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Fractures in bone tumour prosthesis

  • Review Article
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Abstract

Purpose

The aim of the present narrative review is to report the different aspects related to the fractures around tumour prosthetic implants in terms of technical and medical issues.

Methods

A non systematic literature review on the topic was performed.

Results

Given the increased rate of limb salvage procedures and megaprostheses implanted for bone tumours, the increased number of osteoporotic periprosthetic fractures, and the burden of revision arthroplasty, the number of surgeries using endoprosthetic implants is likely to increase in the near future. Surgeons will face more frequently the complications related to tumour endoprosthetic implant. Endoprosthetic reconstruction has a higher risk of intra-operative and post-operative complications compared to conventional prosthetic replacement.

Conclusions

Very rare reports and recommendations are available in literature regarding the treatment of periprosthetic fractures after megaprosthesis, and there is currently no consensus about which should be the standard management for periprosthetic fractures in this population of patients.

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References

  1. Gebhart M, Shumelinsky F (2012) Management of periprosthetic fractures in patients treated with a megaprosthesis for malignant bone tumours around the knee. Acta Orthop Belg 78:558–563

    PubMed  Google Scholar 

  2. Piccioli A, Maccauro G, Scaramuzzo L, Graci C, Spinelli MS (2013) Surgical treatment of impending and pathological fractures of tibia. Injury 44:1092–1096

    Article  CAS  PubMed  Google Scholar 

  3. Piccioli A, Spinelli MS, Maccauro G (2014) Impending fracture: A difficult diagnosis. Injury 45(Suppl 6):S138–S141

    Article  PubMed  Google Scholar 

  4. Clement ND, MacDonald D, Moran M, Burnett R, Howie CR, Patton JT (2015) Mega prosthetic distal femoral arthroplasty for non-tumour indications: Does the indication affect the functional outcome and survivorship? Knee Surg Sports Traumatol Arthrosc 23:1330–1336

    Article  CAS  PubMed  Google Scholar 

  5. Berend KR, Lombardi AV Jr (2009) Distal femoral replacement in non tumor cases with severe bone loss and instability. Clin Orthop Relat Res 467:485–492

    Article  PubMed Central  PubMed  Google Scholar 

  6. Kostuj T, Streit R, Baums MH, Schaper K, Meurer A (2015) Midterm Outcome after Mega-Prosthesis Implanted in Patients with Bony Defects in Cases of Revision Compared to Patients with Malignant Tumors. J Arthroplasty. doi:10.1016/j.arth.2015.04.002

    PubMed  Google Scholar 

  7. Grimer RJ, Carter SR, Tillman RM, Sneath RS, Walker PS, Unwin PS, Shewell PC (1999) Endoprosthetic replacement of the proximal tibia. J Bone Joint Surg (Br) 81:488–494

    Article  CAS  Google Scholar 

  8. Plötz W, Rechl H, Burgkart R, Messmer C, Schelter R, Hipp E, Gradinger R (2002) Limb salvage with tumor endoprostheses for malignant tumors of the knee. Clin Orthop Relat Res 405:207–215

    Article  PubMed  Google Scholar 

  9. Hardes J, Gebert C, Schwappach A, Ahrens H, Streitburger A, Winkelmann W, Gosheger G (2006) Characteristics and outcome of infections associated with tumor endoprostheses. Arch Orthop Trauma Surg 126:289–296

    Article  CAS  PubMed  Google Scholar 

  10. Gosheger G, Gebert C, Ahrens H, Streitbuerger A, Winkelmann W, Hardes J (2006) Endoprosthetic reconstruction in 250 patients with sarcoma. Clin Orthop Relat Res 450:164–171

    Article  PubMed  Google Scholar 

  11. Mittermayer F, Krepler P, Dominkus M, Schwameis E, Sluga M, Heinzl H, Kotz R (2001) Long-term followup of uncemented tumor endoprostheses for the lower extremity. Clin Orthop Relat Res 388:167–177

    Article  PubMed  Google Scholar 

  12. Clarke HD, Berry DJ, Sim FH (1998) Salvage of failed femoral megaprostheses with allograft prosthesis composites. Clin Orthop Relat Res 356:222–229

    Article  PubMed  Google Scholar 

  13. Mavrogenis AF, Ruggieri P, Mercuri M, Papagelopoulos PJ (2008) Megaprosthetic reconstruction for malignant bone tumors: complications and outcomes. J Long-Term Eff Med Implants 18:239–251

    Article  PubMed  Google Scholar 

  14. Sewell MD, Hanna SA, McGrath A, Aston WJ, Blunn GW, Pollock RC, Skinner JA, Cannon SR, Briggs TW (2011) Intercalary diaphyseal endoprosthetic reconstruction for malignant tibial bone tumours. J Bone Joint Surg (Br) 93:1111–1117

    Article  CAS  Google Scholar 

  15. Healey JH, Morris CD, Athanasian EA, Boland PJ (2013) Compress knee arthroplasty has 80% 10-year survivorship and novel forms of bone failure. Clin Orthop Relat Res 471:774–783

    Article  PubMed Central  PubMed  Google Scholar 

  16. Ahlmann ER, Menendez LR, Kermani C, Gotha H (2006) Survivorship and clinical outcome of modular endoprosthetic reconstruction for neoplastic disease of the lower limb. J Bone Joint Surg 88B:790–795

    Article  Google Scholar 

  17. Kinkel S, Lehner B, Kleinhans JA, Jakubowitz E, Ewerbeck V, Heisel C (2010) Medium to long term results after reconstruction of bone defects at the knee with tumor endoprostheses. J Surg Oncol 101:166–169

    CAS  PubMed  Google Scholar 

  18. Sim IW, Tse LF, Ek ET, Powell GJ, Choong PF (2007) Salvaging the limb salvage: management of complications following endoprosthetic reconstruction for tumours around the knee. Eur J Surg Oncol 33:796–802

    Article  PubMed  Google Scholar 

  19. Capanna R, Scoccianti G, Frenos F, Vilardi A, Beltrami G, Campanacci DA (2015) What was the survival of megaprostheses in lower limb reconstructions after tumor resections? Clin Orthop Relat Res 473:820–830

    Article  PubMed  Google Scholar 

  20. Davis AM, Bell RS, Badley EM, Yoshida K, Williams JI (1999) Evaluating functional outcome in patients with lower extremity sarcoma. Clin Orthop Relat Res 358:90–100

    Article  PubMed  Google Scholar 

  21. Avedian RS, Goldsby RE, Kramer MJ, O’Donnell RJ (2007) Effect of chemotherapy on initial compressive osseointegration of tumor endoprostheses. Clin Orthop Relat Res 459:48–53

    Article  CAS  PubMed  Google Scholar 

  22. Graci C, Maccauro G, Muratori F, Spinelli MS, Rosa MA, Fabbriciani C (2010) Infection following bone tumor resection and reconstruction with tumoral prostheses: a literature review. Int J Immunopathol Pharmacol 23:1005–1013

    CAS  PubMed  Google Scholar 

  23. Rayan F, Dodd M, Haddad FS (2008) European validation of the Vancouver classification of periprosthetic proximal femoral fractures. J Bone Joint Surg (Br) 90:1576–1579

    Article  CAS  Google Scholar 

  24. Rorabeck CH, Taylor JW (1999) Classification of periprosthetic fractures complicating total knee arthroplasty. Orthop Clin North Am 30:209–214

    Article  CAS  PubMed  Google Scholar 

  25. Piccioli A, Spinelli MS, Forsberg JA, Wedin R, Healey JH, Ippolito V, Daolio PA, Ruggieri P, Maccauro G, Gasbarrini A, Biagini R, Piana R, Fazioli F, Luzzati A, Di Martino A, Nicolosi F, Camnasio F, Rosa MA, Campanacci DA, Denaro V, Capanna R (2015) How do we estimate survival? External validation of a tool for survival estimation in patients with metastatic bone disease-decision analysis and comparison of three international patient populations. BMC Cancer 15:424

    Article  PubMed Central  PubMed  Google Scholar 

  26. Wright TW, Cofield RH (1995) Humeral fractures after shoulder arthroplasty. J Bone Joint Surg Am 77:1340–1346

    CAS  PubMed  Google Scholar 

  27. Worland RL, Kim DY, Arredondo J (1999) Periprosthetic humeral fractures: management and classification. J Shoulder Elbow Surg 8:590–594

    Article  CAS  PubMed  Google Scholar 

  28. Henderson ER, Groundland JS, Pala E, Dennis JA, Wooten R, Cheong D, Windhager R, Kotz RI, Mercuri M, Funovics PT, Hornicek FJ, Temple HT, Ruggieri P, Letson GD (2011) Failure mode classification for tumor endoprostheses: retrospective review of five institutions and a literature review. J Bone Joint Surg Am 93:418–429

    Article  PubMed  Google Scholar 

  29. Wedin R, Bauer HC (2005) Surgical treatment of skeletal metastatic lesions of the proximal femur: endoprosthesis or reconstruction nail? J Bone Joint Surg (Br) 87:1653–1657

    Article  CAS  Google Scholar 

  30. Davidson D, Pike J, Garbuz D, Duncan CP, Masri BA (2008) Intraoperative periprosthetic fractures during total hip arthroplasty. Evaluation and management. J Bone Joint Surg Am 90:2000–2012

    Article  PubMed  Google Scholar 

  31. Palumbo BT, Henderson ER, Groundland JS, Cheong D, Pala E, Letson GD, Ruggieri P (2011) Advances in segmental endoprosthetic reconstruction for extremity tumors : a review of contemporary designs and techniques. Cancer Control 18:160–170

    PubMed  Google Scholar 

  32. Weiss RJ, Ekström W, Hansen BH, Keller J, Laitinen M, Trovik C, Zaikova O, Wedin R (2013) Pathological subtrochanteric fractures in 194 patients: a comparison of outcome after surgical treatment of pathological and non-pathological fractures. J Surg Oncol 107:498–504

    Article  PubMed  Google Scholar 

  33. Tyler WK, Healey JH, Morris CD, Boland PJ, O'Donnell RJ (2009) Compress periprosthetic fractures: interface stability and ease of revision. Clin Orthop Relat Res 467:2800–2806

    Article  PubMed Central  PubMed  Google Scholar 

  34. Teunis T, Nota SP, Hornicek FJ, Schwab JH, Lozano-Calderón SA (2014) Outcome after reconstruction of the proximal humerus for tumor resection: a systematic review. Clin Orthop Relat Res 472:2245–2253

    Article  PubMed Central  PubMed  Google Scholar 

  35. Mankin HJ, Gebhardt MC, Jennings LC, Springfield DS, Tomford WW (1996) Long-term results of allograft replacement in the management of bone tumors. Clin Orthop Relat Res 324:86–97

    Article  PubMed  Google Scholar 

  36. Thompson RC Jr, Pickvance EA, Garry D (1993) Fractures in large-segment allografts. J Bone Joint Surg Am 75:1663–1673

    PubMed  Google Scholar 

  37. McDonough EB, Crosby LA (2005) Periprosthetic fractures of the humerus. Am J Orthop (Belle Mead NJ) 34:586–591

    Google Scholar 

  38. Williams GR Jr, Iannotti JP (2002) Management of periprosthetic fractures: the shoulder. J Arthroplasty 17(4 Suppl 1):14–16

    Article  PubMed  Google Scholar 

  39. Manfrini M, Tiwari A, Ham J, Colangeli M, Mercuri M (2011) Evolution of surgical treatment for sarcomas of proximal humerus in children: retrospective review at a single institute over 30 years. J Pediatr Orthop 31:56–64

    Article  PubMed  Google Scholar 

  40. van de Sande MA, Dijkstra PD, Taminiau AH (2011) Proximal humerus reconstruction after tumour resection: biological versus endoprosthetic reconstruction. Int Orthop 35:1375–1380

    Article  PubMed Central  PubMed  Google Scholar 

  41. Boyd AD Jr, Thornhill TS, Barnes CL (1992) Fractures adjacent to humeral prostheses. J Bone Joint Surg Am 74:1498–1504

    PubMed  Google Scholar 

  42. Campbell JT, Moore RS, Iannotti JP, Norris TR, Williams GR (1998) Periprosthetic humeral fractures: mechanisms of fracture and treatment options. J Shoulder Elbow Surg 7406–7413

  43. Kumar S, Sperling JW, Haidukewych GH, Cofield RH (2004) Periprosthetic humeral fractures after shoulder arthroplasty. J Bone Joint Surg Am 86A:680–689

    Google Scholar 

  44. Boileau P, Krishnan SG, Tinsi L, Walch G, Coste JS, Molé D (2002) Tuberosity malposition and migration: reasons for poor outcomes after hemiarthroplasty for displaced fractures of the proximal humerus. J Shoulder Elbow Surg 11:401–412

    Article  CAS  PubMed  Google Scholar 

  45. Frankle MA, Greenwald DP, Markee BA, Ondrovic LE, Lee WE 3rd (2001) Biomechanical effects of malposition of tuberosity fragments on the humeral prosthetic reconstruction for four-part proximal humerus fractures. J Shoulder Elbow Surg 10:321–326

    Article  CAS  PubMed  Google Scholar 

  46. Greiner SH, Diederichs G, Kröning I, Scheibel M, Perka C (2009) Tuberosity position correlates with fatty infiltration of the rotator cuff after hemiarthroplasty for proximal humeral fractures. J Shoulder Elbow Surg 18:431–436

    Article  PubMed  Google Scholar 

  47. Angelini A, Henderson E, Trovarelli G, Ruggieri P (2013) Is there a role for knee arthrodesis with modular endoprostheses for tumor and revision of failed endoprostheses? Clin Orthop Relat Res 471:3326–3335

    Article  PubMed Central  PubMed  Google Scholar 

  48. Hardes J, von Eiff C, Streitbuerger A, Balke M, Budny T, Henrichs MP, Hauschild G, Ahrens H (2010) Reduction of periprosthetic infection with silver-coated megaprostheses in patients with bone sarcoma. J Surg Oncol 101:389–395

    PubMed  Google Scholar 

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Acknowledgments

We gratefully acknowledge Prof. Roberta Aronica for English revision of the current manuscript.

Conflict of interest

The authors state that they have no competing interests to declare.

Author information

Authors and Affiliations

  1. Centro Oncologico di Palazzo Baleani, Azienda Policlinico Umberto I, Roma, Italy

    Andrea Piccioli

  2. Presidio Ospedaliero Gubbio Gualdo Tadino, ASL Umbria 1, Roma, Italy

    Barbara Rossi

  3. Ospedale Cristo Re, Roma, Italy

    Federico Maria Sacchetti

  4. Department of Orthopaedic and Traumatology, Catholic University Hospital, Rome, Italy

    Maria Silvia Spinelli

  5. Department of Orthopaedics and Trauma Surgery, University Campus Bio-Medico of Rome, Rome, Italy

    Alberto Di Martino

Authors
  1. Andrea Piccioli
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  2. Barbara Rossi
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  3. Federico Maria Sacchetti
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  4. Maria Silvia Spinelli
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  5. Alberto Di Martino
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Corresponding author

Correspondence to Andrea Piccioli.

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Piccioli, A., Rossi, B., Sacchetti, F.M. et al. Fractures in bone tumour prosthesis. International Orthopaedics (SICOT) 39, 1981–1987 (2015). https://doi.org/10.1007/s00264-015-2956-7

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  • DOI: https://doi.org/10.1007/s00264-015-2956-7

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