A Comparison of Oncological and Surgical Outcomes in Endoprosthetic Reconstruction Versus Rotationplasty for Pediatric Lower Extremity Bone Sarcomas

OrthoMedia ◽  
2021 ◽  
Keyword(s):  
Lower Extremity ◽  
Surgical Outcomes ◽  
Endoprosthetic Reconstruction ◽  
Bone Sarcomas

Functional and Surgical Outcomes After Endoprosthetic Reconstruction With Expandable Prostheses in Children: A Systematic Review

Orthopedics ◽  
2019 ◽  
Vol 42 (4) ◽  
pp. 184-190
Author(s):  
Olga D. Savvidou ◽  
Angelos Kaspiris ◽  
Leonidas Dimopoulos ◽  
George Georgopoulos ◽  
Stavros D. Goumenos ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Outcomes ◽  
Endoprosthetic Reconstruction

scholarly journals Current review of surgical management options for extremity bone sarcomas

2019 ◽  
Vol 4 (5) ◽  
pp. 174-182 ◽  
Author(s):  
Catalin Cirstoiu ◽  
Bogdan Cretu ◽  
Bogdan Serban ◽  
Zsombor Panti ◽  
Mihai Nica
Keyword(s):  
Surgical Management ◽  
Survival Rates ◽  
Bone Sarcoma ◽  
Functional Results ◽  
Bone Transport ◽  
Endoprosthetic Reconstruction ◽  
Management Options ◽  
Surgical Options ◽  
Bone Sarcomas ◽  
Excision Margins

Modern surgical management of extremity bone sarcomas is governed by limb-sparing surgery combined with adjuvant and neoadjuvant chemotherapy. All the resection and reconstruction techniques have to achieve oncologic excision margins, with survival rates and functional results superior to amputation. The main reconstruction techniques of bone defects resulted after resection are: modular endoprosthetic reconstruction; bone graft reconstruction; bone transport; resection arthrodesis; and rotationplasty. Oncologic resection and modular endoprosthetic reconstruction are the generally approved surgical options adopted for the majority of cases in major specialized bone sarcoma centres. Good basic principles, efficient multidisciplinary approach and sustained research in the field can provide a better future for the challenge posed by extremity bone sarcoma treatment. Cite this article: EFORT Open Rev 2019;4:174-182. DOI: 10.1302/2058-5241.4.180048

Endoprosthetic Proximal Femoral Hemiarthroplasty Versus Total Hip Endoprosthetic Reconstruction After Proximal Femoral Resections in Young Adults

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohamed Abdel Rahman Mostafa ◽  
Sherif Ishak Azmy ◽  
Kyrillos Magdy Rashid
Keyword(s):  
Limb Salvage ◽  
Proximal Femur ◽  
Meta Analysis ◽  
Case Control ◽  
Endoprosthetic Reconstruction ◽  
Total Hip ◽  
Search Results ◽  
Bone Sarcomas ◽  
Primary Bone

Abstract Background Metastatic tumors are the most common malignant lesion of the proximal femur, with carcinomas being the most frequent. The proximal femur and midfemur are common sites for primary bone sarcomas; approximately16% of Ewing's sarcomas, 13% chondrosarcomas and 10% of osteosarcomas develop at these locations. The major aim in the management of patients who have bone malignancies is prolonging their survival. Primary bone sarcomas that require surgical resection can be treated by either amputation or limb salvage. Most studies which compared both approaches reported that limb salvage had no adverse effect on patients’ survival on long-term. Objective This is a systematic review of literature with meta-analysis study that compare the functional outcomes and complications of the methods; proximal femoral hemi versus total arthroplasty after proximal femur resection followed by endoprosthetic reconstruction and provide recommendations by the best available evidence. Methods We included Randomized control trails (RCTs), including cluster RCTs, controlled (non-randomized) clinical trials or cluster trials, prospective and retrospective comparative cohort studies, and case-control or nested case-control studies and controlled clinical trials. We excluded cross-sectional studies, case reports, review articles, letters to the editor, meeting abstracts, and technique papers. Search results conducted to systematic review management software and manually screened for eligibility were included. Critical appraisal checklist was used to assess the search results based on the inclusion/exclusion criteria. Results Twenty-three studies are included. Quality appraisal demonstrated that all but one study is retrospective. The pooled results from the meta-analysis showed that the rate of aseptic loosening was only 2% when reconstruction occurs with endoprosthetic proximal femoral hemiarthroplasty. There was unimportant heterogeneity in the included studies. The rate of conversion to total hip arthroplasty (THA) is 4.6% to 8% of oncological patients. The rate of periprosthetic fracture was only 1% Conclusion Proximal femoral endoprosthesis has definitive benefits in the treatment of primary or metastatic tumors affecting the proximal femur. The implants tend to improve the function and quality of life of patients with metastatic disease and high-grade localized disease. It also provides them with a relatively pain-free limb with good functional capacity. With continuing advances in the surgical and oncological fields, there is a great potential for curative limb salvage surgery in the long term. Reconstruction with endoprosthetic Proximal femoral hemiarthroplasty after proximal femoral resection in young adults can confer additional stability with a reduced dislocation rates and systemic complications as compared to total hip arthroplasty.

When is the Critical Time for Soft Tissue Reconstruction of Open Tibia Fracture Patients?

2020 ◽  
Author(s):  
Seung Yeol Lee ◽  
Ik Hyun Seong ◽  
Bo Young Park
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Roc Curve ◽  
Complication Rate ◽  
Surgical Outcomes ◽  
Revision Rate ◽  
Single Type ◽  
Soft Tissue Reconstruction ◽  
Complication Rates ◽  
Tissue Reconstruction

Abstract Background The timing of soft tissue reconstruction for soft-tissue defect in patients with open fractures in the lower extremity is known to be critical for successful outcomes. However, medical advances, including development of dressing materials and refinement in the microsurgical techniques, might have undergone modifications in this “critical period.” There have been no studies on the role of timing on reconstructive outcomes. Thus, we have analyzed the effect of reconstruction timing on optimal surgical outcomes and complication rates in a single type of lower extremity injury. Methods Data of patients who underwent microvascular free tissue transfer with an open fracture in the lower extremity from 2014 through 2016 were retrospectively reviewed (n = 103). Surgical outcomes, including flap complication rate, flap revision rate, and long-term bony complications, were analyzed serially in accordance with time interval until coverage using the receiver operating characteristic (ROC) curve analysis. Significant factors with a p < 0.05 in the univariate analysis were included in the multivariate logistic regression model to identify independent risk factors. Results A total of 46 patients (33 males and 13 females) were finally included in the study. Based on the association between surgical timing and flap-related complication rate, the best cutoff period for surgery was 33 days, with an area under the curve of 0.658 (p = 0.040). Further, in the revision rate, the cutoff period was identified as 10 days (p = 0.016). Regarding the incidence of bony complications, ROC curve showed that the maximal period until operation was 91 days with no influence on the occurrence of bony complications (p = 0.029). Conclusion Although the best method is an early reconstruction, many modalities such as negative pressure wound therapy play a role as a temporary measure. Our study suggests that the acute or early period for successful reconstruction might be extended compared with previous studies.

Surgery for bone sarcomas of the lower extremity

2016 ◽  
Vol 27 (6) ◽  
pp. 593-598 ◽  
Author(s):  
Ginger E. Holt ◽  
Robert J. Wilson
Keyword(s):  
Lower Extremity ◽  
Bone Sarcomas

scholarly journals Prophylactic Antibiotic Regimens In Tumor Surgery (PARITY): a multi-center randomized controlled study comparing alternative antibiotic regimens in patients undergoing tumor resections with endoprosthetic replacements—a statistical analysis plan

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Patricia Schneider ◽  
◽  
Diane Heels-Ansdell ◽  
Lehana Thabane ◽  
Michelle Ghert
Keyword(s):  
Statistical Analysis ◽  
Lower Extremity ◽  
Controlled Trial ◽  
Tumor Resection ◽  
Prophylactic Antibiotic ◽  
Statistical Analysis Plan ◽  
Controlled Study ◽  
Tumor Surgery ◽  
Endoprosthetic Reconstruction ◽  
Randomized Controlled

Abstract Background Limb salvage with endoprosthetic reconstruction is the current standard practice for the surgical management of lower extremity bone tumors in skeletally mature patients and typically includes tumor resection followed by the functional limb reconstruction with modular metallic and polyethylene endoprosthetic implants. However, owing to the complexity and length of these procedures, as well as the immunocompromised nature of patients treated with chemotherapy, the risk of surgical site infection (SSI) is high. The primary research objective of the Prophylactic Antibiotic Regimens In Tumor Surgery (PARITY) trial is to assess whether a 5-day regimen of post-operative antibiotics decreases the risk of SSI at 1 year post-operatively compared to a 1-day regimen. This article describes the statistical analysis plan for the PARITY trial. Methods/design The PARITY trial is an ongoing multi-center, blinded parallel two-arm randomized controlled trial (RCT) of 600 participants who have been diagnosed with a primary bone tumor, a soft tissue sarcoma that has invaded the bone or oligometastatic bone disease of the femur or tibia that requires surgical resection and endoprosthetic reconstruction. This article describes the overall analysis principles, including how participants will be included in each analysis, the presentation of results, adjustments for covariates, the primary and secondary outcomes, and their respective analyses. Additionally, we will present the planned sensitivity and sub-group analyses. Discussion Our prior work has demonstrated (1) high rates of SSI after the treatment of lower extremity tumors by surgical excision and endoprosthetic reconstruction, (2) highly varied opinion and practice among orthopedic oncologists with respect to prophylactic antibiotic regimens, (3) an absence of applicable RCT evidence, (4) extensive support from international investigators to participate in a RCT, and (5) the feasibility of conducting a definitive RCT to evaluate a 5-day regimen of post-operative antibiotics in comparison with a 1-day regimen. Trial registration ClinicalTrials.gov NCT01479283. Registered on 24 November 2011

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