Lower Limb Salvage Surgery: Modular Endoprosthesis in Bone Tumour Treatment

Overview

Journal Int Orthop

Specialty Orthopedics

Date 2006 Aug 10

PMID 16896869

Citations 26

Authors

D Orlic

M Smerdelj

R Kolundzic

M Bergovec

Affiliations

Soon will be listed here.

Abstract

We retrospectively analysed 90 patients who underwent "en bloc" resection and modular endoprosthesis reconstruction in the lower limbs between 1987-2003. After proximal femur resection, reconstruction was performed with a modular endoprosthesis by Howmedica (KFTR, designed by Kotz) and modular revision endoprosthesis by W. Link or Lima-Lto (Revision system, designed by Wagner). The knee joint was reconstructed with a modular endoprosthesis (Howmedica, KFTR designed by Kotz) after distal femur or proximal tibia resection. Malignant bone tumours were present in 58 patients (64.5%), benign tumours in 16 (17.8%), metastases in 8 (8.9%), tumour-like lesions in 4 (4.4 %) and non-tumour-related destruction of the femur in 4 patients (4.4%). High-grade tumours were found in the majority of malignant bone tumours (70.7%). Treatment complications, which occurred in 26 patients, were: local recurrence of the tumour, deep infection, acetabular destruction following hemiarthroplasty, recurrent dislocations of endoprosthesis, periprosthetic fracture and hardware problems. In total, 23 patients (25.6%) died due to tumours. Endoprostheses should be considered as a treatment of choice for bone tumours in the hip and knee joint region. Advances in limb salvage surgery are, and will long continue to be, a great challenge for orthopaedic oncologists of the 21st century.

Citing Articles

Functional and Oncological Outcome of Patients with Distal Femoral Osteosarcoma Managed by Limb Salvage Using Modular Endoprosthesis.

Sadek W, Ebeid W, El Ghoneimy A, Ebeid E, Senna W Ann Surg Oncol. 2023; 30(8):5150-5158.

PMID: 37273024 PMC: 10319677. DOI: 10.1245/s10434-023-13679-x.

Outcomes of Tumor Resection and Reconstruction by Megaprosthesis around Knee: Our Experience.

Kar B, Ojha M, Yadav S, Agrawal A, Sakale H J Orthop Case Rep. 2022; 11(6):49-52.

PMID: 35437493 PMC: 9009471. DOI: 10.13107/jocr.2021.v11.i06.2254.

Distal femoral replacement - Cemented or cementless? Current concepts and review of the literature.

Christ A, Hornicek F, Fabbri N J Clin Orthop Trauma. 2021; 19:11-16.

PMID: 34040980 PMC: 8138588. DOI: 10.1016/j.jcot.2021.04.032.

Assessment of Extra-Cortical Bone Bridge Interface in Cemented Mega Endoprosthesis for Limb Salvage Surgery.

Murugan K, Faisham W, Zulmi W Malays Orthop J. 2021; 15(1):93-99.

PMID: 33880154 PMC: 8043634. DOI: 10.5704/MOJ.2103.014.

Limb salvage surgery of primary and metastatic bone tumors of the lower extremity: Functional outcomes and survivorship of modular endoprosthetic reconstruction.

Topkar O, Sofulu O, Sirin E, Erol B Acta Orthop Traumatol Turc. 2021; 55(2):147-153.

PMID: 33847577 PMC: 11229608. DOI: 10.5152/j.aott.2021.20101.

References

Bickels J, Meller I, Henshaw R, Malawer M . Reconstruction of hip stability after proximal and total femur resections. Clin Orthop Relat Res. 2000; (375):218-30. DOI: 10.1097/00003086-200006000-00027. View

Futani H, Minamizaki T, Nishimoto Y, Abe S, Yabe H, Ueda T . Long-term follow-up after limb salvage in skeletally immature children with a primary malignant tumor of the distal end of the femur. J Bone Joint Surg Am. 2006; 88(3):595-603. DOI: 10.2106/JBJS.C.01686. View

Wedin R . Surgical treatment for pathologic fracture. Acta Orthop Scand Suppl. 2001; 72(302):2p., 1-29. View

Donati D, Giacomini S, Gozzi E, Mercuri M . Proximal femur reconstruction by an allograft prosthesis composite. Clin Orthop Relat Res. 2002; (394):192-200. DOI: 10.1097/00003086-200201000-00023. View

Kotz R, Dominkus M, Zettl T, Ritschl P, Windhager R, Gadner H . Advances in bone tumour treatment in 30 years with respect to survival and limb salvage. A single institution experience. Int Orthop. 2002; 26(4):197-202. PMC: 3620947. DOI: 10.1007/s00264-002-0365-1. View

Manfrini M, Innocenti M, Ceruso M, Mercuri M . Original biological reconstruction of the hip in a 4-year-old girl. Lancet. 2003; 361(9352):140-2. DOI: 10.1016/S0140-6736(03)12192-7. View

Natarajan M, Bose J, Rajkumar G . Proximal femoral reconstruction with custom mega prosthesis. Int Orthop. 2003; 27(3):175-9. PMC: 3458442. DOI: 10.1007/s00264-003-0451-z. View

ENNEKING W, Spanier S, Goodman M . A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res. 1980; (153):106-20. View

POSINKOVIC B, Orlic D . Prosthetic replacement of the knee in the treatment of infected and recurring giant cell tumor of the distal femur. Arch Orthop Trauma Surg (1978). 1983; 102(2):131-4. DOI: 10.1007/BF02498732. View

10.

Eckardt J, Eilber F, Dorey F, Mirra J . The UCLA experience in limb salvage surgery for malignant tumors. Orthopedics. 1985; 8(5):612-21. DOI: 10.3928/0147-7447-19850501-15. View

11.

Link M, Goorin A, Horowitz M, Meyer W, Belasco J, Baker A . Adjuvant chemotherapy of high-grade osteosarcoma of the extremity. Updated results of the Multi-Institutional Osteosarcoma Study. Clin Orthop Relat Res. 1991; (270):8-14. View

12.

Bacci G, Picci P, Ferrari S, Ruggieri P, Casadei R, Tienghi A . Primary chemotherapy and delayed surgery for nonmetastatic osteosarcoma of the extremities. Results in 164 patients preoperatively treated with high doses of methotrexate followed by cisplatin and doxorubicin. Cancer. 1993; 72(11):3227-38. DOI: 10.1002/1097-0142(19931201)72:11<3227::aid-cncr2820721116>3.0.co;2-c. View

13.

Cara J, Canadell J . Limb salvage for malignant bone tumors in young children. J Pediatr Orthop. 1994; 14(1):112-8. DOI: 10.1097/01241398-199401000-00022. View

14.

Malawer M, Chou L . Prosthetic survival and clinical results with use of large-segment replacements in the treatment of high-grade bone sarcomas. J Bone Joint Surg Am. 1995; 77(8):1154-65. DOI: 10.2106/00004623-199508000-00003. View

15.

Cool W, Carter S, Grimer R, Tillman R, Walker P . Growth after extendible endoprosthetic replacement of the distal femur. J Bone Joint Surg Br. 1997; 79(6):938-42. DOI: 10.1302/0301-620x.79b6.7868. View

16.

Kawai A, Muschler G, Lane J, Otis J, Healey J . Prosthetic knee replacement after resection of a malignant tumor of the distal part of the femur. Medium to long-term results. J Bone Joint Surg Am. 1998; 80(5):636-47. DOI: 10.2106/00004623-199805000-00004. View

17.

Ham S, Schraffordt Koops H, Veth R, van Horn J, Molenaar W, Hoekstra H . Limb salvage surgery for primary bone sarcoma of the lower extremities: long-term consequences of endoprosthetic reconstructions. Ann Surg Oncol. 1998; 5(5):423-36. DOI: 10.1007/BF02303861. View

18.

Sanjay B, MOREAU P . Limb salvage surgery in bone tumour with modular endoprosthesis. Int Orthop. 1999; 23(1):41-6. PMC: 3619769. DOI: 10.1007/s002640050301. View

19.

Abudu A, Grimer R, Tillman R, Carter S . The use of prostheses in skeletally immature patients. Orthop Clin North Am. 2005; 37(1):75-84. DOI: 10.1016/j.ocl.2005.08.008. View

20.

Weisstein J, Goldsby R, ODonnell R . Oncologic approaches to pediatric limb preservation. J Am Acad Orthop Surg. 2005; 13(8):544-54. DOI: 10.5435/00124635-200512000-00007. View