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Allograft-prosthetic composite in the proximal tibia after bone tumor resection.

ABSTRACT: UNLABELLED: We consider an allograft-prosthesis composite in the proximal tibia one of the better reconstructive options in this site because it combines the mechanical stability of a prosthesis with the biologic reconstruction of the extensor mechanism. We retrospectively reviewed 62 patients who had proximal tibia reconstructions with allograft-prosthesis composites to ascertain the complications and functional outcomes. By combining an allograft with a prosthesis, placing cement in the graft, and press-fitting the prosthesis in the tibial diaphysis, we obtained satisfactory Musculoskeletal Tumor Society scores in 90.4% of patients, with a 5-year survival rate (73.4%) comparable to that of reconstruction with a modular prosthesis. However, we observed high infection rates (24.2%) and rotation of the medial gastrocnemius seemed not to reduce this complication. For this reason, we do not recommend using this reconstructive technique in patients who will receive postoperative chemotherapy or in patients in whom a previous reconstructive method failed. We believe the ideal candidate is the young patient with a benign aggressive or malignant low-grade tumor who has not undergone previous surgery. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

SUBMITTER: Donati D

PROVIDER: S-EPMC2505118 | biostudies-other | 2008 Feb

REPOSITORIES: biostudies-other

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Project description:ObjectiveTo introduce a novel 3D-printed prosthetic composite for reconstruction of massive bone defects after resection for bone malignancy of lower extremities. The design concept, surgical technique, and the preliminary outcomes were elaborated.MethodsPatients with primary malignant tumors of lower extremities requiring tumor resection and reconstruction were recruited between Jun 2015 and Nov 2018. Patient-specific 3D-printed prostheses were designed according to preoperative imaging data. After tumor resection, reconstruction was performed with composites consisting of 3D- printed prosthesis, beta-tricalcium phosphate (β-TCP) bioceramics and/or vascularized fibula. All patients underwent regular follow-up postoperatively. The functional outcomes were assessed by the Musculoskeletal Tumor Society score (MSTS). Oncological outcomes, imaging results, and complications were recorded and analyzed.ResultsTen cases averaging 12.90 years of age participated in this study. There were five femur and five tibia reconstructions. The mean follow-up period was 16.90 months. At last follow-up, all patients were alive without tumor recurrence. Average MSTS functional score was 80.33 ± 11.05%. All prostheses were intact and stable without failure or systemic breakage. No serious complications occurred after the operation. Postoperative X-ray, computed tomography (CT) and single-photon emission computed tomography (SPECT) showed an ideal integration between the bone and the prosthetic composite. Moreover, vascularized fibula and implanted β-TCP bioceramics indicated relatively high metabolic activity in vivo.ConclusionsPatient-specific 3D-printed prostheses combined with β-TCP bioceramics and/or vascularized fibula provide an excellent option for reconstruction of massive bone defects after lower extremity malignant tumor extirpation. Short-term follow up showed promising clinical results in recovering lower limb function, promoting osseointegration and reducing complications.

Project description:Bone tumor resections for limb salvage have become standard treatment. Recently, computer-assisted navigation has been introduced to improve the accuracy of joint arthroplasty and possible tumor resection surgery; however, like with any new technology, its benefits and limitations need to be characterized for surgeons to make informed decisions about whether to use it.We wanted to (1) assess the technical problems associated with computer-assisted navigation; (2) assess the accuracy of the registration technique; (3) define the time required to perform a navigated resection in orthopedic oncology; and (4) the frequency of complications such as local recurrence, infection, nonunion, fracture, and articular collapse after tumor resection and bone reconstruction with allografts using intraoperative navigation assistance.We analyzed 69 consecutive patients with bone tumors of the extremities that were reconstructed with massive bone allografts using intraoperative navigation assistance with a minimum followup of 12 months (mean, 29 months; range, 12-43 months). All patients had their tumors reconstructed in three-dimensional format in a virtual platform and planning was performed to determine the osteotomy position according to oncology margins in a CT-MRI image fusion. Tumor resections and allograft reconstructions were performed using a computer navigation system according to the previously planned cuts. We analyzed intraoperative data such as technical problems related to the navigation procedure, registration technique error, length of time for the navigation procedure, and postoperative complications such as local recurrence, infection, nonunion, fracture, and articular collapse.In three patients (4%), the navigation was not carried out as a result of technical problems. Of the 66 cases in which navigation was performed, the mean registration error was 0.65 mm (range, 0.3-1.2 mm). The mean required time for navigation procedures, including bone resection and allograft reconstruction during surgery, was 35 minutes (range, 18-65 minutes). Complications that required a second surgical procedure were recorded for nine patients including one local recurrence, one infection, two fractures, one articular collapse, and four nonunions. In two of these nine patients, the allograft needed to be removed. At latest followup, three patients died of their original disease.The navigation procedure could not be performed for technical reasons in 4% of the series. The mean registration error was 0.65 mm in this series and the navigation procedure itself adds a mean of 35 minutes during surgery. The complications rate for this series was 14%. We found a nonunion rate of 6% in allograft reconstructions when we used a navigation system for the cuts.Level IV, case series. See the Guidelines for Authors for a complete description of levels of evidence.

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Allograft-prosthetic composite in the proximal tibia after bone tumor resection.

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