scholarly journals Temporal Hemiarthroplasty for Distal Femoral Osteosarcoma in Early Childhood: A Case Report

2020 ◽  
Author(s):  
Jungo Imanishi ◽  
Masayuki Tanabe ◽  
Taisei Kurihara ◽  
Tomoaki Torigoe ◽  
Jun Kikkawa ◽  
...  
Keyword(s):  
Case Report ◽  
Limb Salvage ◽  
Salvage Surgery ◽  
Limb Length ◽  
Limb Salvage Surgery ◽  
Induced Membrane ◽  
Prosthetic Reconstruction ◽  
Custom Made ◽  
Distal Femoral Resection ◽  
Femoral Resection

Abstract Background: Prosthetic reconstruction for distal femoral osteosarcoma is challenging for younger children. We herein report a successful case of limb-sparing surgery for a younger patient with distal femoral osteosarcoma requiring osteo-articular resection. Case Presentation: A 5-year-old girl with high-grade conventional osteosarcoma in the left distal femurunderwent a series of surgeries. After three cycles of neoadjuvant chemotherapy, limb salvage surgery was planned because femoral rotationplasty had been refused. At 6 years and 2 months old, distal femoral resection and temporary spacer insertion using a 7-mm-diameter intramedullary nail and molded polymethylmethacrylate was performed. At 7 years and 8 months old, secondary surgery was performed because the first spacer had been dislocated and the residual femur became atrophic. The distal end of the residual femur was removed by 1 cm, but the periosteum and induced membrane around polymethylmethacrylate was preserved. In order to stabilize the spacer against the tibia, a custom-made ceramic spacer with a smooth straight 8-mm-diameter stem was utilized. The bone-spacer junction was fixed with polymethylmethacrylate, and then covered with the preserved periosteum and induced membrane. After surgery, the bone atrophy improved. At 9 years and 7 months old, the second spacer was removed because it had loosened, and the knee joint was reconstructed using a custom-made growing femoral prosthesis with a curved porous 8.5-mm-diameter stem. Cancellous bone tips from the proximal tibia were grafted around the bone-prosthesis junction underneath the induced membrane. At 10 years and 5 months old, the patient was able to walk unsupported and a radiograph showed further thickening of the cortex of the residual femur without any stress shielding. Although having 5 cm of limb length discrepancy, the patient and her mother were satisfied with the function. The MSTS score was 24 out of 30 points. Repeated limb length extensions are planned.Conclusions: This case report provides an example of limb salvage surgery after distal femoral resection in a small child. The use of a temporary spacer utilizing partial cementation and preservation of the periosteum and induced membrane appears to afford a viable limb-salvage option after distal femoral resection for younger children.

scholarly journals Temporal hemiarthroplasty for distal femoral osteosarcoma in early childhood: a case report

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Jungo Imanishi ◽  
Masayuki Tanabe ◽  
Taisei Kurihara ◽  
Tomoaki Torigoe ◽  
Jun Kikkawa ◽  
...  
Keyword(s):  
Case Report ◽  
Limb Salvage ◽  
Salvage Surgery ◽  
Limb Length ◽  
Limb Salvage Surgery ◽  
Induced Membrane ◽  
Prosthetic Reconstruction ◽  
Custom Made ◽  
Distal Femoral Resection ◽  
Femoral Resection

Abstract Background Prosthetic reconstruction for distal femoral osteosarcoma is challenging for younger children. We herein report a successful case of limb-sparing surgery for a younger patient with distal femoral osteosarcoma requiring osteo-articular resection. Case presentation A 5-year-old girl with high-grade conventional osteosarcoma in the left distal femur underwent a series of surgeries. After three cycles of neoadjuvant chemotherapy, limb-salvage surgery was planned because femoral rotationplasty had been refused. At 6 years and 2 months old, distal femoral resection and temporary spacer insertion using a 7-mm-diameter intramedullary nail and molded polymethylmethacrylate was performed. At 7 years and 8 months old, secondary surgery was performed because the first spacer had been dislocated and the residual femur became atrophic. The distal end of the residual femur was removed by 1 cm, but the periosteum and induced membrane around polymethylmethacrylate was preserved. In order to stabilize the spacer against the tibia, a custom-made ceramic spacer with a smooth straight 8-mm-diameter stem was utilized. The bone-spacer junction was fixed with polymethylmethacrylate and then covered with the preserved periosteum and induced membrane. After surgery, the bone atrophy improved. At 9 years and 7 months old, the second spacer was removed because it had loosened, and the knee joint was reconstructed using a custom-made growing femoral prosthesis with a curved porous 8.5-mm-diameter stem. Cancellous bone tips from the proximal tibia were grafted around the bone-prosthesis junction underneath the induced membrane. At 10 years and 5 months old, the patient was able to walk unsupported and a radiograph showed further thickening of the cortex of the residual femur without any stress shielding. Although having 5 cm of limb length discrepancy, the patient and her mother were satisfied with the function. The MSTS score was 24 out of 30 points. Repeated limb length extensions are planned. Conclusions This case report provides an example of limb-salvage surgery after distal femoral resection in a small child. The use of a temporary spacer utilizing partial cementation and preservation of the periosteum and induced membrane appears to afford a viable limb-salvage option after distal femoral resection for younger children.

scholarly journals Temporal hemiarthroplasty for distal femoral osteosarcoma in early childhood: A case report

2020 ◽  
Author(s):  
Jungo Imanishi ◽  
Masayuki Tanabe ◽  
Taisei Kurihara ◽  
Tomoaki Torigoe ◽  
Jun Kikkawa ◽  
...  
Keyword(s):  
Case Report ◽  
Limb Salvage ◽  
Salvage Surgery ◽  
Limb Length ◽  
Limb Salvage Surgery ◽  
Induced Membrane ◽  
Prosthetic Reconstruction ◽  
Custom Made ◽  
Distal Femoral Resection ◽  
Femoral Resection

Abstract Background: Prosthetic reconstruction for distal femoral osteosarcoma is challenging for younger children. We herein report a successful case of limb-sparing surgery for a younger patient with distal femoral osteosarcoma requiring osteo-articular resection.Case Presentation: A 5-year-old girl with high-grade conventional osteosarcoma in the left distal femur underwent a series of surgeries. After three cycles of neoadjuvant chemotherapy, limb salvage surgery was planned because femoral rotationplasty had been refused. At 6 years and 2 months old, distal femoral resection and temporary spacer insertion using a 7-mm-diameter intramedullary nail and molded polymethylmethacrylate was performed. At 7 years and 8 months old, secondary surgery was performed because the first spacer had been dislocated and the residual femur became atrophic. The distal end of the residual femur was removed by 1 cm, but the periosteum and induced membrane around polymethylmethacrylate was preserved. In order to stabilize the spacer against the tibia, a custom-made ceramic spacer with a smooth straight 8-mm-diameter stem was utilized. The bone-spacer junction was fixed with polymethylmethacrylate, and then covered with the preserved periosteum and induced membrane. After surgery, the bone atrophy improved. At 9 years and 7 months old, the second spacer was removed because it had loosened, and the knee joint was reconstructed using a custom-made growing femoral prosthesis with a curved porous 8.5-mm-diameter stem. Cancellous bone tips from the proximal tibia were grafted around the bone-prosthesis junction underneath the induced membrane. At 10 years and 5 months old, the patient was able to walk unsupported and a radiograph showed further thickening of the cortex of the residual femur without any stress shielding. Although having 5 cm of limb length discrepancy, the patient and her mother were satisfied with the function. The MSTS score was 24 out of 30 points. Repeated limb length extensions are planned.Conclusions: This case report provides an example of limb salvage surgery after distal femoral resection in a small child. The use of a temporary spacer utilizing partial cementation and preservation of the periosteum and induced membrane appears to afford a viable limb-salvage option after distal femoral resection for younger children.

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

Metals ◽  
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.

Malawer limb salvage surgery for large chondrosarcoma of scapula with functional outcome – A case report

2020 ◽  
Vol 4 (2) ◽  
pp. 76
Author(s):  
Supratim Bhattacharyya ◽  
KP Kunhi Mohammed ◽  
PrafullaKumar Das ◽  
BharatBhusan Satpathy
Keyword(s):  
Case Report ◽  
Functional Outcome ◽  
Limb Salvage ◽  
Salvage Surgery ◽  
Limb Salvage Surgery

scholarly journals THE APPLICATION OF EXPANDABLE ENDOPROSTHETIC RECONSTRUCTION FOR LIMB SALVAGE SURGERY IN THE SKELETALLY IMMATURE PATIENTS

2001 ◽  
Vol 13 (03) ◽  
pp. 141-147 ◽  
Author(s):  
RONG-SEN YANG
Keyword(s):  
Limb Salvage ◽  
Salvage Surgery ◽  
Limb Length Discrepancy ◽  
Limb Length ◽  
Limb Salvage Surgery ◽  
Skeletally Immature ◽  
Endoprosthetic Reconstruction ◽  
Term Survival ◽  
Length Discrepancy ◽  
Primary Bone

The development of new image techniques enables the early detection of bone tumors in the extremities in the past two decades. In addition, new advance of adjuvant therapy improves the long-term survival of patients with primary bone malignancies. Since the primary bone malignancy frequently occurs at the metaphysis of long bones of pediatric patients in the first and second decade, many patients have to face the late problems of limb length discrepancy after the limb salvage operation. Since the inevitable limb length discrepancy will interfere the functional outcomes and cosmetic appearance, the reconstruction of limb defect after limb salvage remains a challenge. Several options of reconstruction are available for these patients, including resection arthrodesis, rotationplasty, osteochondral allograft reconstruction, and endoprosthetic reconstruction. All these methods are difficult to address the limb length discrepancy. The development of expandable endoprosthetic reconstruction makes limb-salvage surgery feasible in the skeletally immature and provides another choice of solution. This article presents the current status of custom-expandable endoprosthetic reconstruction in the skeletally immature patients after wide resection of primary bone malignancies in the extremity. The surgical options, complications and functional results will be emphasized. Basically these expandable endoprostheses can be classified according to the expansion design. Recent reports demonstrated that the results of expandable prosthesis in the growing children are rather acceptable. Some patients can regain the equal limb length after expansion of the prosthesis. However these patients have to take several expansion procedures for the equality of limb length during the growing period. A rather high complication rate of either endoprosthesis-related or disease-associated still needs to be settled in the near future. These include mechanical failure of the expansion mechanism, extensive metallosis, aseptic loosening, fatigue fracture, flexion contracture, local recurrence, delayed wound healing, fat embolism, local overgrowth of counterpart bone, nerve palsy, infection, and bone fracture. Some patients even require an amputation even after expandable endoprosthesis reconstruction because of difficult reconstruction or severe functional impairment. However, with regard to difficult rehabilitation for patients under 8 years, amputation or alternative options need to be considered. A comprehensive discussion with the parents and patient about the detailed treatment protocol is needed before performing reconstruction using expandable endoprosthesis.

scholarly journals Surgical Technique and Outcome of Custom Joint-Sparing Endoprosthesis as a Reconstructive Modality in Juxta-Articular Bone Sarcoma

2019 ◽  
Vol 2019 ◽  
pp. 1-13
Author(s):  
Ahmad M. Shehadeh ◽  
Ula Isleem ◽  
Samer Abdelal ◽  
Hamza Salameh ◽  
Muthana Abdelhalim
Keyword(s):  
Soft Tissue ◽  
Limb Salvage ◽  
Salvage Surgery ◽  
Limb Salvage Surgery ◽  
Complication Rates ◽  
Bone Resection ◽  
Biological Reconstruction ◽  
Custom Made ◽  
Bone Segment ◽  
Modular Implant

Background. Joint-sparing limb salvage surgery (JSLSS) is an advancement in the techniques and concepts of limb salvage surgery, which makes it possible to save not only the limb affected by malignancy but also the adjacent joint and the epiphyseal plate. In the growing child, this procedure is technically demanding due to the availability of small length of bone for implant purchase. Reconstruction options can be biological reconstruction or endoprosthesis; however, the outcome of endoprosthetic reconstruction after joint-sparing resection is not well described in the literature. Purposes. (1) To determine the prosthesis survival rates when using customized Joint-Sparing Endoprosthesis (JSE) after juxta-articular resection of bone tumors, (2) to investigate the rates of local recurrence, (3) to evaluate the need for revision surgery, and (4) to compare the outcome of customized JSE with that of joint-sacrificing techniques. Methods. In our study, joint sparing is defined as any procedure where a custom-made JSE is used in lieu of sacrificing the adjacent joint whenever the length of the remaining bone segment is not enough to accommodate the stem of a modular implant. Twenty-eight patients received JSE, and 31 joints were spared. Their age ranged from 4 to 55 years with a median age of 13 years. Twenty-one patients received surgery for primary reconstruction and 7 patients for revision of failed bone allograft or modular implant. Twenty-four joints are spared in the lower limbs and 7 in the upper limbs. Osteosarcoma was the most common pathological diagnosis (n = 13). Flat surface HA-coated custom JSE was used to spare 15 joints, and short-stemmed custom JSE was used to spare 16 joints. The length of the remaining bone epiphysis for JSE anchorage from the knee and ankle joints was 25–75 mm, median = 45 mm, and the length of the cortical bone remaining for the proximal femur and distal humerus was 5–70 mm, median = 10 mm. Results. Operative time was 2.5 to 4 hours (avg. 3 hr.) The bone resection surface fitted the prosthesis surface with <2 mm difference. Histological examination of all resected specimens shows clear bone resection margins; 2 patients had positive soft tissue margins. At mean follow-up period of 3 years (6 months–10 years), 6 patients developed local and systemic recurrences, three of them had a pathological fracture at the time of diagnosis (P=0.139), and 4 showed a poor response to chemotherapy (P=0.014); all recurrences occurred in the soft tissue. Implant survival at 5 years was 86.15%, and MSTS score was 90% (83–96%). Conclusions. Whenever this kind of implant is affordable and can be utilized, particularly in younger age groups, JSE may be a good reconstruction option to avoid the use of expandable implants and to avoid the potentially higher revision and complication rates associated with biological reconstruction, as well as the complications of conventional joint-sacrificing implant, mainly dislocations and polyethylene wear and tear.

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