Total Femur Replacement for Treatment of Chondrosarcoma Involving the Entire Femur.
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ABSTRACT:
SUBMITTER: Zheng K
PROVIDER: S-EPMC6583750 | biostudies-literature | 2015 Aug
REPOSITORIES: biostudies-literature
Publications
Total Femur Replacement for Treatment of Chondrosarcoma Involving the Entire Femur.
Zheng Kai K Yu Xiu-chun XC Xu Song-feng SF Wang Lei L
Orthopaedic surgery 20150801 3
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Project description:As the numbers of arthroplasties performed worldwide increase, so do complications such as prosthetic joint infection. Cases that require a two-stage revision of a total femur replacement in the femur pose an ongoing challenge to the modern orthopedic surgeon. Unlike antibiotic spacers in hip and knee arthroplasty, there lacks a commercially available cement spacer for use in total femur replacements. We describe a novel technique for the intraoperative fabrication of a total femur spacer which uses modular components. As such, our technique is unique as it is modular and, therefore, highly customisable to each individual patient. Individual components can be made by different members of the team simultaneously and then assembled to make the final construct, thereby minimizing operative time. Furthermore, the inherent stability of the spacer allows immediate partial weightbearing and functional rehabilitation while patients are waiting for their second-stage procedure.
| S-EPMC8495706 | biostudies-literature
Project description:Introduction and importanceTotal femoral replacement (TFR) is a salvage surgical procedure that has been indicated mainly for oncologic indication to avoid lower limb amputation but has recently been indicated for non-oncological disorders.Case presentationWe report the case of a 63-year-old male with chronic osteomyelitis of the left femur, severe pain and bone deformation, the risk of amputation in this patient was very high. The patient underwent total femur replacement (TFR) with a modular mega-prosthesis. TFR was conducted in two phases. The first one consists of femur resection followed by placement of antibiotic cement; and the second operation was performed after 7 weeks, in which a modular mega-prosthesis was implanted. After a 2-month rehabilitation period, the patient recovered basic ambulation without any complaint of pain or detectable residual infection. The 1-year follow-up was uneventful, with no residual pain or infection. The patient retains normal ambulation and daily function.Clinical discussionChronic persistent osteomyelitis is a hard to manage non-neoplastic disorder that leads to amputation in severe cases. In such patients, TFR would be considered as a salvage therapy that could preserve the patient's anatomical integrity and ambulation.ConclusionTo the best of our knowledge, this is the first case of TFR for treatment of chronic persistent osteomyelitis in Vietnam. While TFR are still mainly indicated for oncology patients, TFR is anticipated to be performed more frequently for non-oncological disorders where there are extensive femoral bone loss and risk of amputation.
| S-EPMC8209068 | biostudies-literature
Project description:IntroductionTotal hip replacement is a common and effective surgical intervention for patients with debilitating joint pain but it does represent a significant surgical intervention. For such interventions, blood loss is a potential cause of morbidity and mortality. Optimisation of surgical interventions focuses on reducing such risks. The aim of this study was to determine whether the order of surgical steps, preparing the femur before or after the acetabulum, was associated with the amount of total blood loss in total hip replacement.MethodsWe performed a retrospective study of 100 patients undergoing primary total hip replacement between 2014 and 2018. This was a before and after (interrupted time series) study around the introduction of femur first preparation for total hip replacement in our unit. Fifty patients underwent a standard femoral preparation after placement of the acetabular component. The second 50 patients had the femoral canal prepared and broached prior to the acetabular component. Estimated blood volume and total blood loss associated with the perioperative period were calculated for each patient and a multiple regression analysis performed to account for other patient and surgical variables associated with perioperative blood loss.ResultsThere was a small reduction in total blood loss for the group who underwent femoral preparation prior to acetabular preparation with a mean difference of 39 mls. This difference however was not clinically or statistically (p = 0.392) significant. Gender (p < 0.0001), Body Mass Index (BMI; p < 0.0001), preoperative haematocrit (p < 0.0001), postoperative haematocrit (p < 0.0001) and age (p = 0.004) were the only factors significantly associated with the total volume of blood loss.ConclusionsWhether the femur was prepared before or after the acetabulum did not significantly predict the total volume of blood loss for primary total hip replacement.
| S-EPMC6458339 | biostudies-literature
Project description:BackgroundPeriprosthetic supracondylar fractures in the setting of an ipsilateral total knee and hip replacement are a rare but serious orthopedic challenge.Description of techniqueIn this unique situation, we consider insertion of a custom coupling device with a distal femoral replacement as an appropriate surgical solution that allows for stability and preserves hip and knee functionality, while not relying on the poor healing potential of the remaining intercalary femoral bone.Patients and methodsWe report the outcomes of two patients who underwent this custom coupling procedure.ResultsThese custom devices resulted in successful outcomes with restoration of ambulatory function and range of motion at greater than 14 months follow-up.ConclusionsWe found that this technique provides sufficient stability and preserves functionality in a difficult-to-treat patient population. The results indicate that this technique may be considered as an alternative to more invasive procedures including total femoral replacement and complete femoral allograft constructs.
| S-EPMC3903946 | biostudies-literature
Project description:Treatment of periprosthetic distal femur fractures and comminuted intraarticular distal femur fractures with previous arthritis remains a difficult challenge for orthopedic surgeons. Previous case series have shown that distal femur replacement (DFR) can effectively compensate for bone loss, relieve knee pain, and allow for early ambulation in both of these fracture patterns. Owing to the typical low-energy mechanism of these injuries, a bilateral injury treated with DFR is rarely encountered. We present a patient with traumatic open left Rorabeck III/Su III periprosthetic distal femur fracture and closed right intraarticular distal femur fracture (AO fcation 33-C2) with end-stage arthrosis treated with single-stage bilateral DFR. We suggest that in patients with similar injuries, single-stage bilateral DFR can provide the benefits of early mobilization and accelerated recovery.
| S-EPMC6470367 | biostudies-literature
Project description:BackgroundThe majority of patients with chondrosarcoma of bone have an excellent overall survival after local therapy. However, in case of unresectable locally advanced or metastatic disease the outcome is poor and limited treatment options exist. Therefore we conducted a survey of clinical phase I or II trials and retrospective studies that described systemic therapy for chondrosarcoma patients.Materials and methodsUsing PubMed, clinicaltrials.gov, the Cochrane controlled trial register and American Society of Clinical Oncology (ASCO) abstracts a literature survey was conducted. From the identified items, data were collected by a systematic analysis. We limited our search to semi-recent studies published between 2000 and 2013 to include modern drugs, imaging techniques and disease evaluations.ResultsA total of 31 studies were found which met the criteria: 9 phase I trials, 11 phase II and 8 retrospective studies. In these studies 855 chondrosarcoma patients were reported. The tested drugs were mostly non-cytotoxic, either alone or in combination with another non-cytotoxic agent or chemotherapy. Currently two phase I trials, one phase IB/II trial and three phase II trials are enrolling chondrosarcoma patients.ConclusionBecause chondrosarcoma of bone is an orphan disease it is difficult to conduct clinical trials. The meagre outcome data for locally advanced or metastatic patients indicate that new treatment options are needed. For the phase I trials it is difficult to draw conclusions because of the low numbers of chondrosarcoma patients enrolled, and at different dose levels. Some phase II trials show promising results which support further research. Retrospective studies are encouraged as they could add to the limited data available. Efforts to increase the number of studies for this orphan disease are urgently needed.
| S-EPMC4131227 | biostudies-literature
Project description:Simultaneous prosthetic joint infection of ipsilateral hip and knee arthroplasties is often accompanied by significant bone loss and presents a challenging reconstructive problem. Two-stage reconstruction is favored and requires the placement of a total femur spacer, which is not a commercially available device. We describe a surgical technique, reporting on 2 cases in which a customized total femur antibiotic impregnated spacer was created by combining an articulating knee spacer and an articulating hip spacer with a reinforced cement dowel construct connecting the 2 spacers. Custom total femoral spacers are useful in the management of infected femoral megaprostheses and cases with ipsilateral injected hip and knee arthroplasties and severe femoral bone loss.
| S-EPMC5859218 | biostudies-literature
Project description:BackgroundTotal hip arthroplasty (THA) is one of the most successful procedures in orthopedic surgery. The most frequent THA indications are osteoarthritis and avascular necrosis, whereas symptomatic aseptic loosening is the most common indication to revision surgery. Chondrosarcoma (CS) is the most frequent bone sarcoma in adults, and proximal femur is the most prevalent location. Wide resection is the treatment of choice.We report 3 cases of unrecognized high-grade CS in the setting of primary or revision THA and reviewed the literature on this rare clinical presentation.MethodsA systematic literature review on CS in the setting of THA, published between 1980 and 2020, was performed on PubMed, Embase, Medline, Ovid SP, and Web of Science, using the guidelines set in the Preferred Reporting Items for Systematic Reviews and Mata-analyses (PRISMA).ResultsCase series: Three patients were referred to our sarcoma center after failure of THA due to unrecognized high-grade CS. All 3 had rapid fatal outcome. Literature review: Fifty-nine articles were identified, of which 8 were included in the study. They confirmed that primary or revision THA failure due to unrecognized CS is extremely rare, with only few cases reported in the literature.ConclusionsBefore proceeding to primary or revision arthroplasty, diagnosis must be ascertained. Atypical presentation of a common pathology, such as osteoarthritis, avascular necrosis, or aseptic loosening of an endoprosthesis, should raise suspicion for another cause to symptoms, and additional workup be performed. As our cases demonstrated, unrecognized or inadequately managed bone sarcoma may lead to poor or even fatal outcome.
| S-EPMC7818612 | biostudies-literature
Project description:Various failure mechanisms have been identified in total knee arthroplasty (TKA). We hereby present one case of failure, which stands out because of its rapid and destructive progression. We report the case of a 72-year-old Caucasian female patient who developed a large bone osteolytic lesion of the femur after TKA. The patient presented to our hospital 7 years after the initial surgery, complaining of persistent knee pain. The lesion affected the distal half of the femur and, after a diagnostic workup, required a resection of 20 cm and reconstruction with a tumor prosthesis. Subsequent pathological analysis revealed a reaction to cement and prosthesis components. Periprosthetic osteolysis continues to be a major problem, and a reaction to cement and prosthesis components can be an elusive cause of TKA failure.
| S-EPMC7329907 | biostudies-literature
Project description:Background:Thyroid ultrasound is usually used to risk-stratify incidental thyroid nodules. Nodules with high risk sonographic features for malignancy are evaluated by fine-needle aspiration. The role of core needle biopsy for thyroid nodules is limited to cases where the fine needle aspiration is inconclusive. Case presentation:We describe a rare case of mesenchymal chondrosarcoma of the thyroid gland with uncertain primary origin. Thyroid ultrasound showed right sided large, solid, hypoechoic nodule with calcifications and peripheral vascularity and unremarkable isthmus and left thyroid lobe. Fine needle aspiration of the right nodule suggested lymphocytic thyroiditis. The sonographic findings contradicted the typical bilateral clinical and sonographic picture of lymphocytic thyroiditis. A core needle biopsy showed mesenchymal chondrosarcoma. Conclusion:This case highlights the importance of correlating pathologic diagnosis with sonographic findings, the appropriate utilization of fine needle aspiration and core needle biopsy to evaluate thyroid nodules and the rare incidence of mesenchymal chondrosarcoma involving the thyroid.
| S-EPMC7065336 | biostudies-literature