Track topics on Twitter Track topics that are important to you
While complications following massive endoprosthetic reconstruction have been previously described, the incidence and effects of these complications over extended periods of time have not been well characterized in large series. QUESTIONS/
We therefore determined: (1) incidence and types of complications; (2) relative risk of complications; (3) likelihood of secondary complications; (4) whether modularity altered such complications; (5) implant failure and limb salvage rates and (6) implant survival over extended followup.
We retrospectively reviewed 232 patients (241 implants: 50 custom,191 modular) who underwent endoprosthetic reconstruction for malignant and aggressive bone tumors between 1980 and 2002. Complications were classified as infection, mechanical, superficial soft tissue, deep soft tissue, or dislocation. Survival was determined by Kaplan-Meier analysis. Minimum followup was 5 years (mean: 10 years; range: 5-27 years).
One hundred thirty-seven of 232 patients (59%) underwent a single reconstruction. Ninety-five patients had 242 additional procedures. Forty-four revised patients retained their original prosthesis. Limb salvage rate was 90%; implant failure (removal of the cemented part) was seen in 29% (70/241) with a median survival of 190 months. Twenty-five of 50 custom implants failed (8 then failed again) while 30/180 modular implants failed (7 then failed again). Of 70 instances of implant failure, 38/70 were mechanical, 27/70 infectious. Risk of infection increased 30% after a second procedure; 16 of 24 amputations were performed because of infection.
Mechanical complications were the most common cause of implant failure. Infection was the leading cause of both complication and amputation; risk of infection increased substantially with revision surgery. Modular implants had fewer mechanical complications, thus leading to fewer revisions and subsequent infections. LEVEL OF
Level III, therapeutic study. See the guidelines for authors for a complete description of levels of evidence.
Washington Cancer Institute at Washington Hospital Center, Washington, DC, USA.
This article was published in the following journal.
Name: Clinical orthopaedics and related research
Reconstruction options in children after bone tumor resection are as varied as they are challenging. Advances in biologic and endoprosthetic design have led to many choices, all of which must be consi...
This paper describes 3 patients of off-label use of bone morphogenetic protein 2 (rhBMP-2) in the reconstruction of mandibular continuity defects. In the first patient, rhBMP-2 was associated with ili...
To achieve limb salvage and provide the patient with a functional extremity, vascularized free fibula transfer has become the workhorse for segmental bony reconstruction. Because of various host facto...
Reliable acetabular fixation in total hip arthroplasty following periacetabular resections is challenging. Tantalum components have been successfully implemented for difficult revision arthroplasties,...
Giant-cell tumour is a locally aggressive tumour of long bones of epiphyseal region commonly occurring in adults aged 20-40 years. Most common location is distal femur, proximal tibia, and distal rad...
Anesthetic management and fluid therapy is crucial in esophageal resection and reconstruction, which is associated with high incidence of postoperative morbidity and mortality. This study ...
Bioactive fibre-reinforced composite implant is used for reconstruction of skull bone defects and orbital floor defects. Functional and aesthetic outcome is assessed by patient and doctor...
The investigators wish to compare 3 methods for reconstruction of the anterior cruciate ligament using 3 different grafts: bone-patella tendon-bone, hamstrings and iliotibial tract graft, ...
There is little evidence showed that adjuvant therapy had been shown to extend the survival of patients with hepatocellular carcinoma (HCC) receiving surgical resection. We investigated wh...
This trial will study the reconstruction of the anterior part of the mandible and the adjacent soft tissue parts by a mandibular prosthesis made in porous titanium, associated or not, to a...
A bone-patellar tendon graft used for fixation of the ANTERIOR CRUCIATE LIGAMENT during surgical reconstruction of the knee.
Fixation of the ANTERIOR CRUCIATE LIGAMENT, during surgical reconstruction, by the use of a bone- patellar tendon autograft.
Fixation of the ANTERIOR CRUCIATE LIGAMENT, during surgical reconstruction, by the use of a bone-patellar tendon graft.
Complications that affect patients during surgery. They may or may not be associated with the disease for which the surgery is done, or within the same surgical procedure.
The eight bones of the wrist: SCAPHOID BONE; LUNATE BONE; TRIQUETRUM BONE; PISIFORM BONE; TRAPEZIUM BONE; TRAPEZOID BONE; CAPITATE BONE; and HAMATE BONE.
Osteoporosis is a disease in which the bones become extremely porous, are subject to fracture, and heal slowly, occurring especially in women following menopause and often leading to curvature of the spine from vertebral collapse. Follow and track&n...
Antiretroviral Therapy Clostridium Difficile Ebola HIV & AIDS Infectious Diseases Influenza Malaria Measles Sepsis Swine Flu Tropical Medicine Tuberculosis Infectious diseases are caused by pathogenic...