ABSTRACT
Objective@#To investigate the operative method and clinical application of the BARD® Mesh in enhancing joint stability and function of endoprosthetic reconstruction for bone tumors.@*Methods@#From Jan 2013 to Jun 2015, the clinical data of 51 patients aged (44.75±23.18) years underwent wide resection of tumor and endoprosthetic reconstruction using the BARD® Mesh were collected. Among them, 27 were male and 24 were female. The surgical treatments received by these patients included 5 shoulder arthroplasties, 12 elbow replacements, 12 hip replacements and 32 knee replacements (including 24 femoral tumors and 8 tibial tumors). According to the pathologic type, there were 12 metastatic tumors, 20 osteosarcomas, 7 chondrosarcomas, 5 malignant fibrous histiocytomas, 4 giant cell tumors of bone, 1 Ewing sarcoma, 1 leiomyosarcoma and 1 pigmented villonodular synovitis (pvns). These patients received extensive tumor resection, tumorous prosthesis replacement, preserved articular capsule and muscles repair with artificial mesh and endoprosthesis wrapping. The curative effect including joints range of motion and Musculoskeletal Tumour Society Scores (MSTS) were evaluated.@*Results@#The median follow-up time was (19.75±8.17) months. The drainages were removed out on an average of 4 days after operation. The postoperative complications included 2 superficial incision infection, 1 deep incision infection and 1 osteofascial compartment syndrome, infection or dislocation of prosthesis wasn′t observed. The mean active flexion of shoulder joint after replacement was (34.00±10.84)°, mean active abduction was (20.00±9.35)° and the mean MSTS was 19.80±9.54. The superior rate of shoulder flexion function was 0. The mean active flexion of elbow joint after replacement was (75.00±7.07)°, mean active abduction was (-5.00±7.07)° and the mean MSTS was 25.00±2.83. The superior rate of elbow flexion function was 50.0% (1/2). The mean active flexion of hip joint after replacement was (86.67±20.60)°, mean active abduction was (2.08±4.98)° and the mean MSTS was 25.42±1.78. The superior rate of hip flexion function was 83.3% (10/12). The mean active flexion of knee joint after replacement was (89.69±22.39)°, mean active abduction was (-0.63±1.68)° and the mean MSTS was 23.31±2.09. The superior rate of knee flexion function was 50.0%(16/32). Among them, the superior rate of femoral flexion function was 66.7% (16/24), the superior rate of tibial flexion function was 0. All of patients were satisfied with the curative effect of operation at the end of follow-up time.@*Conclusions@#The BARD® Mesh may enhance the attachment of soft-tissue to endoprosthesis, improve the joint stability, decrease the endoprosthetic infection and dislocation, facilitate the attachment of tendon to endoprosthesis and recover the muscular motivation after endoprosthetic reconstruction. This plays an important role in joint stability and motivation reconstruction of soft-tissue impairment, effectively prevents surgical complications.
ABSTRACT
Giant cell tumour is a commonly occurring benign bone tumour in the Indian population. The common sites of involvement in descending order of frequency are distal femur, proximal tibia, distal radius and proximal humerus. The less commonly occurring sites are distal humerus, pelvis and proximal femur. We present six cases of giant cell tumour involving the distal humerus in rural India. After obtaining a tissue diagnosis by Trucut biopsy and classifying using Enneking's classification, we proceeded to perform wide resection followed by endoprosthetic reconstruction using custom mega prosthesis. We present here six patients (M: F: 2: 4) who were managed by us between 2008-2014. They presented to us with pain around the elbow and restriction in range of movements. They were each noted radiographically to have a lytic lesion involving the distal humerus with the likely diagnosis of giant cell tumour. Closed biopsy was done in all of them to obtain a definitive diagnosis. All patients underwent wide resection and reconstruction using distal humerus custom prosthesis. All patients were followed up at 6, 12, 18 and 24 weeks and thereafter six monthly until the last review. They were assessed using the DASH scoring system. All patients were well with no evidence of recurrence with good to fair functional outcome. We conclude that careful pre-operative planning with meticulous soft tissue dissection and good implant metallurgy and design, these tumours can be treated with good long term functional results.
ABSTRACT
Endoprosthetic replacement is the most frequently used surgical method for the skeletal reconstruction in the limb salvage surgery for malignant bone tumors. Modular prostheses are generally used for typical locations such as distal and proximal femur, proximal tibia and proximal humerus. Expandable prosthesis is used to overcome leg length discrepancy in growing children. Aseptic loosening, infection and mechanical failure are major complications resulting in revision surgery. Many efforts should be made to develop more durable and functional implants to improve the quality of life of sarcoma survivors.