Clinical and Functional Outcomes using the Kyocera Modular Limb Salvage System for Lower Extremity Reconstruction

Abstract Background: Segmental metallic endoprostheses are widely used and important in reconstructive procedures of the lower limb. Most of the currently available endoprostheses are made in Europe or the United States of America and are too large for Asian knees. The Japanese Musculoskeletal Oncology Group developed a tumor prosthesis better suited for Asian skeletal anatomy, the Kyocera Modular Limb Salvage System (KLS).Methods: We performed a retrospective review of the records of patients who underwent reconstruction using KLS implants. Thirty-five patients fulfilled the inclusion criteria, 20 having undergone limb salvage surgery for tumor and 15, joint arthroplasty. Functional outcomes were evaluated using the revised Musculoskeletal rating scale for the tumor group and the Japanese Orthopedic Association Knee Score for the arthroplasty group. Complications and survivorship of the implants were also assessed.Results: At the latest follow-up, in the tumor group, 13 were alive with no evidence of recurrence, 6 died of disease, and 1 was alive with evidence of disease. The average MSTS scores on latest follow-up were 63 for the proximal femur, 67 for the distal femur, and 92 for the proximal tibia. The mean prosthesis survival was 28 months. Complications include 4 cases of aseptic loosening, 2 deep infections, 1 superficial infection, 1 valgus deformity, 2 periprosthetic fractures, 2 incidences of excessive polyethylene wear, and 2 local tumor recurrences. In the arthroplasty group, 1 patient had a persistent low grade infection on the latest follow-up. The post-operative JOA score was 61(mean). Complications included 3 cases of aseptic loosening, 2 deep infections, 2 implant failures, 1 superficial infection, 1 valgus deformity, and 1 soft tissue defect.Conclusion: Early results of the KLS implant system are encouraging, with comparable clinical outcomes to other systems in the literature. A longer follow-up study with increased numbers of patients is necessary to further validate the functional outcomes and prosthesis survival using the KLS system for limb salvage surgery.

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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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Functional Outcome in Sarcomas Treated With Limb-Salvage Surgery or Amputation

Sarcoma ◽

10.1080/13577149878118 ◽

1998 ◽

Vol 2 (1) ◽

pp. 19-23 ◽

Cited By ~ 20

Author(s):

Rikke Johansen ◽

Ole S. Nielsen ◽

Johnny Keller

Keyword(s):

Functional Outcome ◽

Limb Salvage ◽

Salvage Surgery ◽

Univariate Analysis ◽

Soft Tissue Sarcomas ◽

Post Treatment ◽

Limb Salvage Surgery ◽

Functional Evaluation ◽

Functional Scores

Purpose.In all patients treated at the Centre for Bone and Soft Tissue Sarcomas of Aarhus the functional outcome is prospectively evaluated by use of the Enneking system for the functional evaluation after surgical treatment of tumours of the musculoskeletal system. This system has been accepted by the Musculoskeletal Tumour Society and the International Symposium on Limb Salvage.Patients/methods.In the present study the functional outcome after limb-salvage surgery (89 patients) and amputation (58 patients) was compared. In the limb-salvage group the treatment was surgery alone in 50% and surgery combined with either radiotherapy in 39% or chemotherapy in 11%. Inclusion criteria were: Deep seated extremity sarcomas, age >14 years, more than 1 year post-treatment follow-up time and alive at the end of the study. Median age was 49 years (range 14–88 years). Median tumour diameter was 8 cm (range 1–20 cm), median follow-up time was 4.8 years (range 1–11 years). Wilcoxon andχ2-tests were used for statistical analyses.Results.The two groups were comparable according to age, sex, size of tumour, type of tumour, location of tumour, as well as post-treatment follow-up time. The functional scores were significantly higher after limb-salvage surgery as compared to amputation, the median scores being 85 and 47, respectively (p<0.001). A similar difference was observed if the Enneking scores were subdivided into general health-related scores and extremity-related scores. No association was found between functional scores and the following factors by use of univariate analysis: size of tumour, radiation therapy, localization of tumour and surgical margin.Discussion.We conclude that this study indicates that limb-salvage surgery is associated with a better functional outcome than that observed after amputation. However, whether this also indicates a difference in quality of life needs further studies.

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Does neo-adjuvant chemotherapy increase the risk of infection after limb salvage surgery for bone tumors?

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.20532 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 20532-20532

Author(s):

S. Sankaranarayanan ◽

V. Sokolovskiy ◽

V. Voloshin ◽

M. Aliev ◽

V. Zubikov ◽

...

Keyword(s):

Adjuvant Chemotherapy ◽

Limb Salvage ◽

Bone Tumors ◽

Salvage Surgery ◽

Limb Salvage Surgery ◽

Team Approach ◽

Group A ◽

Neo Adjuvant Chemotherapy ◽

Group B

20532 Background: Neo-adjuvant chemotherapy is commonly used to eradicate the micro metastases and to prepare the patient for limb-salvage surgery. It helps the surgeon to get good oncological margin intraoperatively. Methods: Between the period of 1992 - 2005, 321 patients underwent limb salvage surgery for bone tumors at the Department of General Oncology (Bone & Soft tissue tumors), N. N. Blokhin Russian Cancer Research Center & Moscow Regional Clinical Research Institute, Moscow, Russian Federation. 230/321 patients (Group A) received neo-adjuvant chemotherapy. The course of chemotherapy ranges from 2 to 11 cycles. 95/321 patients (Group B) did not receive neo-adjuvant chemotherapy. The histological diagnoses were: 155 - High grade osteosarcoma, 38 - Giant cell tumor, 36 - Malignant fibrous histiocytoma, 29 - Chondrosarcoma, 25 - Periosteal osteosarcoma, 21 - Metastasis from other organs and 17 - Ewing's tumor. Results: In Group A, 27 patients (11.7%) and in Group B, 7 (7.3%) had infection of endoprosthetic bed. Suppression of the immune system by chemotherapeutic agents is the main reason for the higher incidence of infection in Group A. All the 27 patients in Group A and 2 patients in Group B had revisional endoprosthetic replacement. In group A 7/27 and in Group B none of the 7 patients died of post operative infection. The follow-up ranged from 1 - 13 years (mean follow-up 6 years). Discussion: In our opinion, it has a major disadvantage, i.e. it increases the risk of postoperative infection. How best to combine this drug is still unknown. In the future, therapy for bone tumors should be enhanced by advances in pharmacology, immunology, and molecular genetics that will lead to more efficacious, specific and less toxic treatments. An interdisciplinary team approach is needed in order to advance the goal of local tumor control, limb salvage with optimum extremity function, minimal morbidity and improved long term survival. No significant financial relationships to disclose.

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Massive autoclaved allografts and autografts for limb salvage surgery A1-8 year follow-up of 23 patients

Acta Orthopaedica Scandinavica ◽

10.3109/17453679708996184 ◽

1997 ◽

Vol 68 (4) ◽

pp. 392-395 ◽

Cited By ~ 43

Author(s):

Naohiro Asada ◽

Hiroyuki Tsuchiya ◽

Katsuhiko Kitaoka ◽

Yoshihiko Mori ◽

Katsuro Tomita

Keyword(s):

Limb Salvage ◽

Salvage Surgery ◽

Limb Salvage Surgery

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Limb salvage surgery of primary and metastatic bone tumors of the lower extremity: Functional outcomes and survivorship of modular endoprosthetic reconstruction

Acta Orthopaedica et Traumatologica Turcica ◽

10.5152/j.aott.2021.20101 ◽

2021 ◽

Vol 55 (2) ◽

pp. 147-153

Author(s):

Osman Mert Topkar ◽

◽

Omer Sofulu ◽

Evrim Sirin ◽

Bulent Erol ◽

...

Keyword(s):

Lower Extremity ◽

Limb Salvage ◽

Functional Outcomes ◽

Bone Tumors ◽

Salvage Surgery ◽

Limb Salvage Surgery ◽

Endoprosthetic Reconstruction

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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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Psychosocial and functional outcomes in long-term survivors of osteosarcoma: A comparison of limb-salvage surgery and amputation

Pediatric Blood & Cancer ◽

10.1002/pbc.22419 ◽

2010 ◽

Vol 54 (7) ◽

pp. 990-999 ◽

Cited By ~ 54

Author(s):

Rhonda S. Robert ◽

Giulia Ottaviani ◽

Winston W. Huh ◽

Shana Palla ◽

Norman Jaffe

Keyword(s):

Limb Salvage ◽

Functional Outcomes ◽

Salvage Surgery ◽

Limb Salvage Surgery ◽

Long Term Survivors

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Surgical Technique and Outcome of Joint Sparing Limb Salvage Surgery by Three-dimensional-printed Prothesis for Children With Osteosarcoma in Distal Femur

10.21203/rs.3.rs-50585/v1 ◽

2020 ◽

Author(s):

Tao Cai ◽

Chunlin Zhang ◽

Lei Zhang ◽

Kunpeng Zhu ◽

Jianping Hu ◽

...

Keyword(s):

Surgical Technique ◽

Limb Salvage ◽

Distal Femur ◽

Salvage Surgery ◽

Three Dimensional ◽

Limb Length Discrepancy ◽

Limb Salvage Surgery ◽

3D Printed ◽

The Mean

Abstract Purpose The purpose of this study was to introduce the surgical technique and functional outcome of joint-sparing limb salvage surgery with metaphyseal osteotomy by dependent design of three-dimensional printed prothesis for children with osteosarcoma in distal femur.Methods Between 2012 to 2019, we performed twelve joint sparing limb salvage surgeries (JSLSS) with metaphyseal osteotomy for the children of osteosarcoma in the distal femur with our dependent design of 3D-printed guided plate and prothesis. The clinical assessment including resection margin, limb-length discrepancy, orthopaedic complications and functional outcome would be analyzed.Results The mean operation time for JSLSS was 107.6 minutes and the average blood loss was 194.5ml with the dependent design of 3D-printed prosthesis. With the assistance of guide plate, the mean margin of the osteosarcoma from the epiphyseal plate was 1.6 cm and the mean limb-length discrepancy was 2.2 cm with maximum follow-up period of seven years (mean 45.3 months, range 12-84 months). All the patients could bend their knee through >90° flexion, achieved similar results for ROMs in 6DOF during gait compared with normal data of Chinese knees, and the mean MSTS score was 94.7 for the patients with JSLSS. One patient had a superficial infection and there was one patient of local recurrence happened during the follow-up with the necrosis rate less than 90% by preoperative chemotherapy. None aseptic loosening happened in distal femur for the patients in this group with dependent design of 3D-printed prosthesis.Conclusion Joint-sparing limb salvage surgery by metaphyseal osteotomy with the dependent design of 3D-printed prosthesis and guide plate would be a good choice for the children with osteosarcoma in distal femur.

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