Aims. The aim of this study was to characterize the factors leading to
Patients with
Aims. Prior cost-effectiveness analyses on osseointegrated prosthesis for transfemoral unilateral amputees have analyzed outcomes in non-USA countries using generic quality of life instruments, which may not be appropriate when evaluating disease-specific quality of life. These prior analyses have also focused only on patients who had failed a socket-based prosthesis. The aim of the current study is to use a disease-specific quality of life instrument, which can more accurately reflect a patient’s quality of life with this condition in order to evaluate cost-effectiveness, examining both treatment-naïve and socket refractory patients. Methods. Lifetime Markov models were developed evaluating active healthy middle-aged male amputees. Costs of the prostheses, associated complications, use/non-use, and annual costs of arthroplasty parts and service for both a socket and osseointegrated (OPRA) prosthesis were included. Effectiveness was evaluated using the questionnaire for persons with a
Aims. The aim of this study was to compare the cost-effectiveness of
treatment with an osseointegrated percutaneous (OI-) prosthesis
and a socket-suspended (S-) prosthesis for patients with a transfemoral
amputation. Patients and Methods. A Markov model was developed to estimate the medical costs and
changes in quality-adjusted life-years (QALYs) attributable to treatment
of unilateral
Introduction. Transtibial osseointegration (TFOI) for amputees has limited but clear literature identifying superior quality of life and mobility versus a socketed prosthesis. Some amputees have knee arthritis that would be relieved by a total knee replacement (TKR). No other group has reported performing a TKR in association with TTOI (TKR+TTOI). We report the outcomes of nine patients who had TKR+TTOI, followed for an average 6.5 years. Materials & Methods. Our osseointegration registry was retrospectively reviewed to identify all patients who had TTOI and who also had TKR, performed at least two years prior. Four patients had TKR first the TTOI, four patients had simultaneous TKR+TTOI, and one patient had 1 OI first then TKR. All constructs were in continuity from hinged TKR to the prosthetic limb. Outcomes were: complications prompting surgical intervention, and changes in daily prosthesis wear hours, Questionnaire for Persons with a Transfemoral Amputation (QTFA), and Short Form 36 (SF36). All patients had clinical follow-up, but two patients did not have complete survey and mobility tests at both time periods. Results. Six (67%) were male, average age 51.2±14.7 years. All primary amputations were performed to manage traumatic injury or its sequelae. No patients died. Five patients (56%) developed infection leading to eventual
Observing a decreasing number of
Noting a decreasing number of
Aims. The aim of this study was to describe implant and patient-reported outcome in patients with a unilateral
Rates of prosthetic joint infection in megaprostheses are high. The application of silver ion coating to implants serves as a deterrent to infection and biofilm formation. A retrospective review was performed of all silver-coated MUTARS endoprosthetic reconstructions (SC-EPR) by a single Orthopaedic Oncology Surgeon. We examined the rate of component revision due to infection and the rate of infection successfully treated with antibiotic therapy. We reviewed overall revision rates, sub-categorised into the Henderson groupings for endoprosthesis modes of failure (Type 1 soft tissue failure, Type 2 aseptic loosening, Type 3 Structural failure, Type 4 Infection, Type 5 tumour progression). 283 silver-coated MUTARS endoprosthetic reconstructions were performed for 229 patients from October 2012 to July 2022. The average age at time of surgery was 58.9 years and 53% of our cohort were males. 154 (71.3%) patients underwent SC-EPR for oncological reconstruction and 32 (14.8%) for reconstruction for bone loss following prosthetic joint infection(s). Proximal femur SC-EPR (82) and distal femur (90) were the most common procedures. This cohort had an overall revision rate of 21.2% (60/283 cases). Component revisions were most commonly due to Type 4 infection (19 cases), Type 2 aseptic loosening/culture negative disease (15 cases), and Type 1 dislocation/soft tissue (12 cases). Component revision rate for infection was 6.7% (19 cases). 15 underwent exchange of implants and 4 underwent
A retrospective case control study of all rehabilitated patients who suffered amputations of the lower extremity by sepsis was performed in the HELIOS centre of rehabilitation for amputees, Bad Berleburg, Germany. This study examines patients who had undertaken an amputation of the lower extremity caused by severe sepsis and septic shock. Methods: Case control study. The clinical reports of 448 patients with amputations of the lower extremity clinically rehabilitated from 2010 to 2013 were systematically and statistically evaluated. Sepsis is classified in 4 categories: SIRS, sepsis, severe sepsis and septic shock. Epidemiology: The mean age of the amputees was 61.33 years, with 25 men and 11 women. Marital status: 16 patients are married (44.44%), 7 divorced, 5 widowed, 7 unmarried, 1 unknown. 24 patients are retired (66.67%). School-leaving qualifications: 22 elementary school (61.11%), 8 secondary school, 1 high school, 5 unknown. Health insurance: AOK 10 patients (27.77%), BEK 7 patients (19.44%), pension insurance 9 patients (25.0%). The medial time of hospitalization in the clinic for rehabilitation of the amputated patients suffering sepsis was 27.23 days. Results: 36 patients, – 8.03 % of all – with 39 amputations, suffered a loss of the lower extremity caused by severe sepsis and septic shock: 1 patient suffered an exarticulation of both hips, 20 patients suffered a
This is a retrospective study of survivors of
recent conflicts with an open fracture of the femur. We analysed
the records of 48 patients (48 fractures) and assessed the outcome.
The median follow up for 47 patients (98%) was 37 months (interquartile
range 19 to 53); 31 (66%) achieved union; 16 (34%) had a revision
procedure, two of which were
Brånemark R, Berlin Ö, Hagberg K, Bergh P, Gunterberg B, Rydevik B. A novel osseointegrated percutaneous prosthetic system for the treatment of patients with
This study aimed to characterise severe open femoral fractures sustained by military personnel and to describe their orthopaedic management and preliminary outcomes. The UK Military Trauma Registry was searched for open femoral fractures sustained between 2006–2010. Clinical records and radiographs were reviewed and data gathered on demographics, injury, management and preliminary outcomes. Thirty-four patients with 34 open femoral fractures were eligible for inclusion. The mean NISS was 22.4 (SD 12.28). Nineteen fractures were caused by gunshot wounds (56%), with the remainder due to blasts. Three patients (9%) suffered Grade 4 segmental bone loss. Intramedullary nailing was used in 22 patients (69%). A minimum of 12 month follow up was available for 33 patients (97%). Twenty-three patients (70%) had achieved fracture union within the first twelve months. One patient suffered deep infection requiring surgical debridement. Ten patients (30%) underwent a revision procedure due to femoral shortening or malunion: two required a
Total femoral arthroplasty (TFA) is a rare procedure used in cases of significant femoral bone loss, commonly from cancer, infection, and trauma. Low patient numbers have resulted in limited published work on long-term outcomes, and even less regarding TFA undertaken for non-oncological indications. The aim of this study was to evaluate the long-term clinical outcomes of all TFAs in our unit. Data were collected retrospectively from a large tertiary referral revision arthroplasty unit’s database. Inclusion criteria included all patients who underwent TFA in our unit. Preoperative demographics, operative factors, and short- and long-term outcomes were collected for analysis. Outcome was defined using the Musculoskeletal Infection Society (MSIS) outcome reporting tool.Aims
Methods
Aim. The first osseointegrated
We retrospectively reviewed 19 femoral non-unions. Age group ranged from 17–72 yrs with mean of 40 yrs. 12 were men and 7 were women. 11 fractures involved diaphysis and 8 involved supracondylar area. 5 cases were infected non-unions. Time from fracture to defini-tive treatment varied from 5 to 88 months (mean 21 months). Open technique was used in 18 cases. In 8 cases we have used autogenous cancellous bone graft and in 3 cases BMP7 was used in addition to bone graft. 9 cases were treated with Ilizarov frame without bone graft, 6 with plate &
bone graft, 3 with intramedullary nail and 1 with bone graft alone. Internal bone transport was carried out in 5 cases to achieve limb length equality. Fracture union was achieved in 16 patients with 7 excellent and 8 good results as per ASAMI criteria. 15 cases achieved excellent to good functional results. Because of persistent infection, 2 distal femoral non-unions required
Aim and methods: We present our results on the treatment an outcome of femoral non-unions in our institution as tertiary referral centre. Retrospective analysis was performed using the ASAMI criteria. Results: 19 patients, 12 men and 7 women were retrospectively assessed. Mean age was 40 years (range 17–72). 11 fractures were in the diaphysiseal area and 8 were in the supracondylar area. 5 cases were infected non-unions. Time from fracture to definitive treatment varied from 5 to 88 months (mean 21 months). Open technique was used in 18 cases. In 8 cases we have used autogenous cancellous bone graft and in 3 cases BMP7 was used in addition to bone graft. 9 cases were treated with Ilizarov frame without bone graft, 6 with plate and bone graft, 3 with intramedullary nail and 1 with bone graft alone. Internal bone transport was carried out in 5 cases to achieve limb length equality. Fracture union was achieved in 16 patients with 7 excellent and 8 good results as per ASAMI criteria. 15 cases achieved excellent to good functional results. Because of persistent infection, 2 distal femoral non-unions required
Purpose. Rotationplasty was first described in 1930 by Borggreve for treatment of limb shortening with knee ankylosis after tuberculosis. In 1948, Van Nes described its use for management of congenital defects of the femur and in the 1980s, Kotz and Salzer reported on patients with malignant bone tumors around the knee treated by rotationplasty as an alternative to above-knee amputation. Currently, rotationplasty is one of the options for surgical management of lower extremity bone sarcomas in skeletally immature patients but alternative limb salvage techniques, such as the use of expandable endoprosthesis, are also available. Despite rather satisfactory functional results have been uniformly associated with rotationplasty, concern still exists about the potential psychological impact of the new body imagerelated to the strange appearance of the rotated limb. Results of rotationplasty for sarcomas of the distal femur over a 20-year period were analyzed, focusing on long-term survival, function, quality of life and mental health. Method. Retrospective study of 73 children who had a rotationplasty performed at two institutions between 1984 and 2007 for a bone sarcoma of the distal femur; 42 males and 31 females, mean age at surgery 8.7 yrs (range 3–17). Four patients were converted to
Introduction and Aims: Orthopaedic oncologists are often consulted regarding problems involving salvage of the distal femur due to bone loss, non-unions, infections. In young patients, extensive bony reconstruction is often necessary; in elderly, low demand patients, replacement with an endoprosthetic device results in decreased surgical time and more rapid mobilisation. Method: Since 1991, 27 patients underwent reconstruction with a custom modular distal femoral replacement and rotating hinged knee joint (DFR). Twenty-two (81%) were revised to a DFR from an existing knee arthroplasty. Diagnoses included fracture, non-union, osteomyelitis, osteolysis or deformity. Average age was 66 (25–85); 83% were female. Most patients had undergone multiple prior surgeries. Patients with a history of infection had undergone aggressive resection and insertion of spacers with prolonged antibiotic administration, however they had no infection at the time of DFR reconstruction. All endoprostheses were cemented. Patients were allowed immediate weight-bearing and rehabilitation similar to patients undergoing TKA. Results: One elderly patient died in the immediate peri-operative period of respiratory failure and one was lost to follow-up after placement in a nursing home. Average follow-up on 25 evaluable patients was 47 months (7–122). Reoperations were for recurrent infection (six) and tibial component loosening (three). Five of the six with infection were treated with synovectomy, antibiotic beads and suppressive oral antibiotics, and all five devices are still in place at an average of 54 months (range, 25–100). One severely diabetic patient had had multiple episodes of sepsis unrelated to the prosthesis which eventually seeded the distal femur and required a hip disarticulation. MSTS functional scores at last follow-up averaged 49% (13–80%) and HSS knee scores averaged 71% (37–90%). Conclusion: DFR is a useful salvage procedure in low demand patients. Initially, six patients were scheduled for
Venous tumour thrombus (VTT) is a rare finding in osteosarcoma. Despite the high rate of VTT in osteosarcoma of the pelvis, there are very few descriptions of VTT associated with extrapelvic primary osteosarcoma. We therefore sought to describe the prevalence and presenting features of VTT in osteosarcoma of both the pelvis and the limbs. Records from a single institution were retrospectively reviewed for 308 patients with osteosarcoma of the pelvis or limb treated between January 2000 and December 2022. Primary lesions were located in an upper limb (n = 40), lower limb (n = 198), or pelvis (n = 70). Preoperative imaging and operative reports were reviewed to identify patients with thrombi in proximity to their primary lesion. Imaging and histopathology were used to determine presence of tumour within the thrombus.Aims
Methods