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1
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Öztürk R. Expandable endoprostheses in skeletally immature patients: Where we are. World J Orthop 2024; 15:312-317. [PMID: 38680670 PMCID: PMC11045467 DOI: 10.5312/wjo.v15.i4.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/26/2024] [Accepted: 03/15/2024] [Indexed: 04/16/2024] Open
Abstract
Approximately 45 percent of malignant bone tumors are seen under the age of 16 and one of the important results of growth plate sacrification in patients with immature skeletons is limb inequality. Until the early 1990s, the treatment options for these patients were rotationplasty or amputation. Multimodal approaches that combine imaging, chemotherapy, and surgical techniques have enabled the development of limb-preserving methods with satisfactory results. In order to overcome inequality problems, expandable prostheses have been developed in the 1980s. Extendable endoprosthesis replacements have been improved over the years and are now an established and safe alternative. Noninvasive prostheses appear to be advantageous compared to minimally invasive expandable prostheses that require multiple surgical procedures, but the complication rate remains high. Therefore, although expandable prostheses are not the definitive answer to the treatment of bone sarcomas in skeletally immature children, they are still a suitable interim choice until full adulthood is achieved. Due to reported high complication rates, the procedures require significant experience and are recommended for use only in specialized cancer centers.
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Affiliation(s)
- Recep Öztürk
- Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Essen 45143, Germany
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2
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Trikoupis IG, Mavrodontis II, Papadopoulos DV, Goumenos SD, Georgoulis DA, Gavriil P, Melissaridou D, Savvidou OD, Kontogeorgakos VA, Papagelopoulos PJ. 3D-printed glenoid implant reconstruction, after partial scapulectomy for malignant tumors: a case series. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1557-1562. [PMID: 38280074 PMCID: PMC10980628 DOI: 10.1007/s00590-024-03839-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 01/18/2024] [Indexed: 01/29/2024]
Abstract
PURPOSE Glenoid tumors are extremely rare, and reconstruction remains very challenging. The aim of this study is to present the clinical and functional outcomes, of a new glenoid reconstruction method using 3-dimensional-printed implant. METHODS Four patients with primary glenoid tumors underwent reconstruction using 3-dimensional-printed glenoid implant linked with reverse shoulder arthroplasty. We retrospectively reviewed the clinical and functional outcome, using MSTS and DASH score, as well as complications' rate. RESULTS Wide excision was achieved in all patients. No local recurrence or distant metastasis was diagnosed at the follow-up period. The mean MSTS score was 80.5%, and DASH score was 15.2%. According to Hendersons' classification, there were no postoperative complications. CONCLUSION The use of 3-dimensional-printed implants, can be a very reliable solution with satisfying clinical and functional outcomes for reconstruction, in patients with musculoskeletal malignancies of the glenoid. Level of evidence IV Treatment Study.
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Affiliation(s)
- Ioannis G Trikoupis
- First Department of Orthopedic Surgery and Traumatology, National and Kapodistrian University of Athens, School of Medicine, "ATTIKON" University General Hospital, Rimini 1, Chaidari, 12462, Athens, Greece
| | - Ioannis I Mavrodontis
- First Department of Orthopedic Surgery and Traumatology, National and Kapodistrian University of Athens, School of Medicine, "ATTIKON" University General Hospital, Rimini 1, Chaidari, 12462, Athens, Greece
| | - Dimitrios V Papadopoulos
- Second Department of Orthopedics, National and Kapodistrian University of Athens, 'Agia Olga' Hospital, Th. Konstantopoulou 3-5, Nea Ionia, 14233, Athens, Greece
| | - Stavros D Goumenos
- First Department of Orthopedic Surgery and Traumatology, National and Kapodistrian University of Athens, School of Medicine, "ATTIKON" University General Hospital, Rimini 1, Chaidari, 12462, Athens, Greece
| | - Dimitrios A Georgoulis
- First Department of Orthopedic Surgery and Traumatology, National and Kapodistrian University of Athens, School of Medicine, "ATTIKON" University General Hospital, Rimini 1, Chaidari, 12462, Athens, Greece
| | - Panagiotis Gavriil
- First Department of Orthopedic Surgery and Traumatology, National and Kapodistrian University of Athens, School of Medicine, "ATTIKON" University General Hospital, Rimini 1, Chaidari, 12462, Athens, Greece
| | - Dimitra Melissaridou
- First Department of Orthopedic Surgery and Traumatology, National and Kapodistrian University of Athens, School of Medicine, "ATTIKON" University General Hospital, Rimini 1, Chaidari, 12462, Athens, Greece
| | - Olga D Savvidou
- First Department of Orthopedic Surgery and Traumatology, National and Kapodistrian University of Athens, School of Medicine, "ATTIKON" University General Hospital, Rimini 1, Chaidari, 12462, Athens, Greece
| | - Vasileios A Kontogeorgakos
- First Department of Orthopedic Surgery and Traumatology, National and Kapodistrian University of Athens, School of Medicine, "ATTIKON" University General Hospital, Rimini 1, Chaidari, 12462, Athens, Greece
| | - Panayiotis J Papagelopoulos
- First Department of Orthopedic Surgery and Traumatology, National and Kapodistrian University of Athens, School of Medicine, "ATTIKON" University General Hospital, Rimini 1, Chaidari, 12462, Athens, Greece.
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Portney DA, Bi AS, Christian RA, Butler BA, Peabody TD. Outcomes of Expandable Prostheses for Primary Bone Malignancies in Skeletally Immature Patients: A Systematic Review and Pooled Data Analysis. J Pediatr Orthop 2020; 40:e487-e497. [PMID: 32501921 DOI: 10.1097/bpo.0000000000001459] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Osteosarcoma and other primary bone malignancies are relatively common in skeletally immature patients. Current literature features case series with disparate complication rates, making it difficult for surgeons to educate patients on outcomes after limb salvage with expandable prostheses. This study aims to provide an update on complication rates, mortality, and functional outcomes in patients who undergo limb salvage with expandable prostheses for primary bone malignancies. METHODS A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An exhaustive PubMed/Medline and Cochrane search of peer-reviewed published literature from 1997 to 2017 was performed, yielding a total of 1350 studies. After multiple rounds of review for inclusion and exclusion criteria, 28 retrospective studies were included. All were level IV evidence of case series and retrospective studies. Overall, this included 634 total patients and 292 patients with individual patient data. The primary outcomes studied were complication rates, mortality, and Musculoskeletal Tumor Society (MSTS) functional score. Secondary outcomes included complication rate subtypes, number of lengthening procedures, mean amount lengthened, and prevalence of limb length discrepancies. RESULTS A total of 292 patients with individual patient data averaged 10.1 years at the surgery and had a mean follow-up of 67 months. Two hundred sixteen patients (74%) had tumors of the distal femur. MSTS scores averaged 80.3 and overall mortality was 22%. Patients with distal femur tumors averaged 4.4 lengthening procedures and 43 mm lengthened. Leg length discrepancy (LLD) was 36% overall, which increased with longer periods of follow-up (P<0.001). Overall complication and revision rate was 43%, increasing to 59% in patients with 5 to 10 years of follow-up, and 89% in patients with >10 years of follow-up. Minimally invasive prostheses had lower rates of complications than noninvasive prostheses (P=0.024), specifically mechanical complications (P=0.028), mostly because of increased rates of lengthening and device failure in the noninvasive models (21% vs. 4%, P=0.0004). CONCLUSIONS Despite its limitations, which include entirely heterogenous and retrospective case series data, this systematic review provides clinicians with pooled summary data representing the largest summary of outcomes after reconstruction with expandable prostheses to date. This analysis can assist surgeons to better understand and educate their patients and their families on functional outcomes, mortality, and complication rates after limb-sparing reconstruction with expandable prostheses for primary bone malignancies. LEVEL OF EVIDENCE Level IV-retrospective case series with pooled data.
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Affiliation(s)
- Daniel A Portney
- Feinberg School of Medicine
- Department of Orthopaedic Surgery, University of Chicago, Chicago, IL
| | - Andrew S Bi
- Feinberg School of Medicine
- Department of Orthopaedic Surgery, New York University, New York, NY
| | - Robert A Christian
- Feinberg School of Medicine
- Department of Orthopaedic Surgery, Northwestern University, Evanston
| | - Bennet A Butler
- Feinberg School of Medicine
- Department of Orthopaedic Surgery, Northwestern University, Evanston
| | - Terrance D Peabody
- Feinberg School of Medicine
- Department of Orthopaedic Surgery, Northwestern University, Evanston
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4
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Kurze C, Keel MJB, Kollár A, Siebenrock KA, Klenke FM. The pararectus approach-a versatile option in pelvic musculoskeletal tumor surgery. J Orthop Surg Res 2019; 14:232. [PMID: 31337419 PMCID: PMC6651940 DOI: 10.1186/s13018-019-1275-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 07/10/2019] [Indexed: 11/21/2022] Open
Abstract
Background Pelvic tumors are usually resected through the utilitarian pelvic incision, an extended ilioinguinal/iliofemoral approach. The pararectus approach, an intrapelvic anatomical approach with extraperitoneal access to the pelvis, has been established previously for the treatment of pelvic and acetabular fractures. However, it has not been used to address pelvic tumors. The study aimed at investigating the feasibility of this approach for pelvic tumor surgery and the possibilities of combining this approach with standard approaches to the hip joint. Methods Thirteen patients that underwent pelvic tumor resections were retrospectively reviewed. Tumor resections were performed through the pararectus (n = 10) or extended pararectus approach (n = 3). In six of those cases, the pararectus approach was combined with extrapelvic approaches including the modified Gibson (n = 4), the Kocher-Langenbeck (n = 1), and the trochanteric flip approach (n = 1). The mean follow-up was 32.6 ± 9.1 months. Results In all cases, the tumor resections were carried out according to the preoperative plan. In seven of 13 cases, wide resections were performed; six of 13 cases were planned close resections. Four cases of major complications were observed (vascular injury, deep infection, iliac vein thrombosis, total hip arthroplasty dislocation). Minor complications were observed in two cases. One tumor recurred locally. At the final follow-up, 10 patients were alive, eight of those without evidence of disease. Conclusion The study demonstrated the suitability of the pararectus approach for pelvic tumor resections. The possibility to combine the approach with standard approaches to the hip joint allowed for single-stage reconstructions of the pelvis and the hip joint without sacrificing surgical margins and function. The pararectus approach is a versatile option adding to the established approaches for musculoskeletal tumor surgery of the pelvis.
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Affiliation(s)
- Christophe Kurze
- Department of Orthopedic Surgery, Inselspital, Bern University Hospital, CH-3010, Bern, Switzerland
| | | | - Attila Kollár
- Department of Medical Oncology, Inselspital, Bern University Hospital, CH-3010, Bern, Switzerland
| | - Klaus Arno Siebenrock
- Department of Orthopedic Surgery, Inselspital, Bern University Hospital, CH-3010, Bern, Switzerland
| | - Frank Michael Klenke
- Department of Orthopedic Surgery, Inselspital, Bern University Hospital, CH-3010, Bern, Switzerland.
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Stranix JT, Vranis NM, Lam G, Rapp T, Saadeh PB. Posterior "Open Book" approach for type 1 internal hemipelvectomy. Hip Int 2019; 29:336-341. [PMID: 30465435 DOI: 10.1177/1120700018812415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Internal limb-sparing hemipelvectomy is currently the preferred surgical option for resection of pelvic tumours. Obtaining an acceptable functional outcome through the standard ilioinguinal or iliofemoral incisions, only compounds the already challenging dissection, resection and reconstruction of these extensive en-bloc extirpative oncologic operations. SURGICAL TECHNIQUE We describe a novel surgical approach to the lateral pelvis that minimises injury to the gluteal muscles, spares the gluteal vessels and provides a broad yet shallow operative field conducive to microsurgery with sizeable vasculature in close proximity to facilitate any microsurgical reconstruction. Access to the ilium and sacrum for Enneking Type 1 and Type 4 resections respectively is obtained by reflecting a skin and soft tissue flap anteriorly while the gluteal muscles are reflected posteriorly and inferiorly. This technique minimises the amount of tissue reflected in any particular direction, therefore, providing a broad and shallow operative field which benefits the orthopaedic oncologic surgeon and the plastic reconstructive surgeon. CONCLUSION The "posterior open-book" approach offers a promising alternative to the standard ilioinguinal or iliofemoral incisions for internal limb-sparing Type 1 hemipelvectomies while also optimising the exposure for subsequent reconstructive procedures.
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Affiliation(s)
- John T Stranix
- 1 Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Neil M Vranis
- 1 Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Gretl Lam
- 1 Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Timothy Rapp
- 2 Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Pierre B Saadeh
- 1 Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
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Huang H, Li Y, Wu M, Luo J, Nie J, Hou B, He Q, Diao Y, Qi L, Zhao Y, Liu Y, Yang D, Zhou L. Effects of ethanol on the anticancer function of doxorubicin in JJ012 cells. Future Oncol 2018; 14:1285-1297. [PMID: 29774752 DOI: 10.2217/fon-2017-0547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Chondrosarcoma is difficult to treat because of resistance to conventional chemotherapy and radiotherapy. This study evaluated the effects of ethanol in combination with doxorubicin in chondrosarcoma cells. MATERIALS & METHODS JJ012, was treated with doxorubicin alone or in combination with ethanol. Effects on cellular proliferation, migration, invasion, apoptosis, and the cell cycle were evaluated. RESULTS Treatment of JJ012 cells with 100 mM ethanol and doxorubicin resulted in reduced cell growth, invasion, and migration. In addition, doxorubicin uptake into the nucleus was enhanced and p53 mRNA expression was upregulated in JJ012 cells. CONCLUSION Ethanol combined with doxorubicin increased doxorubicin uptake in the nucleus and enhanced the effects of doxorubicin in JJ012 cells.
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Affiliation(s)
- Hui Huang
- Department of Biochemistry & Molecular Biology, Harbin Medical University, Harbin, PR China.,Translational Medicine Center of Northern China, Harbin Medical University, Harbin, PR China.,Basic Medical Institute of Heilongjiang Medical Science Academy, Harbin, PR China.,Key Laboratory of Cardiovascular Medicine Research (Harbin Medical University), Ministry of Education, Harbin, PR China
| | - Yanze Li
- Department of Biochemistry & Molecular Biology, Harbin Medical University, Harbin, PR China.,Translational Medicine Center of Northern China, Harbin Medical University, Harbin, PR China.,Basic Medical Institute of Heilongjiang Medical Science Academy, Harbin, PR China.,Key Laboratory of Cardiovascular Medicine Research (Harbin Medical University), Ministry of Education, Harbin, PR China
| | - Mingjuan Wu
- Heilongjiang Academy of Traditional Chinese Medicine, Harbin, PR China
| | - Jing Luo
- Department of Biochemistry & Molecular Biology, Harbin Medical University, Harbin, PR China.,Translational Medicine Center of Northern China, Harbin Medical University, Harbin, PR China
| | - Junhui Nie
- Department of Biochemistry & Molecular Biology, Harbin Medical University, Harbin, PR China.,Translational Medicine Center of Northern China, Harbin Medical University, Harbin, PR China
| | - Baoyu Hou
- Department of Biochemistry & Molecular Biology, Harbin Medical University, Harbin, PR China.,Translational Medicine Center of Northern China, Harbin Medical University, Harbin, PR China
| | - Qi He
- Department of Biochemistry & Molecular Biology, Harbin Medical University, Harbin, PR China.,Translational Medicine Center of Northern China, Harbin Medical University, Harbin, PR China
| | - Yan Diao
- Department of Biochemistry & Molecular Biology, Harbin Medical University, Harbin, PR China.,Translational Medicine Center of Northern China, Harbin Medical University, Harbin, PR China
| | - Lin Qi
- Department of Radioimmunossay, Heilongjiang Province Hospital, Harbin, PR China
| | - Yuanyuan Zhao
- Department of Anesthesiology, Heilongjiang Province Hospital, Harbin, PR China
| | - Ying Liu
- Department of Gastroenterology, Heilongjiang Province Hospital, Harbin, PR China
| | - Dan Yang
- Department of Biochemistry & Molecular Biology, Harbin Medical University, Harbin, PR China.,Translational Medicine Center of Northern China, Harbin Medical University, Harbin, PR China.,Basic Medical Institute of Heilongjiang Medical Science Academy, Harbin, PR China.,Key Laboratory of Cardiovascular Medicine Research (Harbin Medical University), Ministry of Education, Harbin, PR China
| | - Lingyun Zhou
- Department of Biochemistry & Molecular Biology, Harbin Medical University, Harbin, PR China.,Translational Medicine Center of Northern China, Harbin Medical University, Harbin, PR China.,Basic Medical Institute of Heilongjiang Medical Science Academy, Harbin, PR China.,Key Laboratory of Cardiovascular Medicine Research (Harbin Medical University), Ministry of Education, Harbin, PR China
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Polychronidou G, Karavasilis V, Pollack SM, Huang PH, Lee A, Jones RL. Novel therapeutic approaches in chondrosarcoma. Future Oncol 2017; 13:637-648. [PMID: 28133974 DOI: 10.2217/fon-2016-0226] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Chondrosarcoma is a malignant tumor of bones, characterized by the production of cartilage matrix. Due to lack of effective treatment for advanced disease, the clinical management of chondrosarcomas is exceptionally challenging. Current research focuses on elucidating the molecular events underlying the pathogenesis of this rare bone malignancy, with the goal of developing new molecularly targeted therapies. Signaling pathways suggested to have a role in chondrosarcoma include Hedgehog, Src, PI3k-Akt-mTOR and angiogenesis. Mutations in IDH1/2, present in more than 50% of primary conventional chondrosarcomas, make the development of IDH inhibitors a promising treatment option. The present review discusses the preclinical and early clinical data on novel targeted therapeutic approaches in chondrosarcoma.
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Affiliation(s)
| | | | - Seth M Pollack
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Paul H Huang
- Division of Cancer Biology, The Institute of Cancer Research, London, UK
| | - Alex Lee
- Sarcoma Unit, Royal Marsden Hospital, London, UK
| | - Robin L Jones
- Sarcoma Unit, Royal Marsden Hospital, London, UK.,Division of Clinical Studies, The Institute of Cancer Research, London, UK
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Liu D, Hua Z, Yan X, Jin Z. Biomechanical analysis of a novel hemipelvic endoprosthesis during ascending and descending stairs. Proc Inst Mech Eng H 2016; 230:962-75. [PMID: 27587536 DOI: 10.1177/0954411916663970] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 07/21/2016] [Indexed: 11/16/2022]
Abstract
In this study, the biomechanical characteristic of a newly developed adjustable hemipelvic prosthesis under dynamic loading conditions was investigated using explicit finite element method. Both intact and reconstructed pelvis models, including pelvis, femur and soft tissues, were established referring to human anatomic data using a solid geometry of a human pelvic bone. Hip contact forces during ascending stairs and descending stairs were imposed on pelvic models. Results showed that maximum von Mises stresses in reconstructed pelvis were 421.85 MPa for prostheses and 109.12 MPa for cortical bone, which were still within a low and elastic range below the yielding strength of Ti-6Al-4V and cortical bone, respectively. Besides, no significant difference of load transferring paths along pelvic rings was observed between the reconstructed pelvis and natural pelvis models. And good agreement was found between the overall distribution of maximum principal stresses in trabecular bones of reconstructed pelvis and natural pelvis, while at limited stances, principal stresses in trabecular bone of reconstructed pelvis were slightly lower than natural pelvis. The results indicated that the load transferring function of pelvis could be restored by this adjustable hemipelvic prosthesis. Moreover, the prosthesis was predicted to have a reliable short- and long-term performance. However, due to the occurrence of slightly lower principal stresses at a few stances, a porous structure applied on the interface between the prosthesis and bone would be studied in future work to obtain better long-term stability.
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Affiliation(s)
- Dongxu Liu
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, P.R. China
| | - Zikai Hua
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, P.R. China
| | - Xinyi Yan
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, P.R. China
| | - Zhongmin Jin
- School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, P.R. China School of Mechanical Engineering, University of Leeds, Leeds, UK
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Li Y, Liao F, Xu HR, Niu XH. Is There a Reliable Method to Predict the Limb Length Discrepancy after Chemotherapy and Limb Salvage Surgery in Children with Osteosarcoma? Chin Med J (Engl) 2016; 129:1912-6. [PMID: 27503014 PMCID: PMC4989420 DOI: 10.4103/0366-6999.187849] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: For a child with osteosarcoma, prediction of the limb length discrepancy at maturity is important when planning for limb salvage surgery. The purpose of this study was to provide a reliable prediction method. Methods: A retrospective review of Chinese children receiving chemotherapy for osteosarcoma before skeletal maturity was conducted. Standing full-length radiographs of the lower extremity were used for length measurements. Length-for-age curves were constructed using the LMS method. The lower limb multiplier for a specific age and gender was calculated using the formula M = Lm/L, where M was the gender- and age-specific multiplier, Lm was the bone length at maturity, and L was the age-specific bone length. Prematurity and postmaturity radiographs were used to assess the accuracy of the prediction methods. Results: A total of 513 radiographs of 131 boys and 314 radiographs of 86 girls were used to calculate the coefficients of the multiplier. The multipliers of 8-, 9-, 10-, 11-, 12-, 13-, 14-, 15-, 16-, 17-, and 18-year-old boys after chemotherapy for osteosarcoma were 1.394, 1.306, 1.231, 1.170, 1.119, 1.071, 1.032, 1.010, 1.004, 1.001, and 1.000, respectively; while for girls at the same ages, the multipliers were 1.311, 1.221, 1.146, 1.092, 1.049, 1.021, 1.006, 1.001, 1.000, 1.000, and 1.000, respectively. Prematurity and postmaturity femoral and tibial lengths of 21 patients were used to assess the prediction accuracy. The mean prediction error was 0 cm, 0.8 cm, and 1.6 cm for the multiplier method using our coefficients, Paley's coefficients, and Anderson's method, respectively. Conclusions: Our coefficients for the multiplier method are reliable in predicting lower limb length growth of Chinese children with osteosarcoma.
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Affiliation(s)
- Yuan Li
- Department of Orthopedic Oncology Surgery, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, Beijing 100035, China
| | - Feng Liao
- Department of Orthopedic Oncology Surgery, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, Beijing 100035, China
| | - Hai-Rong Xu
- Department of Orthopedic Oncology Surgery, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, Beijing 100035, China
| | - Xiao-Hui Niu
- Department of Orthopedic Oncology Surgery, Beijing Jishuitan Hospital, The Fourth Clinical Medical College of Peking University, Beijing 100035, China
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10
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Torner F, Segur JM, Ullot R, Soldado F, Domenech P, DeSena L, Knorr J. Non-invasive expandable prosthesis in musculoskeletal oncology paediatric patients for the distal and proximal femur. First results. INTERNATIONAL ORTHOPAEDICS 2016; 40:1683-1688. [PMID: 26996901 DOI: 10.1007/s00264-016-3163-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 03/06/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE The non-invasive expandable prosthesis for skeletally immature patients is used after limb salvage surgery following tumor resection. The aim of the study was to assess the effectiveness of this treatment. METHODS Seven paediatric patients with femoral tumors had resection and limb salvage with an uncemented non-invasive growing prosthesis. Mean age at the time of surgery was 9.8 (range 8-12) years. There were six distal femur osteosarcomas and one proximal femur Ewing sarcoma. Six total knee prosthesis were implanted at the time of primary tumor resection and one bipolar hip prosthesis was a revision from a failed osteoarticular hip allograft. Functional outcomes and emotional acceptance were assessed using the MSTS score. RESULTS The mean follow-up was 65.3 months (range 29-91) months. Two patients died of pulmonary metastasis and there was no local recurrence. The mean femoral resection was 18 cm (range 17-19) on the knee, and 24 cm on the hip. Mean total expansion was 36.4 mm (range 12.3-63.5). The mean MSTS score after rehabilitation was 26.3 (range 21-29). There was one lengthening device failure, one late infection and one patient who required iliofemoral bypass grafting surgery for a pelvic metastasis. No local recurrence occurred. CONCLUSIONS The non-invasive expandable prosthesis reduces the final limb-length discrepancy in growing patients with an acceptable function and appears to have an advantage as compared to invasive expandable prostheses which require multiple surgical procedures, but the complications rate is still high.
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Affiliation(s)
- Ferran Torner
- Department of Orthopaedics, Hospital Sant Joan de Déu, University of Barcelona, Passeig Sant Joan de Déu, 2, Esplugues de Llobregat, 08950, Barcelona, Spain.
| | - Josep M Segur
- Department of Orthopaedics, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Rosendo Ullot
- Department of Orthopaedics, Hospital Sant Joan de Déu, University of Barcelona, Passeig Sant Joan de Déu, 2, Esplugues de Llobregat, 08950, Barcelona, Spain
| | - Francisco Soldado
- Department of Orthopaedics, Hospital Sant Joan de Déu, University of Barcelona, Passeig Sant Joan de Déu, 2, Esplugues de Llobregat, 08950, Barcelona, Spain
| | - Pedro Domenech
- Department of Orthopaedics, Hospital Sant Joan de Déu, University of Barcelona, Passeig Sant Joan de Déu, 2, Esplugues de Llobregat, 08950, Barcelona, Spain
| | - Lydia DeSena
- Department of Orthopaedics, Hospital Sant Joan de Déu, University of Barcelona, Passeig Sant Joan de Déu, 2, Esplugues de Llobregat, 08950, Barcelona, Spain
| | - Jorge Knorr
- Department of Orthopaedics, Hospital Sant Joan de Déu, University of Barcelona, Passeig Sant Joan de Déu, 2, Esplugues de Llobregat, 08950, Barcelona, Spain
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11
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State-of-the-art approach for bone sarcomas. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2014; 25:5-15. [DOI: 10.1007/s00590-014-1468-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 04/15/2014] [Indexed: 11/26/2022]
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Abstract
OBJECTIVES The objective of the authors was to provide an up-to-date review about the epidemiology, diagnosis, and surgical management of the malignant primary sacral tumors. METHODS A PubMed search was conducted using a combination of the following items: (('Spinal Neoplasms'[Mesh]) AND 'Sacrum'[Mesh]) NOT ('Metastasis' OR 'Metastases' OR 'Benign'). The literature review and the author's own surgical experiences were used to assess the current treatment strategies of the malignant sacral tumors. RESULTS Twenty case series were identified, which studies discuss in detail the surgical strategies, the postoperative complications, the functional and oncologic outcome, and the recurrence-free and disease-specific survival of this rare patient category. DISCUSSION Sacral tumors are rare pathologies. Their management generates a complex medical problem, as they usually are diagnosed in advanced stages with extended dimensions involving the sacral nerves and surrounding organs. The evaluation and complex treatment of these rare tumors require a multidisciplinary approach, optimally at institutions with comprehensive care and experience. Although conventional oncologic therapeutic methods should be used as neoadjuvant or adjuvant therapies in certain histological types, en bloc resection with wide surgical margins is essential for long-term local oncologic control. This is often technically difficult to achieve, as just a few centers in the world perform sacral tumor surgeries on a regular basis, and have enough wide experience. Therefore international cooperation and organization of multicenter tumor registries are essential to develop evidence based treatment protocols.
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