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Bone & Joint Open
Vol. 3, Issue 9 | Pages 733 - 740
21 Sep 2022
Sacchetti F Aston W Pollock R Gikas P Cuomo P Gerrand C

Aims

The proximal tibia (PT) is the anatomical site most frequently affected by primary bone tumours after the distal femur. Reconstruction of the PT remains challenging because of the poor soft-tissue cover and the need to reconstruct the extensor mechanism. Reconstructive techniques include implantation of massive endoprosthesis (megaprosthesis), osteoarticular allografts (OAs), or allograft-prosthesis composites (APCs).

Methods

This was a retrospective analysis of clinical data relating to patients who underwent proximal tibial arthroplasty in our regional bone tumour centre from 2010 to 2018.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XIV | Pages 58 - 58
1 Apr 2012
Funovics P Edelhauser G Kubista B Kotz R Dominkus M
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Aim. Preoperative serum CRP has been identified as an independent predictor in various malignancies. For osteosarcoma, however, the value of serological markers is unreliable. Aim of this study was to evaluate the prognostic power of preoperative CRP in patients with osteosarcoma. Method. Out of our prospective database, 87 patients with osteosarcoma (43 female, 44 male with an average age of 20.4 years) have been identified with complete documentation of peri-operative CRP-levels, a minimum two year follow-up and after exclusion of concomitant infection, smoking-history or cardio-vascular disease. Pre-operative CRP before tumour resection was correlated with clinical and pathological factors, overall survival and infection rates in an uni- and multi-variate statistical model with and without landmark analysis. Results. Mean pre-operative serum CRP was 0.73mg/dL (range 0.0 to 8.5) and significantly correlated with overall survival, age at time of operation and histological subtype, but not with sex, tumour grading, response to chemotherapy, recurrent disease or post-operative infection in uni-variate analysis. Patients with CRP <1mg/dL had a five year overall survival of 70% compared to 43% for patients with CRP >1mg/dL (p=0.023). In multi-variate analysis both age and pre-operative CRP had an independent significant influence on overall survival. The hazard ratio for patients with elevated levels of CRP was 1.252. In a subgroup analysis of 60 patients with endoprosthetic replacement, pre-operative CRP was no significant predictor for deep prosthetic infection and infection was no significant predictor for overall survival with and without landmark-analysis though patients with infection showed lower levels of CRP. However, this difference was not significant. Conclusion. Pre-operative serum CRP is an independent prognostic factor for overall survival of patients with osteosarcoma, but not for infection. Its role in predicting response to established chemotherapies, as well as the controversially discussed impact of infection on survival will remain subject of multi-centre investigations


Bone & Joint Research
Vol. 9, Issue 7 | Pages 333 - 340
1 Jul 2020
Mumith A Coathup M Edwards TC Gikas P Aston W Blunn G

Aims

Limb salvage in bone tumour patients replaces the bone with massive segmental prostheses where achieving bone integration at the shoulder of the implant through extracortical bone growth has been shown to prevent loosening. This study investigates the effect of multidrug chemotherapy on extracortical bone growth and early radiological signs of aseptic loosening in patients with massive distal femoral prostheses.

Methods

A retrospective radiological analysis was performed on adult patients with distal femoral arthroplasties. In all, 16 patients were included in the chemotherapy group with 18 patients in the non-chemotherapy control group. Annual radiographs were analyzed for three years postoperatively. Dimensions of the bony pedicle, osseointegration of the hydroxyapatite (HA) collar surface, bone resorption at the implant shoulder, and radiolucent line (RLL) formation around the cemented component were analyzed.


The Bone & Joint Journal
Vol. 102-B, Issue 1 | Pages 64 - 71
1 Jan 2020
Tsuda Y Fujiwara T Stevenson JD Parry MC Tillman R Abudu A

Aims

The purpose of this study was to report the long-term results of extendable endoprostheses of the humerus in children after the resection of a bone sarcoma.

Methods

A total of 35 consecutive patients treated with extendable endoprosthetic replacement of the humerus in children were included. There were 17 boys and 18 girls in the series with a median age at the time of initial surgery of nine years (interquartile range (IQR) 7 to 11).


The Bone & Joint Journal
Vol. 100-B, Issue 1 | Pages 101 - 108
1 Jan 2018
Stevenson JD Kumar VS Cribb GL Cool P

Aims

Dislocation rates are reportedly lower in patients requiring proximal femoral hemiarthroplasty than for patients undergoing hip arthroplasty for neoplasia. Without acetabular replacement, pain due to acetabular wear necessitating revision surgery has been described. We aimed to determine whether wear of the native acetabulum following hemiarthroplasty necessitates revision surgery with secondary replacement of the acetabulum after proximal femoral replacement (PFR) for tumour reconstruction.

Patients and Methods

We reviewed 100 consecutive PFRs performed between January 2003 and January 2013 without acetabular resurfacing. The procedure was undertaken in 74 patients with metastases, for a primary bone tumour in 20 and for myeloma in six. There were 48 male and 52 female patients, with a mean age of 61.4 years (19 to 85) and median follow-up of two years (interquartile range (IQR) 0.5 to 3.7 years). In total, 52 patients presented with a pathological fracture and six presented with failed fixation of a previously instrumented pathological fracture.


The Bone & Joint Journal
Vol. 99-B, Issue 6 | Pages 841 - 848
1 Jun 2017
Hipfl C Stihsen C Puchner SE Kaider A Dominkus M Funovics PT Windhager R

Aims

Pelvic reconstruction after the resection of a tumour around the acetabulum is a challenging procedure due to the complex anatomy and biomechanics. Several pelvic endoprostheses have been introduced, but the rates of complication remain high. Our aim was to review the use of a stemmed acetabular pedestal cup in the management of these patients.

Patients and Methods

The study involved 48 patients who underwent periacetabular reconstruction using a stemmed pedestal cup (Schoellner cup; Zimmer Biomet Inc., Warsaw, Indiana) between 2000 and 2013. The indications for treatment included a primary bone tumour in 27 patients and metastatic disease in 21 patients. The mean age of the patients at the time of surgery was 52 years (16 to 83).


Bone & Joint 360
Vol. 1, Issue 4 | Pages 36 - 36
1 Aug 2012
Carey Smith R Wood D


The Journal of Bone & Joint Surgery British Volume
Vol. 88-B, Issue 6 | Pages 790 - 795
1 Jun 2006
Ahlmann ER Menendez LR Kermani C Gotha H

We reviewed retrospectively the results in 211 consecutive patients who had undergone limb salvage for bone neoplasia with endoprosthetic reconstruction of the proximal femur (96), distal femur (78), proximal tibia (30) and total femur (7). Their mean age was 50 years (11 to 86) and the mean follow-up period was 37.3 months (1 to 204). A total of 35 (16.6%) prostheses failed. Overall, implant survival was 78% (95% confidence interval (CI) 0.29 to 0.54) at five years, 60% (95% CI 0.93 to 2.35) at ten years and 60% (95% CI 1.27 to 3.88) at 15 years. Survivorship of the limb was 97.6% (95% CI 1.73 to 3.35) at ten years. The gender, age, diagnosis and location of the tumour were not prognostic variables for failure. Modular endoprosthetic replacement in the lower limb is a durable long-term reconstructive option, with the implants generally outlasting the patient.