Patient-Specific Implants for Pelvic Tumor Resections

Introduction Limb salvage surgery for periacetabular malignancies is technically demanding and associated with a considerable likelihood of postoperative complications and surgical revision. Reconstruction using custom-made implants represents the treatment of choice. This study was conducted to analyze treatment outcomes of custom-made implants in a single orthopaedic tumor center. Patients and Methods Twenty patients with a histologically verified periacetabular malignancy and a median follow up time of 5 (1–17) years were included. Results The median number of revision surgeries per patient was 1.5 (0–7). Complications were dislocations in 3 patients, aseptic loosening in 4 patients, deep infections in 9 patients, thromboembolic events in 5 patients and sciatic nerve lesions in 4 patients. Overall survival was 77% after one year, 69% after two years and 46% after five years. Median Harris Hip Score was 81 (37–92) points at last follow up. Conclusion Although internal hemipelvectomy and reconstruction using custom-made implants is linked with a high risk of postoperative complications, good functional outcomes can be regularly achieved. This information may help treating surgeons to find adequate indications, as eligible patients need to be critically selected and integrated into the decision-making process.

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The Dislocating Hip Replacement – Revision with a Dual Mobility Cup in 56 Consecutive Patients

The Open Orthopaedics Journal ◽

10.2174/1874325001408010268 ◽

2014 ◽

Vol 8 (1) ◽

pp. 268-271 ◽

Cited By ~ 21

Author(s):

Thomas Jakobsen ◽

Andreas Kappel ◽

Flemming Hansen ◽

Niels Krarup

Keyword(s):

Median Number ◽

Harris Hip Score ◽

Consecutive Series ◽

Dual Mobility Cup ◽

Dual Mobility ◽

Hip Replacements ◽

The Mean ◽

Difficult Challenge ◽

One Year

Introduction: Recurrent dislocations of hip replacements are a difficult challenge. One treatment option for recurrent dislocations is the use of a dual mobility cup. The aim of this study was to retrospective investigate the effect of dual mobility cups as a treatment for recurrent dislocations in a consecutive series. Materials and Methods: 56 consecutive patients were revised in the period November 2000 to December 2010. The mean age at revision was 72 years (SD 11, range 37-92)) and median number of dislocations before revision surgery were 4 (IQR, 2-11). In all cases, revision was made with a Saturne dual mobility cup (Amplitude, Neyron, France). The mean follow-up period was 44 months (SD 30, range 0.1-119). Results: One patient (1.8%) experienced a re-dislocation. Three patients (5.3%) had to be revised. One due to disintegration between the femoral head and inner shell, one due to loosening of the acetabular component, and one due to infection. Harris Hip Score improved from a mean of 76 before index surgery to 87 within one year after index surgery. Conclusion: This study advocates the use of a dual mobility cup for treatment of recurrent dislocations of THR. However, studies with a longer follow up are needed in order to evaluate implant survival.

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Brain Tumor Resection in Elderly Patients: Potential Factors of Postoperative Worsening in a Predictive Outcome Model

Cancers ◽

10.3390/cancers13102320 ◽

2021 ◽

Vol 13 (10) ◽

pp. 2320

Author(s):

Paolo Ferroli ◽

Ignazio Gaspare Vetrano ◽

Silvia Schiavolin ◽

Francesco Acerbi ◽

Costanza Maria Zattra ◽

...

Keyword(s):

Brain Tumor ◽

Postoperative Complications ◽

Elderly Patients ◽

Performance Status ◽

Tumor Resection ◽

Patient Specific ◽

Invasive Treatment ◽

Tertiary Referral Center ◽

Surgical Complexity

The decision of whether to operate on elderly patients with brain tumors is complex, and influenced by pathology-related and patient-specific factors. This retrospective cohort study, based on a prospectively collected surgical database, aims at identifying possible factors predicting clinical worsening after elective neuro-oncological surgery in elderly patients. Therefore, all patients ≥65 years old who underwent BT resection at a tertiary referral center between 01/2018 and 12/2019 were included. Age, smoking, previous radiotherapy, hypertension, preoperative functional status, complications occurrence, surgical complexity and the presence of comorbidities were prospectively collected and analyzed at discharge and the 3-month follow-up. The series included 143 patients (mean 71 years, range 65–86). Sixty-five patients (46%) had at least one neurosurgical complication, whereas 48/65 (74%) complications did not require invasive treatment. Forty-two patients (29.4%) worsened at discharge; these patients had a greater number of complications compared to patients with unchanged/improved performance status. A persistent worsening at three months of follow-up was noted in 20.3% of patients; again, this subgroup presented more complications than patients who remained equal or improved. Therefore, postoperative complications and surgical complexity seem to influence significantly the early outcome in elderly patients undergoing brain tumor surgery. In contrast, postoperative complications alone are the only factor with an impact on the 3-month 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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Risk Forecast of In-Stent Restenosis by CFD Method

Applied Mechanics and Materials ◽

10.4028/www.scientific.net/amm.553.235 ◽

2014 ◽

Vol 553 ◽

pp. 235-239

Author(s):

Chang Yan Lin ◽

Xiu Jian Liu ◽

Yu Yang Liu ◽

Chuang Ye Xu ◽

Guang Hui Wu

Keyword(s):

Arterial Wall ◽

Patient Specific ◽

Stent Restenosis ◽

Stent Treatment ◽

Bifurcation Lesions ◽

Risk Forecast ◽

One Year ◽

Cfd Method ◽

In Stent Restenosis

The treatment of plaques near and involving coronary bifurcations (CB) is especially challenging, considering more plaques localized these regions and higher post-interventional in-stent restenosis (ISR) risk, mainly due to hemodynamic injury provoked on the arterial wall. Therefore optimization of stenting should begin with an understanding of how disease localized to these regions and why ISR formed associated with flow patterns. We chose four patients with bifurcation lesions, two patients with ISR and two without ISR according to the follow-up computed tomography angiography (CTA). Based on patient-specific pre-interventional and virtual stented geometries from CTA images, numerical simulation indicated that the wall shear stress (WSS) in stented segments, where the ISR occurred in one year, was lower than those without ISR, however. For bifurcation lesion, the stenting segments WSS is supposed a marker to forecast the ISR risk after stent treatment.

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What are the Risk Factors for Worse Outcomes of Meniscus Surgery in 23-39-Year-Old Patients Ligamentously Stable Knees?

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00468 ◽

2020 ◽

Vol 8 (7_suppl6) ◽

pp. 2325967120S0046

Author(s):

◽

Megan Flynn ◽

Anthony Egger ◽

Yuxuan Jin ◽

Elizabeth Sosic ◽

...

Keyword(s):

Risk Factors ◽

Young Adult ◽

Patient Reported Outcomes ◽

Meniscal Repair ◽

Patient Specific ◽

Lower Baseline ◽

Patient Reported ◽

Grade 3 ◽

One Year

Objectives: Meniscus tears are a common and significant source of knee dysfunction in active young adult patients, and no high-quality prospective cohort or RCTs studies exist evaluating patient-reported outcomes in patients in this age group with ligamentously stable knees. Our objective was to identify patient-reported outcomes and patient-specific risk factors from a prospective cohort with a minimum of one-year follow-up following meniscal repair or excision in patients with ligamentously stable knees. We hypothesized that both groups would have significant improvement in outcomes; patients undergoing meniscal repair would have a higher reoperation rate; and articular cartilage injuries, subsequent knee surgery, and certain demographic characteristics would be significant risk factors to inferior outcomes at one year. Methods: Between February 2015 and December 2017, ligamentously stable meniscal procedures were enrolled and prospectively followed using the outcomes management evaluation system (OME) at Cleveland Clinic. Patients aged 23-39 preoperatively completed a series of validated outcome measurements including the Knee Injury and Osteoarthritis Outcome Score for both Pain (KOOS Pain) and Quality of Life (KOOS QoL). At the time of surgery, physicians documented all intra-articular findings, treatment, and surgical techniques utilized. Patients were followed at minimum of 1-year postoperatively through the OME platform and asked to complete the same outcome instruments done at baseline as well as a question designed to evaluate the Patient Acceptable Symptom State (PASS). The incidence and details of any subsequent knee surgeries were also obtained. Multivariable regression analysis was used to identify significant predictors of outcomes. Results: A total of 371 patients aged 23-39 underwent meniscus excision or repair during the study period. One hundred ninety-four met inclusion criteria, and one-year follow-up was obtained on 72% (n = 139) of the cohort (67% male; median age 32). Both KOOS Pain and KOOS QoL improved significantly at one-year for the entire cohort. Fourteen percent of the cohort (9% on the ipsilateral knee, 5% on the contralateral knee) underwent subsequent surgery at a minimum of one-year postoperatively. The patient-specific risk factors for worse one-year outcomes included preoperative baseline mental capacity score (VR-12 MCS), lower baseline KOOS QoL score, and the intraoperative finding of any grade 3 or 4 chondral changes. Conclusion: Young adult patients with ligamentously stable knees undergoing meniscal surgery have significantly improved patient-reported outcomes regardless of excision or repair; however, 14% of patients underwent additional knee surgery at a minimum of one-year postoperatively. The risk factors for worse outcomes include lower baseline mental health score, lower baseline KOOS QoL score, and any grade 3 or 4 chondromalacia scene.

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Vascularized fibular epiphyseal transfer for proximal humeral reconstruction in children with a primary sarcoma of bone

The Bone & Joint Journal ◽

10.1302/0301-620x.100b4.bjj-2017-0830.r1 ◽

2018 ◽

Vol 100-B (4) ◽

pp. 535-541 ◽

Cited By ~ 11

Author(s):

J. D. Stevenson ◽

R. Doxey ◽

A. Abudu ◽

M. Parry ◽

S. Evans ◽

...

Keyword(s):

Limb Salvage ◽

Avascular Necrosis ◽

Proximal Humerus ◽

Bone Tumour ◽

Limb Salvage Surgery ◽

Primary Sarcoma ◽

Toronto Extremity Salvage Score ◽

The Mean ◽

One Year

Aims Preserving growth following limb-salvage surgery of the upper limb in children remains a challenge. Vascularized autografts may provide rapid biological incorporation with the potential for growth and longevity. In this study, we aimed to describe the outcomes following proximal humeral reconstruction with a vascularized fibular epiphyseal transfer in children with a primary sarcoma of bone. We also aimed to quantify the hypertrophy of the graft and the annual growth, and to determine the functional outcomes of the neoglenofibular joint. Patients and Methods We retrospectively analyzed 11 patients who underwent this procedure for a primary bone tumour of the proximal humerus between 2004 and 2015. Six had Ewing’s sarcoma and five had osteosarcoma. Their mean age at the time of surgery was five years (two to eight). The mean follow-up was 5.2 years (1 to 12.2). Results The overall survival at five and ten years was 91% (confidence interval (CI) 95% 75% to 100%). At the time of the final review, ten patients were alive. One with local recurrence and metastasis died one-year post-operatively. Complications included seven fractures, four transient nerve palsies, and two patients developed avascular necrosis of the graft. All the fractures presented within the first postoperative year and united with conservative management. One patient had two further operations for a slipped fibular epiphysis of the autograft, and a hemi-epiphysiodesis for lateral tibial physeal arrest. Hypertrophy and axial growth were evident in nine patients who did not have avascular necrosis of the graft. The mean hypertrophy index was 65% (55% to 82%), and the mean growth was 4.6 mm per annum (2.4 to 7.6) in these nine grafts. At final follow-up, the mean modified functional Musculoskeletal Tumour Society score was 77% (63% to 83%) and the mean Toronto Extremity Salvage Score (TESS) was 84% (65% to 94%). Conclusion Vascularized fibular epiphyseal transfer preserves function and growth in young children following excision of the proximal humerus for a malignant bone tumour. Function compares favourably to other limb-salvage procedures in children. Longer term analysis is required to determine if this technique proves to be durable into adulthood. Cite this article: Bone Joint J 2018;100-B:535–41.

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The use of an Ossis custom 3D-printed tri-flanged acetabular implant for major bone loss: minimum 2-year follow-up

Hip International ◽

10.1177/1120700018760817 ◽

2018 ◽

Vol 28 (6) ◽

pp. 668-674 ◽

Cited By ~ 15

Author(s):

David C Kieser ◽

Ramez Ailabouni ◽

Sandra C J Kieser ◽

Michael C Wyatt ◽

Paul C Armour ◽

...

Keyword(s):

New Technology ◽

Deep Infection ◽

Harris Hip Score ◽

Patient Specific ◽

Outcome Analysis ◽

Bone Contact ◽

Functional Scores ◽

3D Printed ◽

Acetabular Implant

Introduction: Custom 3D-printed acetabular implants are a new technology used in hip surgery with ever-increasing frequency. They offer patient-specific implants to optimise filling of bone defects and implant-bone contact, without the need for excessive bone resection. Methods: This is a retrospective cohort study of 46 consecutive patients who underwent an Ossis unilateral custom 3D-printed acetabular implant. Clinical (Oxford Hip Score OHS-60), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Harris Hip Score (HHS) and radiological (restoration of biomechanical hip centre, osteointegration, wear, heterotrophic ossification) results were assessed. Results: Patient mean age was 68 years and follow-up was 38 months (minimum 24 months). 10 patients were excluded from the outcome analysis; 2 patients died, 1 required revision for deep infection and 7 were lost to follow-up. Of the 36 patients included, 21 had severe osteolysis. 7 were revised for infection, 3 for tumoural defects, 3 for metallosis, 1 for dysplasia and 1 for trauma (Paprosky 2a [n=6], 2b [n=2], 2c [n=5], 3a [n=6], 3b [n=11], pelvic dissociation [n=6]). OHS significantly improved postoperatively (16-8-48.4 p=0.027). Postoperative functional scores were good (WOMAC 98; HHS 79). The biomechanical hip centre was restored in all patients. 1 patient had early implant migration with subsequent stabilisation. 2 patients had radiographs concerning for failure of osteointegration. 1 patient had recurrent dislocations. Conclusions: The mid-term results of the Ossis custom 3D-printed tri-flanged acetabular implant for the management of severe acetabular defects are encouraging. The improvement in functional scores and radiographic outcomes are comparable to similar designs. In addition, no cases have required revision for aseptic loosening.

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Survival after resection plus intra-operative radiofrequency ablation (IRFA) to treat colorectal liver metastases (CLM): Results of an international collaborative study.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.3558 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 3558-3558 ◽

Cited By ~ 2

Author(s):

Serge Evrard ◽

Abou Diallo ◽

Veronique Brouste ◽

Caroline Lalet ◽

Gregoire Desolneux ◽

...

Keyword(s):

Local Recurrence ◽

Collaborative Study ◽

Hepatic Metastases ◽

Median Number ◽

Clinical Databases ◽

Median Size ◽

Group Survival ◽

One Year ◽

International Collaborative Study

3558 Background: Adding IRFA to parenchymal resection to treat CLM is gaining increasing acceptance in specialized HPB teams treating complex, bilobar disease. Objectives were to confirm the promising results of the prospective CLOCC and ARF2003 trials on a larger international scale. Methods: Four centers combined their clinical databases regarding IRFA for CLM. Demographics, treatments, CLM characteristics, complications (Clavien-Dindo), local recurrence, and survivals (liver progression-free, LPFS, relapse-free, RFS and overall, OS) were analyzed. Results: 280 patients (38% female, median age 61y) received resection plus IRFA over 2001-2011. 205 had synchronous CLM (73%) and 247 bilateral (88%). 227 patients received pre-operative chemotherapy (173 one line, 37 two lines, 10 three lines, 7 missing); 189 received post-operative chemotherapy (103 one line, 46 two lines, 40 three lines). Median number of tumors resected was 2 (range 1-19) and ablated 2 (1-12). Median size (mm) of largest CLM ablated per patient was 8.5(0.1-50). 96 patients experienced complications: 29 G1, 19 G2, 35 G3, 10 G4, and 3 deaths. 48 patients had local recurrence of ablated CLM. 155 patients developed new CLM, 165 extra-hepatic metastases, and 119 patients died during follow-up. One-year, 3-year and median (months) RFS, LPFS and OS were respectively: RFS 41%(95CI35-47), 14%(95CI9-19), 9m (95CI8-11); LPFS 53%(95CI47-59), 31%(95CI25-37), 15m (95CI11-19); OS 90%(95CI85-93), 58%(95CI51-65), 40m (95CI37-50). Median follow-up was 38m (95CI34-49). Conclusions: In this difficult-to-treat group, survival results were good and comparable with rates reported after resection only. IRFA complements resection, enabling to treat more patients, and offers the advantage of sparing healthy parenchyma.

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An Ex-Press implant versus trabeculectomy in a fibrotic bleb with late failure after previous trabeculectomy

International Journal of Ophthalmology ◽

10.18240/ijo.2021.03.08 ◽

2021 ◽

Vol 14 (3) ◽

pp. 383-387

Author(s):

Faried Wagdy ◽

◽

Hisham Elsorogy ◽

Ahmed Alnagdy ◽

Dina Abd Elfattah ◽

...

Keyword(s):

Postoperative Complications ◽

Open Angle Glaucoma ◽

Implant Surgery ◽

Late Failure ◽

Group I ◽

The Mean ◽

The Difference ◽

One Year ◽

Age Range

AIM: To compare the outcome of an Ex-Press implant and subscleral trabeculectomy (SST) in the management of glaucoma after previous trabeculectomy on a fibrotic bleb. METHODS: This randomized prospective study included 28 eyes from 28 patients (age range: 42-55y) with primary open angle glaucoma (POAG) presented with elevated intraocular pressure (IOP) with fibrotic bleb despite previous SST for more than 4mo. The eyes enrolled in the study were divided into two groups: group I (subjected to Ex-Press implant surgery) and group II [subjected to SST with mitomycin C (MMC)]. The follow-up continued one year after surgery to evaluate IOP, visual acuity (VA), visual field (VF), and postoperative complications. RESULTS: A significant decrease in IOP was found in both groups with a higher reduction in Ex-Press implant surgery with the mean IOP of 14.50 mm Hg (P=0.001), while the SST group recorded the mean IOP of 16.50 mm Hg (P=0.001) after one year. However, the difference between the two groups in terms of the decrease in IOP was insignificant. Fewer postoperative complications were recorded in the Ex-Press implant surgery and more cases requiring further anti-glaucomatous medications were seen in the SST group. Both groups showed stability in terms of VA and VF. CONCLUSION: Ex-Press implant surgery and SST with MMC are two surgical alternatives for controlling IOP in late failure that occurs more than 4mo after previous SST with a fibrotic bleb. However, Ex-Press shunt is a safer surgery with fewer complications.

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One-year outcomes of microshunt implantation in pseudoexfoliation glaucoma

PLoS ONE ◽

10.1371/journal.pone.0256670 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0256670

Author(s):

Matthias Nobl ◽

Sigrid Freissinger ◽

Stefan Kassumeh ◽

Siegfried Priglinger ◽

Marc J. Mackert

Keyword(s):

Postoperative Complications ◽

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Similar Efficacy ◽

Choroidal Detachment ◽

Pseudoexfoliation Glaucoma ◽

Patient Demographics ◽

One Year ◽

Definition Of

Purpose To compare the safety and efficacy of microshunt implantation augmented with Mitomycin C in patients with pseudoexfoliation glaucoma (PEXG) and primary open-angle glaucoma (POAG). Methods In this retrospective, single centre, interventional study, 46 eyes of 41 patients with PEXG (20 eyes) and POAG (26 eyes) underwent microshunt implantation. Definition of failure was an intraocular pressure (IOP) lower than 5 or higher than 17mmHg on two consecutive visits, an IOP reduction lower than 20% on two consecutive visits, the need of surgical revisions or reoperations or loss of light perception. Outcome was rated as complete success if achieved without medication, otherwise as qualified success. Furthermore, postoperative complications and interventions were compared between the two groups. Results Patient demographics were similar, except for older age in the PEXG group (70.9±8.6 versus 77.6±8; p = 0.02). Mean IOP dropped from 21.5±5.8mmHg (PEXG) and 18.2±4.5mmHg (POAG) at baseline to 12.8±3.0mmHg (p<0.0001) and 12.9±4.2mmHg (p<0.0001), respectively, at one year. Mean number of medications were reduced from 2.8±1.3 to 0.3±0.8 for PEXG patients (p<0.0001) and from 2.7±1.3 to 0.3±0.8 for POAG patients (p<0.0001). At one year of follow-up 75.0% of PEXG patients achieved complete success and 80.0% qualified success. In the POAG group rates were 73.1% and 76.9%, respectively. Postoperative complications were comparable between both groups, except for higher rates of hypotony (p = 0.04) and choroidal detachment (p = 0.03) in the PEXG group. Conclusion Microshunt implantation demonstrated similar efficacy results in PEXG and POAG eyes at a follow-up of 12 months. Higher rates of transient hypotony and choroidal detachment were observed in PEXG eyes.

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