.001) and lower MSTS scores (p = 0.010) compared with those of the JA group only at one year postoperatively. There was no difference between groups either at three years for ROM (p = 0.185) and MSTS score (p = 0.678) or at five years for ROM (p = 0.687) and MSTS score (p = 0.536), postoperatively. Patients in the JA group tended to have more complications (p = 0.074). Survival of primary reconstruction in the JP group was better than that of the JA group (p = 0.030). Conclusion Cryoablation-aided joint-sparing surgery offers native joint preservation with comparable functional recovery and more durable reconstruction without jeopardizing oncological outcomes compared with conventional limb salvage surgery. Cite this article: Bone Joint J 2021;103-B(8):1421–1427.

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

Metals ◽

10.3390/met11050707 ◽

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.

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Endoprosthetic Reconstruction in Limb Salvage for Malignant Bone Tumours in Children

Journal of Orthopedics and Orthopedic Surgery ◽

10.29245/2767-5130/2021/2.1135 ◽

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.

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Treatment-Related Prognostic Factors in Managing Osteosarcoma around the Knee with Limb Salvage Surgery: A Lesson from a Long-Term Follow-Up Study

BioMed Research International ◽

10.1155/2019/3215824 ◽

2019 ◽

Vol 2019 ◽

pp. 1-13 ◽

Cited By ~ 2

Author(s):

Jianping Hu ◽

Chunlin Zhang ◽

Kunpeng Zhu ◽

Lei Zhang ◽

Tao Cai ◽

...

Keyword(s):

Overall Survival ◽

Prognostic Factors ◽

Local Recurrence ◽

Limb Salvage ◽

Salvage Surgery ◽

Survival Rates ◽

Tumor Resection ◽

Limb Salvage Surgery ◽

Related Factors

Purpose. The aim of this study was to assess the treatment-related factors associated with local recurrence and overall survival of patients with osteosarcoma treated with limb-salvage surgery. Patients and Methods. Treatment-related factors were analyzed to evaluate their effects on local recurrence-free survival (LRFS) and overall survival (OS) in 182 patients from 2004 to 2013. Results. The mean length of follow-up was 73.4 ± 34.7 months (median, 68 months; range, 12-173 months), and 63 patients died by the end of the follow-up. The 5-year and 10-year overall survival rates were 68.6 ± 6.6% and 59.4 ± 10.6%, respectively. Univariate analysis showed that treatment-related prognostic factors for overall survival were prolonged symptom intervals >=60 days, biopsy/tumor resection performed by different centers, previous medical history, incomplete preoperative chemotherapy (<8 weeks), and prolonged postoperative interval >21 days. In the multivariate analysis, biopsy/tumor resection performed by different centers, incomplete implementation of planned new adjuvant chemotherapy, and delayed resumption of postoperative chemotherapy (>21 days) were risk factors for poor prognosis; biopsy/tumor resection performed by different centers and tumor necrosis <90% were independent predictors of local recurrence. Conclusion. For localized osteosarcoma treated with limb-salvage surgery, it is necessary to optimize timely standard chemotherapy and to resume postoperative chemotherapy to improve survival rates. Biopsies should be performed at experienced institutions in cases of developing local recurrence.

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Surgical Treatment of Malignant Tumors of the Calcaneus

Journal of the American Podiatric Medical Association ◽

10.7547/0003-0538-104.1.71 ◽

2014 ◽

Vol 104 (1) ◽

pp. 71-76 ◽

Cited By ~ 6

Author(s):

Jing Li ◽

Zheng Wang

Keyword(s):

Limb Salvage ◽

Malignant Tumors ◽

Treatment Modalities ◽

Wide Resection ◽

Resection Margins ◽

Tumor Control ◽

Limb Salvage Surgery ◽

Salvage Procedure ◽

Musculoskeletal Tumor ◽

Musculoskeletal Tumor Society

Background Amputation has been most commonly considered the only option to achieve local tumor control for calcaneal malignancies. Advances in oncologic treatment modalities and wide resection have made limb salvage increasingly possible. We retrospectively reviewed nine patients with calcaneal malignancies treated with different surgical options. Methods The diagnoses included chondrosarcoma in three patients, Ewing's sarcoma in three, osteosarcoma in two, and small round cell sarcoma in one. Four patients were managed by below-the-knee amputation owing to neurovascular invasion. Five patients were managed by limb salvage procedures. Pedicled osteomyocutaneous fibular grafts were used to reconstruct the defects created after total calcanectomy in limb salvage procedures. Clinical and radiographic evaluations were performed, and functional outcomes were assessed using the Musculoskeletal Tumor Society score. Results The patients were followed up for a mean of 42.3 months. Wide resection margins were achieved in all of the patients with limb salvage surgery. At the final follow-up, two patients had died of disease. Lung metastasis was found in two patients who were alive with disease. Five patients had no evidence of disease. No local recurrence occurred in this series. All of the fibular flaps survived, and fibula hypertrophies were observed in three patients. Average Musculoskeletal Tumor Society scores were 74.6% and 83.2% in patients with amputation and limb salvage, respectively. Conclusions After wide resection of a calcaneal malignancy, biological reconstruction using pedicled osteocutaneous fibular flaps has proved to be a successful limb salvage procedure, offering a satisfactory oncologic and functional outcome alternative to amputation in selected patients.

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

The Bone & Joint Journal ◽

10.1302/0301-620x.102b2.bjj-2019-0535.r1 ◽

2020 ◽

Vol 102-B (2) ◽

pp. 170-176 ◽

Cited By ~ 1

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

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Functional Outcomes of Limb Salvage Surgery in Patients with Giant Cell Tumor of Bone of the Lower Extremities: A Retrospective Study

Journal of Oncology Research ◽

10.30564/jor.v3i2.3669 ◽

2021 ◽

Vol 3 (2) ◽

Author(s):

Daniela Kristina D. Carolino ◽

Edwin Joseph R. Guerzon ◽

Richard S. Rotor

Keyword(s):

Giant Cell Tumor ◽

Giant Cell ◽

Limb Salvage ◽

Functional Outcomes ◽

Salvage Surgery ◽

Lower Extremities ◽

Cell Tumor ◽

Limb Salvage Surgery ◽

Msts Score

Giant cell tumor of the bone (GCTB) is a benign, locally aggressive neoplasm that is relatively rare, with a propensity to result in progressive bone destruction, and is associated with a high risk of recurrence. There is no widely held consensus regarding its ideal treatment. Worldwide, there are varying techniques ranging from intralesional curettage to resection of the lesion, supplemented with combinations of numerous adjuncts and fillers, depending on the resected amount and integrity of bone, as well as the preference of the surgeon. This was a cross-sectional study that included 20 patients who underwent limb salvage surgery for giant cell tumor of the bone of the lower extremities from January 2009 to February 2020 at two tertiary hospitals. The mean follow-up period was 37.3 months (SD=2.84). The extended curettage (EC) group had a mean Musculoskeletal Tumor Rating Scale (MSTS) score of 28.18 (SD=7.51) which is considered as an excellent outcome, while the resection (RS) group had an mean MSTS score of 19.67 (SD=11.02), which is considered as a good outcome. EC resulted to a total of eight complications (47%), while RS had one complication (33%). Prevalence of recurrence was noted to be 11.75% among those who underwent EC, while no recurrence was noted among those in the RS group. Use of bone cement as a filler was noted to have less recurrence as compared with the use of bone grafts, however were both were noted to result in excellent functional outcomes. Despite the prevalence of complications and recurrence of GCTB of the salvaged extremity in those who underwent EC, there is still report of excellent functionality. It is hence important to disclose all these possible outcomes and to stress the importance of compliance to follow-up for monitoring of these events.

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Hemicortical Resection and Biological Reconstruction using Allograft for Parosteal Osteosarcoma of the Distal Femur. A Case Series

10.21203/rs.3.rs-1119930/v1 ◽

2021 ◽

Author(s):

Olga D Savvidou ◽

Stavros Goumenos ◽

Ioannis Trikoupis ◽

Angelos Kaspiris ◽

Dimitra Melissaridou ◽

...

Keyword(s):

Local Recurrence ◽

Functional Outcomes ◽

Distal Femur ◽

Parosteal Osteosarcoma ◽

Complication Rates ◽

Posterior Surface ◽

Musculoskeletal Tumor Society ◽

Biological Reconstruction ◽

Msts Score

Abstract Background: Parosteal osteosarcoma (PAO), which is a surface osteosarcoma, can be treated with wide excision and endoprosthetic or allograft application. However, due to the low local recurrence and metastasis rate, when it appears in the posterior surface of the distal femur, can be managed with hemicortical wide resection and biological reconstruction with hemicortical allograft.The purpose of this study was to evaluate the oncological and functional outcomes of patients with parosteal osteosarcoma (PAO) of the posterior cortex of the distal femur who underwent biological reconstruction after hemicortical resection. Methods: Eleven patients who underwent wide tumor resection and defect reconstruction of the posterior surface of the distal femur using hemicortical allograft were studied retrospectively. Local recurrence, metastasis, complications and the functional outcome using the Musculoskeletal Tumor Society scoring system (MSTS Score) were evaluated.Results: The average postoperative follow-up period was 53.64 months (range, 30 to 84 months). At the latest follow up, all patients were free of the disease without appearing any metastases. A patient with local recurrence underwent revision surgery with fibula autograft reconstruction. The mean MSTS score was 93.45 ± 3.56. Conclusions: In patients with PAO of the posterior aspect of the distal femur the treatment of hemicortical resection and allograft reconstruction has satisfactory oncological and functional outcomes and low complication rates.

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