Extra-articular wide tumor resection and limb reconstruction in malignant bone tumors invading the knee joint

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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Risk factors and outcomes for failure of biological reconstruction after resection of primary malignant bone tumors in the extremities

Scientific Reports ◽

10.1038/s41598-021-00092-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Taweechok Wisanuyotin ◽

Permsak Paholpak ◽

Winai Sirichativapee ◽

Weerachai Kosuwon

Keyword(s):

Risk Factors ◽

Functional Outcomes ◽

Bone Tumors ◽

Tumor Resection ◽

Tumor Location ◽

Complication Rates ◽

Malignant Bone Tumors ◽

Biological Reconstruction ◽

Significant Difference ◽

Autograft Group

AbstractBiological reconstruction is widely used to reconstruct bone defects after resection of bone tumors in the extremities. This study aimed to identify risk factors for failure and to compare outcomes of the allograft, nonvascularized autograft, and recycled frozen autograft reconstruction after resection of primary malignant bone tumors in the extremities. A retrospective study was performed at a single center between January 1994 and December 2017. Ninety patients with primary malignant bone tumors of the extremities were treated with tumor resection and reconstruction using one of three bone graft methods: nonvascularized autograft (n = 27), allograft (n = 34), and recycled frozen autograft (n = 29). The median time for follow-up was 59.2 months (range 24–240.6 months). Overall failure of biological reconstruction occurred in 53 of 90 patients (58.9%). The allograft group had the highest complication rates (n = 21, 61.8%), followed by the recycled frozen autograft (n = 17, 58.6%) and nonvascularized autograft (n = 15, 55. 6%) groups. There was no statistically significant difference among these three groups (p = 0.89). The mean MSTS score was 22.6 ± 3.4 in the nonvascularized autograft group, 23.4 ± 2.6 in the allograft group, and 24.1 ± 3.3 in the recycled frozen autograft group. There was no significant difference among the groups (p = 0.24). After bivariate and multivariable analyses, patient age, sex, tumor location, graft length, methods, and type of reconstruction had no effects on the failure of biological reconstruction. Biological reconstruction using allograft, nonvascularized autograft, and recycled frozen autograft provide favorable functional outcomes despite high complication rates. This comparative study found no significant difference in functional outcomes or complication rates among the different types of reconstruction.

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Management of Juxtaphyseal Malignant Bone Tumors Around the Knee Joint: New Concepts in Limb-Sparing Surgery

Pediatric Lower Limb Deformities ◽

10.1007/978-3-319-17097-8_21 ◽

2016 ◽

pp. 349-358

Author(s):

Hidenori Matsubara ◽

Hiroyuki Tsuchiya

Keyword(s):

Knee Joint ◽

Bone Tumors ◽

Malignant Bone Tumors ◽

New Concepts

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The Evaluation of the Surgical and Functional Reseults of the Tumor Resection Prothesis in Proximal Femur Malignant Bone Tumors

Acta Oncologica Turcica ◽

10.5505/aot.2019.62134 ◽

2019 ◽

Vol 52 (2) ◽

pp. 250-255

Author(s):

Selçuk Yılmaz ◽

İsmail Burak Atalay ◽

Recep Öztürk ◽

Bedii Şafak Güngör

Keyword(s):

Proximal Femur ◽

Bone Tumors ◽

Tumor Resection ◽

Malignant Bone Tumors

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Reconstruction of Total Bone Defects following Resection of Malignant Tumors of the Upper Extremity with 3D Printed Prostheses: Presentation of Two Patients with a Follow-Up of Three Years

Case Reports in Orthopedics ◽

10.1155/2020/8822466 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Thomas Ackmann ◽

Sebastian Klingebiel ◽

Georg Gosheger ◽

Anna Rachbauer ◽

Christoph Theil ◽

...

Keyword(s):

Upper Extremity ◽

Bone Tumors ◽

Malignant Tumors ◽

Local Treatment ◽

Tumor Resection ◽

Bone Defects ◽

Malignant Bone Tumors ◽

Term Survival ◽

First Case ◽

3D Printed

Wide tumor resection is the local treatment of choice for patients with primary malignant bone tumors and a prerequisite for long-term survival. We present two patients that underwent total bone resection in the upper limb because of primary malignant bone tumors. The defects were then reconstructed by a 3D printed prosthesis, a procedure that, to our knowledge, has not been reported for bone defects of the upper extremity so far. Complete resection of the affected bone was required in a five-year-old girl with a high-grade osteoblastic osteosarcoma of the humerus and a 53-year-old man with a dedifferentiated leiomyosarcoma of the radius, due to the tumor’s extent. Following neoadjuvant chemotherapy, resection of the entire affected humerus including the axillary nerve took place in the first case and the entire affected radius including parts of the radial nerve in the second case. Approximately three years after surgery, both patients are alive and pain-free. Despite a postoperative drop hand that affected the now 56-year-old man, he is able to carry out everyday activities such as brushing his teeth, writing, and eating. The now eight-year-old girl is also able to engage in normal activities with her left arm such as eating and carrying lightweight objects. Both patients are tumor-free to date.

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Pedicle frozen autograft-prosthesis composite reconstructions for malignant bone tumors of the proximal femur

10.21203/rs.2.16782/v1 ◽

2019 ◽

Author(s):

gang xu ◽

Shinji Miwa ◽

Norio Yamamoto ◽

Katsuhiro Hayashi ◽

Akihiko Takeuchi ◽

...

Keyword(s):

Proximal Femur ◽

Functional Outcomes ◽

Bone Tumors ◽

Tumor Resection ◽

Malignant Bone Tumors ◽

Musculoskeletal Tumor ◽

Musculoskeletal Tumor Society ◽

Biological Reconstruction ◽

The Mean

Abstract Background Limb salvage surgery is becoming increasingly popular after tumor resection in the lower extremity. Biological reconstruction and use of megaprosthesis are main methods for malignant bone tumors of the proximal femur, which remain controversial due to short- and long-term complication in the proximal femur. Tumor-bearing bone treated by liquid nitrogen is one of biological reconstruction. This study aimed to evaluate the mid- and long-term functional outcomes and complications in patients treated with frozen autograft–prosthesis composite (FAPC) reconstructions in the proximal femur. Methods This retrospective study included 19 patients (10 women, 9 men) with malignant tumors of the proximal femur who underwent tumor-wide resection and FAPC reconstruction (mean age, 46 years; range, 9-77 years). The mean follow-up period of 66 months (range, 9-179 months). Functional outcomes, oncological outcome and complications were evaluated by Musculoskeletal Tumor Society score, clinical and radiological examinations. Results The overall survival rate was 68.4%, and the mean Musculoskeletal Tumor Society functional score was 26.4 points (88%). FAPC survival rates were 100% and 50% at 5 and 10 years, respectively. Five of the 19 patients (26%) had complications: 2 required prosthesis removal and 2 developed a deep infection around acetabular. Wear of the acetabulum occurred in 2 cases, while disease recurrence was occurred in 1 case. There were no cases of greater trochanter avulsion, obvious absorption around frozen bone, prosthesis loosening or leg length discrepancy. Conclusions Due to without femoral osteotomy, ease of soft-tissue attachment and preservation of bone matrix, FAPC reconstruction provide early limb stability and satisfactory functional outcome after malignant bone tumor resection in the proximal femur.

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Scintigraphy with 99m Tc-Phosphonate and 67Gallium in Patients Suspected of Primary Bone Tumors

Nuklearmedizin ◽

10.1055/s-0037-1620567 ◽

1982 ◽

Vol 21 (04) ◽

pp. 136-139 ◽

Cited By ~ 2

Author(s):

C.-J. Edeling

Keyword(s):

Soft Tissue ◽

Bone Scintigraphy ◽

Primary Tumor ◽

Bone Tumors ◽

Whole Body ◽

Skeletal Metastases ◽

Malignant Bone Tumors ◽

67Ga Scintigraphy ◽

Primary Bone Tumors ◽

Primary Bone

Whole-body scintigraphy with both 99mTc-phosphonate and 67Ga was performed on 92 patients suspected of primary bone tumors. In 46 patients with primary malignant bone tumors, scintigraphy with 99mTc-phosphonate disclosed the primary tumor in 44 cases and skeletal metastases in 11, and 67Ga scintigraphy detected the primary tumor in 43 cases, skeletal metastases in 6 cases and soft-tissue metastases in 8 cases. In 25 patients with secondary malignant bone tumors, bone scintigraphy visualized a single lesion in 10 cases and several lesions in 15 cases, and 67Ga scintigraphy detected the primary tumor in 17 cases, skeletal metastases in 17 cases and soft-tissue metastases in 9 cases. In 21 patients with benign bone disease positive uptake of 99mTc-phosphonate was recognized in 19 cases and uptake of 67Ga in 17 cases. It is concluded that bone scintigraphy should be used in patients suspected of primary bone tumors. If malignancy is suspected, 67Ga scintigraphy should be performed in addition.

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