scholarly journals Preliminary results of a new intercalary modular endoprosthesis for the management of diaphyseal bone metastases

2021 ◽  
Author(s):  
Kadir Büyükdoğan ◽  
Barlas Göker ◽  
Mazhar Tokgözoğlu ◽  
Ulukan İnan ◽  
Korhan Özkan ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Functional Results ◽  
Bone Lesions ◽  
Complication Rates ◽  
Short Term ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Type Iv ◽  
Diaphyseal Bone

Objectives: This study aims to evaluate functional outcomes of patients and to analyze complication rates of modular intercalary endoprosthetic reconstruction after resection of metastatic diaphyseal bone lesions. Patients and methods: Between December 2017 and February 2020, 22 patients (15 males, 7 females; median age: 64.2 years; range, 49 to 91) who underwent reconstruction with modular intercalary endoprostheses for metastatic bone tumors at five different centers were retrospectively analyzed. Age, sex, diagnosis, follow-up duration, previous treatments of patients, and resection lengths were recorded. The Musculoskeletal Tumor Society Scores (MSTS) were used to assess functional status of available patients at the final follow-up. Failures were categorized according to the Henderson classification. Results: Locations of the resected tumors included 10 humeri (45.5%), five tibiae (22.7%), and seven femurs (31.8%). The length of the resected tissues ranged from 35 mm to 180 mm. Seven patients (31.8%) died of disease, and one patient died of pneumonia within follow-up period. The functional outcomes of surviving patients were satisfying with a median MSTS score of 86.9% (range, 70 to 100%) at a median follow-up of 17 months (range, 8 to 26). There were two cases of type II (9%), one cases of type IIIa (4.5%), two cases of type IIIb (9%), and one case of type IV (4.5%) failure. Complications were most commonly observed in tibial reconstructions. Conclusion: The good short-term functional results were achieved in surviving patients. Uncomplicated patients were able to perform daily living activities without limitations. The overall rate of complications was relatively low and, among them, mechanical problems were the most commonly encountered problems.

scholarly journals Intra-articular soft-tissue sarcoma of the knee: Is extra-articular resection and tumor endoprosthetic reconstruction the solution? A retrospective report on eight cases

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Markus Nottrott ◽  
Arne Streitbürger ◽  
Georg Gosheger ◽  
Wiebke Guder ◽  
Gregor Hauschild ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Knee Joint ◽  
Limb Salvage ◽  
Soft Tissue Sarcomas ◽  
Rare Condition ◽  
Functional Results ◽  
Extensor Mechanism ◽  
Complication Rates ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society

Intra-articular sarcoma of the knee joint is a very rare condition. Extra-articular resection and reconstruction with a tumor prosthesis is usually performed. This report describes the results with this rare surgical procedure. This retrospective study evaluated the clinical and functional results after extra-articular resection of the knee joint in eight patients with soft-tissue sarcomas of the knee that were reconstructed using a tumor endoprosthesis. Five of the eight patients (62.5%) ultimately had to undergo amputation, mainly due to periprosthetic infection. In addition, two patients experienced periprosthetic fractures. The mean Musculoskeletal Tumor Society score was 18 (range 10-22), as function was impaired due to a weak extensor mechanism. These results suggest that in patients with intraarticular soft-tissue sarcomas, limb salvage procedures with tumor prostheses after extra-articular resection are associated with very high complication rates. In most cases, long-term limb salvage was not possible. When limb salvage is successful, function is also poor due to a weak extensor mechanism in the knee joint. The indication for this procedure should therefore be considered critically.

scholarly journals Hemicortical Resection and Biological Reconstruction using Allograft for Parosteal Osteosarcoma of the Distal Femur. A Case Series

2021 ◽  
Author(s):  
Olga D Savvidou ◽  
Stavros Goumenos ◽  
Ioannis Trikoupis ◽  
Angelos Kaspiris ◽  
Dimitra Melissaridou ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Functional Outcomes ◽  
Distal Femur ◽  
Parosteal Osteosarcoma ◽  
Complication Rates ◽  
Posterior Surface ◽  
Musculoskeletal Tumor Society ◽  
Biological Reconstruction ◽  
Msts Score

Abstract Background: Parosteal osteosarcoma (PAO), which is a surface osteosarcoma, can be treated with wide excision and endoprosthetic or allograft application. However, due to the low local recurrence and metastasis rate, when it appears in the posterior surface of the distal femur, can be managed with hemicortical wide resection and biological reconstruction with hemicortical allograft.The purpose of this study was to evaluate the oncological and functional outcomes of patients with parosteal osteosarcoma (PAO) of the posterior cortex of the distal femur who underwent biological reconstruction after hemicortical resection. Methods: Eleven patients who underwent wide tumor resection and defect reconstruction of the posterior surface of the distal femur using hemicortical allograft were studied retrospectively. Local recurrence, metastasis, complications and the functional outcome using the Musculoskeletal Tumor Society scoring system (MSTS Score) were evaluated.Results: The average postoperative follow-up period was 53.64 months (range, 30 to 84 months). At the latest follow up, all patients were free of the disease without appearing any metastases. A patient with local recurrence underwent revision surgery with fibula autograft reconstruction. The mean MSTS score was 93.45 ± 3.56. Conclusions: In patients with PAO of the posterior aspect of the distal femur the treatment of hemicortical resection and allograft reconstruction has satisfactory oncological and functional outcomes and low complication rates.

Scapulectomy for Fibromatosis – Ocological and Functional Outcomes

2021 ◽  
Vol 12 (4) ◽  
pp. 2541-2547
Author(s):  
Shanmugasundaram Gouthaman ◽  
Mohan Choudhary B ◽  
Chandiralekha S ◽  
Dorai Kumar R ◽  
Jagadesh Chandra Bose
Keyword(s):  
World Literature ◽  
Posterior Approach ◽  
Aggressive Fibromatosis ◽  
Functional Results ◽  
Surgical Oncology ◽  
Adjuvant Radiation ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Disease Free Interval

Aggressive fibromatosis is a locally invasive tumor that does not metastasize. Only few cases of scapulectomy for fibromatosis of scapular muscles are reported in the world literature. We present two consecutive cases of scapulectomy done for fibromatosis of periscapular muscles at the Department of Surgical Oncology in our centre between 2014 and 2019. One patient underwent subtotal scapulectomy by posterior approach and the other patient underwent scapulectomy below spine of scapula by combined anterior and posterior approach. The follow-up period of both the patients was 5 years. One patient developed recurrence after 9 months of surgery dealt by re-resection followed by adjuvant radiation. The modified Musculoskeletal Tumor Society (MSTS) score for scapular surgery was 20 in the first patient and 22 in the second patient. Both of them are able to carry out normal regular activities with the compensation from the opposite upper limb. Scapulectomy for symptomatic fibromatosis of the scapular muscles gives acceptable functional results and good disease-free interval. Scapulectomy should be considered as part of resection for better tumor clearance in fibromatosis involving muscles around the scapula. Further studies are needed to evaluate and validate the need for radical surgery in this setting.

scholarly journals Comparison of short-time functional outcomes after TKA between Multigen Plus CR and Physica KR prostheses

2021 ◽  
Author(s):  
P. Lisý ◽  
J. Čabala ◽  
M. Hrubina ◽  
M. Melišík ◽  
L. Nečas
Keyword(s):  
Functional Outcomes ◽  
Primary Total Knee Arthroplasty ◽  
Functional Results ◽  
Womac Score ◽  
Clinical Results ◽  
Short Term ◽  
Significant Difference ◽  
Womac Questionnaire ◽  
Long Term Follow Up

Abstract Background Aim of this study was to compare functional results within 36 months following primary total knee arthroplasty (TKA) using a conventional prosthesis Multigen Plus CR and a new Physica KR implant. Our hypothesis was that the use of the Kinematics-Retaining design of an TKA implant leads to a significantly greater improvement in the active range of motion and better functional results (KSS 1, KSS 2 and WOMAC score) than the conventional CR implant at short-term follow-up. Materials and methods We retrospectively analysed data of 234 patients who underwent primary TKA at our hospital from April 2010 to August 2015 with the CR type of implant and from July 2014 to August 2015 with the KR implant due to advanced knee arthrosis of IIIrd and IVth grade of Kellgren-Lawrence classification, with no major ligamentous instability. Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) questionnaire, Knee Society Scores 1 (KSS 1) and 2 (KSS 2) and flexion (AROM) were recorded preoperatively and at 6, 12 and 36 months after surgery. Results Our study showed a statistically significant difference in functional results at three years with better KSS 1 score, a tendency to higher values in the KSS 2 score, as well as a statistically significant overall improvement in AROM in favour of the new KR design over the conventional CR implant with a post-hoc power analysis of 83.8%. We found that there was no statistically significant difference between groups when comparing WOMAC score and complications at short-term follow-up. Conclusions Our study provided more favourable clinical results for using Kinematics-Retaining implant in primary TKA. Further studies should focus on radiological and functional outcomes from mid- to long-term follow-up.

scholarly journals The Neoadjuvant Chemotherapy and Expandable Prosthesis Reconstruction to Treat Osteosarcoma Around the Knee in Child

2020 ◽  
Author(s):  
Jiajia Cheng ◽  
Junqi Huang ◽  
Wenzhi Bi ◽  
Gang Han ◽  
Jinpeng Jia ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Limb Salvage ◽  
Growth Period ◽  
Functional Results ◽  
Limb Salvage Surgery ◽  
High Survival ◽  
Level Of Evidence ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society

Abstract Background: To investigate: (1) what are the prognosis in patients treated with this chemotherapy scheme and limb salvage; (2) what are the clinical outcomes of expandable endoprosthesis reconstruction in child?Methods: From January 2009 to December 2014, we retropected 29 skeletally immature kids ( mean age, 10.5 years; range, 6-15 years) with osteosarcoma around knee. Of the 29 patients who underwent neoadjuvant chemotherapy and limb salvage surgery, this expandable prosthesis was implanted to reconstruct. These 29 patients were included in our retrospection. No patients were missed during follow-up. The evaluation index involved follow-up time, complication, functional results, lengthening procedures. The survivorship and recurrence were assessed by SPSS software. The function was assessed by Musculoskeletal Tumor Society (MSTS) scoring system.Results: A mean of follow-up time was 8.9 years (range, 6-12years). The overall 5-year survival was 89.1% based on Kaplan-Meier. Relapse suffered in three patients and one underwent amputation. Lung metastasis developed in one patient. At six months after operation, patients had a mean MSTS score of 27 points (range, 24-29). Two patients underwent revision surgery--one for implant infection and one for aseptic loosening.Conclusions: Chemotherapy scheme and limb salvage could achieved high survival rate. Use of this expandable prosthesis was associated with good function and low complication. The character of expandability could be a method to overcome discrepancy in the growth period.Level of Evidence Level IV, therapeutic study.

scholarly journals Experience and Technique for Zenker's Diverticulum Per Oral Endoscopic Myotomy: Z-POEM

2020 ◽  
Author(s):  
Eitan Podgaetz ◽  
Vani Konda
Keyword(s):  
Third Space ◽  
Zenker’S Diverticulum ◽  
Complication Rates ◽  
Short Term ◽  
Zenker's Diverticulum ◽  
Per Oral Endoscopic Myotomy ◽  
Endoscopic Myotomy ◽  
Invasive Techniques ◽  
Per Oral

Abstract Objective With the advent of minimally invasive surgery, incisionless surgery, and third-space endoscopy, the treatment for Zenker's diverticulum has also moved toward less invasive techniques Methods New incisionless per oral techniques can be applied for cricopharyngeal myotomy in Zenker's diverticulum. Results Five patients underwent Zenker's diverticulum per oral endoscopic myotomy (Z-POEM) without complications, minimal discomfort, and narcotic consumption, with complete resolution of their symptoms by history and Eckardt scores. Conclusions Z-POEM is performed entirely endoscopically with very little associated pain or complication rates, with short-term follow-up having excellent functional and symptomatic results.

scholarly journals Custom-Made 3D-Printed Implants as Novel Approach to Reconstructive Surgery after Oncologic Resection in Pediatric Patients

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.

Flap Reconstruction of Sarcoma Defects in the Setting of Neoadjuvant and Adjuvant Radiation

2018 ◽  
Vol 35 (04) ◽  
pp. 287-293 ◽  
Author(s):  
Rohini Kadle ◽  
Catherine Motosko ◽  
George Zakhem ◽  
John Stranix ◽  
Timothy Rapp ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Soft Tissue ◽  
Radiation Treatment ◽  
Soft Tissue Sarcomas ◽  
Adjuvant Radiation ◽  
Complication Rates ◽  
Flap Reconstruction ◽  
Fasciocutaneous Flaps ◽  
Musculoskeletal Tumor Society

Background Limb-sparing treatment of extremity soft tissue sarcomas requires wide resections and radiation therapy. The resulting complex composite defects necessitate reconstructions using either muscle or fasciocutaneous flaps, often in irradiated wound beds. Methods A retrospective chart review was performed of all limb-sparing soft tissue sarcoma resections requiring immediate flap reconstruction from 2012 through 2016. Results Forty-four patients with 51 flaps were identified: 25 fasciocutaneous and 26 muscle-based flaps. Mean defect size, radiation treatment, and follow-up length were similar between groups. More often, muscle-based flaps were performed in younger patients and in the lower extremity. Seventeen flaps were exposed to neoadjuvant radiation, 12 to adjuvant radiation, 5 to both, and 17 to no radiation therapy. Regardless of radiation treatment, complication rates were comparable, with 28% in fasciocutaneous and 31% in muscle-based groups (p < 0.775). Muscle-based flaps performed within 6 weeks of undergoing radiotherapy were less likely to result in complications than those performed after greater than 6 weeks (p < 0.048). At time of follow-up, Musculoskeletal Tumor Society scores for fasciocutaneous and muscle-based reconstructions, with or without radiation, showed no significant differences between groups (mean [SD]: 91% [8%] vs. 89% [13%]). Conclusion The similar complication rates and functional outcomes in this study support the safety and efficacy of both fasciocutaneous flaps and muscle-based flaps in reconstructing limb-sparing sarcoma resection defects, with or without radiotherapy.

scholarly journals Clinical outcome of operative treatment in 18 cases of giant cell tumors of bones

2020 ◽  
Vol 10 (2) ◽  
pp. 67-71
Author(s):  
Suresh Pandey
Keyword(s):  
Clinical Outcome ◽  
Giant Cell ◽  
De Novo ◽  
Excellent Result ◽  
Giant Cell Tumors ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Non Union ◽  
Proximal Fibula

Background: Giant Cell Tumor of the bone (GCTB) has got variable outcome after the different methods of surgical treatment depending upon the site and grade of lesion and extent of tumor removal. This retrospective prospective analysis of operatively treated cases of GCTB of different sites aimed to highlight the clinical outcome. Methods: This was a prospective observational study of 18 cases of GCTB; proximal tibia (n=6), distal femur (n=5), distal radius (n=4), proximal femur (n=1), proximal fibula (n=1) and anterior arc of first rib (n=1) treated with different operative management with mean follow up of 53.61 months. Functional outcome with Musculoskeletal Tumor Society Score (MSTS), recurrence and complications were analyzed with at least 24 months of follow up. Results: There were 10 females and 8 males with average age at presentation 27.3 years (range 15-38). Average duration of symptom was 4.72 months. 2 were cases of recurrence previously op­erated and 16 were de novo cases. Mean MSTS was 84.27% with good to excellent result in 88%. There were no non-union, graft failure, metastasis, prosthetic failure or wound infection till at least 24 months of follow up in any of the cases. Conclusions: Extended curettage or reconstruction with auto graft in grade I and II tumor or en­doprosthesis in higher grade or recurrence of GCTB can give good to excellent functional result in majority of the cases.

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