Late Complications and Survival of Endoprosthetic Reconstruction after Resection of Bone Tumors.
Summary of "Late Complications and Survival of Endoprosthetic Reconstruction after Resection of Bone Tumors."
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
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/20625951
- DOI: http://dx.doi.org/10.1007/s11999-010-1454-x
In the literature, long-term survival of endoprosthetic reconstruction varies widely. Few long-term reports analyze both anatomical and disease-specific implant and patient survival. We retrospectivel...
Intraoperative extracorporeal autogeneous irradiated bone grafting (IORBG) after femoral tumor resection ultimately sometimes will fail in patients achieving long-term survival. There are several alte...
There is concern that regenerative cell-based therapies at the site of malignant primary bone tumours could result in increased risk of local tumour recurrence. We therefore investigated the long-term...
Soft tissue sarcomas are rare, reaching some 1.5% of all malignant tumors. While formerly the surgical management of sarcomas almost exclusively consisted of amputation, in the recent years limb savin...
Osteosarcoma is the most common primary malignant bone tumor. The distal radius is a relatively common skeletal site for primary bone tumors, but not for osteosarcoma. It is difficult to treat Osteosa...
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...
The goal of this clinical research study is to evaluate a new two-stage approach (delayed-immediate reconstruction) to breast reconstruction in women who may require post-mastectomy radiat...
Hypothesis 1: There is less tunnel-widening with bone–patella tendon–bone graft compared with the hamstring graft when the same fixation method is used. Tunnel widening is greater wit...
RATIONALE: Intralesional resection is a less invasive type of surgery for chondrosarcoma of the bone and may have fewer side effects and improve recovery. PURPOSE: This phase II trial is ...
The purpose of this study is to describe the relations between closed suction drains placement in breast reconstructions procedures with silicone prothesis to the development of local woun...
Medical and Biotech [MESH] Definitions
Fixation of the ANTERIOR CRUCIATE LIGAMENT, during surgical reconstruction, by the use of a bone- patellar tendon autograft.
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.
The survival of a graft in a host, the factors responsible for the survival and the changes occurring within the graft during growth in the host.
Endovascular reconstruction of an artery, which may include the removal of atheromatous plaque and/or the endothelial lining as well as simple dilatation. These are procedures performed by catheterization. When reconstruction of an artery is performed surgically, it is called ENDARTERECTOMY.