I will build you up again and you will be rebuilt [Jeremiah 31:4]
Abstract
Survival of osteosarcoma has greatly improved in the past few decades. Knee prosthesis is a well-recognized limb salvage procedure for osteosarcoma of the distal end of the femur. One drawback is that prostheses have a limited life and prosthetic failure with the inherent high rate of reoperations remains a serious long-term problem for former osteosarcoma patients. The segmental cement extraction system (SEG-CES) is a technique to remove cement in arthroplasty revision, based on a cement–bone interface with a lower strength compared to the old cement–new cement interface. We report the case of a 32-year-old former osteosarcoma patient in whom the SEG-CES was applied to remove a long-stemmed total knee cemented prosthesis. The prosthesis was placed 17 years before for a recurrent telangiectatic osteosarcoma of the left femur. Thirteen years after the prosthesis implantation, the patient complained of knee instability, pain, and complete failure of the extensor apparatus. The extraction of the prosthesis was performed using cylindrical batters of diameter corresponding to the diameter of the axle, two hammer extractors clamping the prosthesis components between two jaws. Extraction of the periprosthetic cement in the femoral and tibial components was done using the SEG-CES technique. The successful prosthesis removal performed in this patient allowed us to perform an external fixation with bone lengthening and reconstruction by the Ilizarov method.
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Acknowledgments
The authors wish to express their gratitude to Prof. Carlo Ottaviani, MD, and Prof. Gianni Randelli, MD, for their advice and assistance during the surgical procedures. Appreciation is extended to Prof. Luigi Matturri, MD, Ph.D, for his skillful help in the histopathological examination of the granuloma. The authors did not receive grants or outside funding in support of their research or preparation of this manuscript.
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An erratum to this article can be found at http://dx.doi.org/10.1007/s00167-005-0717-7
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Ottaviani, G., Randelli, P. & Catagni, M.A. Segmental cement extraction system (SEG-CES) and the Ilizarov method in limb salvage procedure after total knee cemented prosthesis removal in a former osteosarcoma patient. Knee Surg Sports Traumatol Arthrosc 13, 557–563 (2005). https://doi.org/10.1007/s00167-004-0575-8
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DOI: https://doi.org/10.1007/s00167-004-0575-8