Revision for Aseptic Loosening of Tumor Prosthesis in Lower Limbs / 肿瘤防治研究

Objective To determine the prosthesis survival and limb function after revision of global modular replacement system (GMRS) tumor prosthesis. Methods We retrospectively analyzed the clinical data of 16 patients who developed aseptic loosening of lower extremity tumor prosthesis and subsequently received revision with GMRS from 2009 to 2012. Kaplan-Meier method was used to calculate the 5- and 8-year survival rates of the prosthesis. The MSTS function scale was used to evaluate the functional outcomes. Results The average follow-up time was 90 months (52-118 months). The 5- and 8-year survival rates of GMRS prosthesis were both 94%. After revision, two patients failed, including one case of infection and one case of repeated aseptic loosening. The average interval between the first joint replacement and revision surgery was 81 months (27-187 months). Until the last follow-up, 93.3%(14/15) of the patients did not develop repeated aseptic loosening, 85.7%(12/14) of the patients who underwent GMRS revision had a longer loosening-free survival than those with the primary joint replacement (90.6±19.3 vs. 43.4±29.7 months, P=0.001). The average MSTS functional score was 27.7(24-30). Conclusion The incidence of repeated aseptic loosening for GMRS prosthesis is low and the limb function is good. The reported technique is satisfactory in the middle and long term.

Prótesis tumoral de cadera en displasia fibrosa de fémur proximal. Informe de un caso / Tumor hip prosthesis in fibrous dysplasia of proximal femur. Case report

Resumen: Antecedentes: La displasia fibrosa se caracteriza por la formación de tejido fibroso inmaduro que genera trabéculas mal formadas. Su afectación puede ser monostótica o poliostótica. Caso clínico: Femenino de 30 años con displasia fibrosa de cadera izquierda. A los 15 años sufre fractura de la misma cadera sin trauma aparente, manejada conservadoramente y con acortamiento importante de la misma extremidad. A los 30 años de edad se embaraza, presenta dolor en cadera izquierda y se exacerba la deformidad y el acortamiento. La radiografía simple muestra deformidad en «cayado de pastor¼, se manejó con bifosfonatos y la tomografía corrobora los hallazgos anteriores. Posteriormente sufrió caída con fractura subtrocantérica de cadera izquierda en sitio de displasia, imagen de vidrio despulido de apariencia quística que involucra el cuello femoral, zona trocantérica y subtrocantérica. Se colocó prótesis tumoral de cadera izquierda, a los cuatro meses mostró evolución favorable. Conclusión: La prótesis tumoral femoral reduce la deformidad, mejora la longitud y disminuye el dolor en pacientes con resección de displasia fibrosa de cadera.

Abstract: Background: Fibrous dysplasia is characterized by the formation of fibrous tissue that generates immature malformed trabeculae. Their involvement may be monostotic or poliostotic. Case report: Thirty years old female with fibrous dysplasia of the left hip. At age 15 suffered hip fracture without apparent trauma, she was managed conservatively and significant shortening of the same limb was observed. At 30 years old, is pregnant, it had left hip pain, deformity and shortening is exacerbated. Simple radiography showed «shepherd's crook deformity¼, she was treated with bisphosphonates. Computed axial tomography corroborates previous findings. She subsequently underwent subtrochanteric fracture fall with left hip dysplasia site, ground glass image of cystic appearance involving the femoral neck, trochanteric and subtrochanteric area. Tumor prosthesis of the left hip was implanted, four months evolution was favorable. Conclusion: Modular hip prosthesis system, reduces deformity, improves length and reduces pain in patients with resection of fibrous dysplasia of the hip.

Locking Mechanism Failure after Distal Femoral Reconstruction with Modular Universal Tumor and Revision System (MUTARS) Tumor Prosthesis / 대한정형외과학회잡지

PURPOSE: We have used Modular Universal Tumor and Revision System (MUTARS) tumor prosthesis to reconstruct segmental resection defect of the distal femur. The purpose of this study was to evaluate the incidence and pattern of locking mechanism breakage and its correlation with other clinical variables. MATERIALS AND METHODS: We retrospectively reviewed 94 patients who were followed-up for more than one year after tumor prosthesis replacement (MUTARS) between 2008 and 2013. We examined the incidence and timing of locking mechanism (PEEK-OPTIMA) failure. We also evaluated the clinical characteristics of patients experiencing locking mechanism failure and compared them with those of other patients. RESULTS: At a mean follow-up of 55 months, we observed locking mechanism failure in 10 of 94 patients (10.6%). The mean age of patients with locking mechanism failure was 29 years (range, 13-54 years); the mean weight and height were 169 cm (range, 151-181 cm) and 67 kg (range, 53-89 kg), respectively. The mean body mass index was 23.5 kg/m² (range, 20.5-29.4 kg/m²). The median time interval between replacement and locking mechanism failure was 26.5 months (range, 12-72 months). The mean body weight of patients with failure was higher than that of patients without failure (p=0.019). CONCLUSION: The incidence of locking mechanism (PEEK-OPTIMA) failure after distal femoral reconstruction with MUTARS was 11%, and there was a correlation between failure and body weight of patients. Advancements in the design and material of locking mechanisms are warranted to reduce the complication.

Limb Salvage Surgery with Tumor Prosthesis for the Malignant Bone Tumors Involving the Proximal Femur / 대한골관절종양학회지

PURPOSE: As well as patient survival, the restoration of postoperative function such as ambulation is important in limb salvage operations for treatment of malignant bone tumors involving the proximal femur. The authors analyzed clinical outcomes of limb salvage operations using tumor prostheses for metastatic or primary malignant bone tumors in the proximal femur. MATERIALS AND METHODS: From February 2005 to January 2014, 20 cases (19 patients) with malignant bone tumor involving the proximal femur with pain or complicated pathologic fracture were treated with segmental resection and limb salvage operations with tumor prostheses. Mean age was 63.1 years (range 35-86). Fourteen patients were male and six ones were female. The mean follow-up period was 20 months (1-94 months). There were 15 cases of metastatic bone tumor, 4 cases of osteosarcoma, and 1 case of multiple myeloma. The primary tumors of the metastatic bone tumors included 4 lung cancers, 3 hepatocellular carcinomas, and 3 renal cell carcinomas. Other primary tumors were breast cancer, thyroid cancer, colon cancer, prostate cancer, and malignant spindle cell tumor, each in 1 case. Modular tumor prostheses were used in all cases; (Kotz's(R) Modular Tumor prosthesis (Howmedica, Rutherford, New Jersey) in 3 cases, MUTARS(R) proximal femur system (Implantcast, Munster, Germany) in 17 cases). Perioperative pain was assessed with Visual Analogue Scales (VAS). Postoperative functional outcome was assessed with Musculoskeletal Tumor Society (MSTS) grading system. RESULTS: Out of 20 cases (19 patients), 11 cases (10 patients) survived at the last follow-up. Average postoperative survival of the 9 deceased patients was 10.1 months (1-38 months). VAS score improved from pre-operative average of 8.40 (5-10) to 1.35 (0-3) after operation. Average postoperative MSTS function score was 19.65 (65.50%, 7-28). The associated complications were 2 local recurrences, 3 hematomas, 3 infections, 2 scrotal swellings, and 1 dislocation. There was no case of periprosthetic fracture or loosening. CONCLUSION: Limb salvage operation with tumor prosthesis is an appropriate treatment for early pain reduction and functional restoration in malignant bone tumors in the proximal femur with pain an/or complicated pathologic fractures.

Outcome of Tumor Prosthetic Reconstruction in Osteosarcoma Patient / 대한골관절종양학회지

PURPOSE: Modular tumor prosthesis is the most popular recontructive modality after resection of malignat tumor in extremity. Complications and survival of tumor prosthesis reconstruction are well-known. however, reports on the long-term outcome of tumor prosthesis in osteosarcoma patientss are scarece. MATERIALS AND METHODS: In 158 cases as diagnosed as osteosarcoma from feburary 1989 to December 2006 in a single cancer center. We retrospectively reviewd 48 osteosarcoma patients who under went tumor prosthetic reconstruction. Mean follow up preiod was 75.6 months (range; 60 to 179 months). There were 28 males, 20 females and mean age was 22.4 years (range; 11-71). Pathologic subtypes were conventional central osteosarcoma in 46 cases and periosteal in 2 cases. The location of the tumor was proximal tibia (26 cases), distal femor (20 cases), femor diaphysis (1 case), and tibia diaphysis (1 case). In 41 cases built-up-type tumor prosthesis have been used and 7 cases expansion-type tumor prosthesis have been used. We used Musculoskeletal tumor society (MSTS) grading system to asses post operation function, and we analyzed survival rate of patient and tumor prosthesis and complication. RESULTS: The overall survival rate was 77.7% and disease free survival rate was 68.9%. The survival rate of tumor prosthesis was 73%, in last follow up tumor prosthesis has been removed in 12 cases. All of them, 17 complications occurred, which included infection in 16 cases, Periprosthetic Fracture and Loosening of tumor prosthesis in 4 cases, articular instability in 4 cases. MSTS functional score was 74.1% in post operation. CONCLUSION: In long term follow up result, Primary tumor prosthesis -a reconstruction method after a wide extensional resecion of a bone tumor- can be a effective treatment method in asepect of survival rate, functional assesment and complication.

Treatment of Infected Tumor Prosthesis in Malignant Bone Tumor / 대한정형외과학회잡지

PURPOSE: The analysis points used in this study were the features, durations, and outcomes following different treatment modalities for an infected tumor prosthesis (TP). These were used to define an appropriate strategy for infected TP. MATERIALS AND METHODS: From December 1986 to November 1999, 215 patients underwent a TP replacement operation in our hospital, and 17 patients with an infected TP were eligible for the study. Forty-two operative procedures were performed on 17 patients (scarectomy 11 cases, partial TP removal and bone cementation 9 cases, complete TP removal and bone cementation 20 cases, and amputation 2 cases). Freedom from infection was defined as no sign of inflammation for 3 months after the operation and its objective variables were CRP, ESR, physical examination, and culture free body fluid. Although one patient received several procedures, we considered each event as a separate variable. The survival rates of the procedures were analysed by Kaplan-Meier plots and these were compared using the log rank test. RESULTS: The cumulative survival of each procedure was 0% by scarectomy at 11 months, 0% by partial TP removal and bone cementation at 12 months, and 34% by complete TP removal and bone cementation at 79 months. Significant differences in survival were found for these procedures (p<.001). CONCLUSION: Aggressive initial management reduces patient's pain and increases the chance of returning to the original functional status.

Functional Evaluation of Tumor Prosthetic Arthroplasty for the Malignant Bone Tumor around the Knee: Interim Report / 대한정형외과학회잡지

With the recent development of tumor prosthesis, limb salvage technique has attributed to the preservation of the limb function in patients with malignant bone tumors around the knee without substantial difference of local recurrence and the survival rate. From Feb., 1991 to Sep., 1992, 9 patients were treated with limb salvage operation with total knee arthroplasty due to the malignant bone tumor around the knee at Dept. of Orthopedic Surgery, Kyungpook National University Hospital. We applied the above procedure mainly to young adult whose tumor was expected to be excised wide marginally without damaging major neurovascular structures. We evaluated the functional status of all 9 patients(4 osteosarcoma, 2 chodrosarcoma, 2 malignant fibrohistiocytoma, 1 malignant giant cell tumor) to estimate the efficacy of limb salvage operation with tumor prosthesis total knee arthroplasty. Mean follow up period was 10 months. Primary tumor site was 4 in distal femur, 5 in proximal tibia and stage was 4 IIa, 5 IIb. Range of the motion of knee is maximum 0°

Treatment of Malignant Bone Tumors by Tumor Prosthesis / 대한정형외과학회잡지

Limb salvage operation was introduced to treat, low grade malignant bone tumors about 100 years ago. However, amputation has been the most popular choice for primary malignant bone tumors. Recent improvement of chemotherapy, diagnostic methods and surgical techniques enabled us to treat more malignant bone tumors such as osteogenic sarcoma with limb salvage operation. 6 cases of malignant bone tumors were treated with wide resection and tumor prosthesis from Oct., 1987 to Jan., 1989 at Dept. of Orthopedic Surgery, Seoul National University Hospital. 4 cases of osteosarcoma, 1 case of parosteal osteosarcoma and 1 case of chondrosarcoma were identified. MRI was useful for determining the extent of tumor and surgical planning. All the patients osteosarcoma had neoadjuvant chemotherapy. The mean follow-up was 14.5 months ranging from 8 to 22 months, and theirresults are so far good except one pulmonary metastasis and one local recurrence. We present this as a preliminary report.