Extra-Articular Wide Tumor Resection and Limb Reconstruction in Malignant Bone Tumors at the Proximal Femur

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

10.21203/rs.2.16782/v2 ◽

2020 ◽

Author(s):

gang xu ◽

Shinji Miwa ◽

Norio Yamamoto ◽

Katsuhiro Hayashi ◽

Akihiko Takeuchi ◽

...

Keyword(s):

Proximal Femur ◽

Functional Outcomes ◽

Bone Tumors ◽

Functional Score ◽

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 69 months (range, 9-179 month). Functional outcomes, oncological outcomes 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, this technique features satisfactory functional outcome and provide biomechanical stability that is comparable to those of other methods of biological reconstruction or megaprosthesis.

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

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-3112-0 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Gang Xu ◽

Shinji Miwa ◽

Norio Yamamoto ◽

Katsuhiro Hayashi ◽

Akihiko Takeuchi ◽

...

Keyword(s):

Proximal Femur ◽

Bone Tumors ◽

Malignant Bone Tumors

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Proximal Femur Versus Acetabular Extra-articular Resection of the Hip Joint for Primary Malignant Bone Tumors : A Retrospective Comparative Review of 33 Cases

10.21203/rs.3.rs-917462/v1 ◽

2021 ◽

Author(s):

Victor Housset ◽

Philippe Anract ◽

Antoine Babinet ◽

Guillaume Auberger ◽

David Biau

Keyword(s):

Hip Joint ◽

Proximal Femur ◽

Bone Tumors ◽

Malignant Bone Tumors ◽

Primary Bone Tumors ◽

Comparative Review ◽

Primary Bone ◽

The Mean ◽

Cumulative Probabilities

Abstract Introduction Extra-articular resection (EAR) of the hip joint is prone to significant complications and morbidity. Thus, this study evaluates the cumulative incidences and main reasons of reoperation following EAR of primary bone tumors of the hip to determine whether the outcomes are different between EAR of the pelvis and that of the proximal femur. Patients and methods Thirty-three patients presented with a PMBT of the proximal femur or pelvis were included in this study. Among all PMBTs, 58% originated from the pelvis and 42% were from the proximal femur. Twenty patients had chondrosarcomas (61%), 10 had osteosarcomas (30%), and 3 had sarcomas of another histological subtype (9%). Results The mean follow-up was of 76 months (range: 24–220 months). The cumulative probabilities of revision for any reason was 52% (95% confidence interval [CI]: 30%–70%) five years after surgery. The five-year cumulative probabilities of revision were 13% (95% CI: 4%–27%), 24% (95% CI: 10%–42%) and 34% (95% CI: 14%–56%) for mechanical, infectious and tumoral reasons, respectively. The five-year cumulative probabilities of revision for any reason were 78% (95% CI: 37%–94%) and 14% (95% CI: 2%–38%) for the pelvis and proximal femur, respectively ( p = 0.004). Posterior column preservation was significantly associated with more mechanical complications even after adjusting for the resection site ( p = 0.043). Conclusion Half of patients undergoing EAR of the hip joint for PMBT of the proximal femur or acetabulum will require another operation. EAR of the pelvis is associated with significantly worse outcome than EAR of the proximal femur.

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

10.21203/rs.2.16782/v3 ◽

2020 ◽

Author(s):

gang xu ◽

Shinji Miwa ◽

Norio Yamamoto ◽

Katsuhiro Hayashi ◽

Akihiko Takeuchi ◽

...

Keyword(s):

Proximal Femur ◽

Functional Outcomes ◽

Bone Tumors ◽

Functional Score ◽

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 69 months (range, 9-179 month). Functional outcomes, oncological outcomes 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, this technique features satisfactory functional outcome and provide biomechanical stability that is comparable to those of other methods of biological reconstruction or megaprosthesis.

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