Limb Salvage in Malignant Bone Tumours - A Prospective Follow-Up Study Conducted at Government Medical College, Thrissur from 2017 to 20

BACKGROUND Limb salvage surgeries - Are they useful compared to amputation in bone tumours (malignant/recurrent). Starting from 1980s, bone tumour treatment has seen a revolution with the advent of limb salvage surgeries. From an era where amputation was the only option to the current day function preserving resections and complex reconstructions has been a major advance. The surgeon must ensure adequate resection of the involved bone and soft tissue so as to minimize chance of local recurrence. At no stage must adequate disease clearance be compromised in an attempt to achieve limb salvage. We analyzed its relevance among our rural population at a tertiary level care centre. Limb salvage surgery basically involves resection and reconstruction. Reconstruction can be either biological or endo prosthetic. Biological can be autograft or allograft. Endoprosthesis can be fixed (custom-made) or modular. Expendable bones like fibula or ulna may not require reconstruction after resection. Prosthesis provide an immediate return to function and unlike bone they are not affected by ongoing adjuvant chemotherapy and radiotherapy. METHODS We conducted an 18-month prospective follow-up study on 10 patients (6 males and 4 females) who had undergone limb salvage surgeries during 2017 - 20 at Government Medical College, Thrissur. Wide excision, wide excision & biological autograft reconstruction, wide excision & modular endoprosthesis reconstruction are the different surgical modalities used. Patients were followed up clinically and radiologically in the orthopaedic out-patient department (OPD) at 6 weeks, 12 weeks and up to 1 ½ years at every 3 months. Functional scoring has been done using musculoskeletal tumour society (MSTS) - 87 scoring system. Study duration: 2017 October to 2020 October (3 years). RESULTS The average score is 64.6 % using the MSTS - 87 system. Maximum score was 83 % and the minimum was 62 %. Most of our patients are doing well and pursuing near-normal life with limb salvage surgeries with very minimal complications. One of our patients succumbed to the disease during the follow-up period. CONCLUSIONS Limb salvage is a better alternative to amputation in malignant and recurrent bone tumours in carefully selected and thoroughly evaluated patients. KEYWORDS Limb Salvage, Malignant & Recurrent Bone Tumours, MSTS - 87 Score, Wide Excision, Biological Autograft, Modular Endoprosthesis Reconstruction

Modular endoprosthetic replacement for proximal tibia tumor patients

The major method of malignant bone tumors treatment is surgery. The most important task of an orthopedic surgeon is to preserve an adjacent joint. Currently, there are a large number of various reconstructive surgeries, including structural bone allograft, allocomposite and modular endoprosthetics replacement. The aim: to analyze the results of surgical treatment for proximal tibia malignant tumors using modular endoprosthesis. Materials and methods. The results of proximal tibia (PT) modular endoprosthetic replacement in 48 patients with PT tumor lesions were evaluated. The patients were divided into two groups: I (n = 36) – tumor resection and primary modular endoprosthesis, II (n = 12) – revision modular endoprosthetic replacement due to complications. Complications were divided into oncological, mechanical and non-mechanical. The functional outcomes were measured using the MSTS and TESS scores. Results. During the treatment, 10 (21.2 %) patients underwent myofascioplastic amputation at the middle third of the thigh: due to periprosthetic infection – 8 people and tumor recurrence – 2. It was found that the patients got back to regular way of life on average in 2.0–2.5 months. Functional results on the MSTS score were 73 ± 12 %, on the TESS score – 74 ± 16 %, which corresponds to good functional results. Among the patients, who underwent limb salvage surgery, no tumor recurrence was detected during a follow-up period from 6 months up to 11 years. Conclusions. The choice of surgical treatment depends on the size of tumor, its location, pathohistomorphological picture, age, presence of pathological fractures, vascular and nerve tumor invasion. The use of modern designs of PT modular tumor endoprostheses and perfect surgeries makes it possible to minimize complications.

THE SURGICAL TREATMENT OF HEAD RADIAL BONE FRACTURE IV TYPE BY MASON-HOTCHKISS FOR THE IMPLEMENTATION OF THE CEMENTLESS BIPOLAR MODULAR ENDOPROSTHESIS OF THE HEAD RADIAL BONE

Aim. The author of the article shows the features of the surgical technique of implantation of the developed cementless modular bipolar endoprosthesis of the head of the radial bone with a pair of metal-metal friction. Materials and methods. The developed cementless modular bipolar endoprosthesis of the radial head with a pair of metal-metal friction. Indications for endoprosthetic of the head of the radial were the fracture of the head IV, according to Mason-Hotchkiss. The result of the treatment was assessed by the Mayo Elbow Performance Score evaluation system. Results and discussion. At fractures on Mason-Hotchkiss IV type, the endoprosthetic of the head of a radial bone is applied. The use of the developed modular endoprosthesis of the head of the radial made it possible to restore the stability of the elbow joint, to resume rotational movements of the head radial, while maintaining the functional volume of flexion-extensor movements, and also to restore the length of the radial bone. Conclusions. The use of the developed advanced cementless bipolar modular endoprosthesis of radial head fracture-dislocation type IV by Mason-Hotchkiss allowed obtaining a good result, according to the assessment of the MEPS clinic (88.5 scores) in 6 months after surgery.

THE RESULTS OF MODULAR ENDOPROSTHESIS OF PERIACETABULAR REGION IN TUMOR LESIONS OF THE ACETABULUM AND HIP JOINT

Surgical treatment of patients with tumoral defeat of pelvic bones, of preacetabular region, in particular, is one of the most challenging topics of modern oncorthopedics. Currently, one of the most modern methods of reconstruction of the pelvic bones is the use of modular endoprostheses based on the conical leg, the advantage of which is the ability to intraoperatively simulate an endoprosthesis that best meets the specific clinical situation. Purpose of research. To assess the benefits of modular endoprosthesis of the acetabulum in patients with tumoral defeat periacetabular region.Patients and methods. Within the period of 2011–2018 30 patients underwent surgical treatment in form of periacetabular resection with a modular endoprosthesis reconstruction in P.Hertsen Moscow Oncology Research Institute – Branch of National Medical Research Radiological Centre of Ministry of Health of Russian Federation. There were 13 men (43%) and 17 women (57%). The median age was 45 years (23–63 years). Primary bone cancers were in 19 (63%) patients, giant cell tumors in 5 (17%), locally advanced soft tissue sarcoma in 1 (3%), solitary metastases of kidney cancer in 2 (7%), and recurrent sarcomas after previous surgical treatment in 3 (10%) patients.Results. The average duration of the operation was 310 min (145–520 min), the volume of intraoperative blood loss was 5520 ml (600–20 000 ml). The positive edge of resection according to the results of the planned morphological study was revealed in 3 (10%) patients. The average follow-up period was 36 months (4-73 months). Disease progression in terms of 6 to 40 months was revealed in 10 (33%) patients. 8 (27%) patients from disease progression. Complications of different types were diagnosed in 11 (37%) patients, among whom infectious complications prevailed 9 (30%). The average value of the functional results on a scale MSTS accounted for 59% (15 to 82%). Conclusion. The use of modular systems of endoprosthesis replacement of the acetabulum and hip joint in tumor lesions is a promising surgical technique that allows to achieve adequate functional results with a comparable number of postoperative complications.