Abstract
We retrospectively analysed 90 patients who underwent “en bloc” resection and modular endoprosthesis reconstruction in the lower limbs between 1987–2003. After proximal femur resection, reconstruction was performed with a modular endoprosthesis by Howmedica (KFTR, designed by Kotz) and modular revision endoprosthesis by W. Link or Lima-Lto (Revision system, designed by Wagner). The knee joint was reconstructed with a modular endoprosthesis (Howmedica, KFTR designed by Kotz) after distal femur or proximal tibia resection. Malignant bone tumours were present in 58 patients (64.5%), benign tumours in 16 (17.8%), metastases in 8 (8.9%), tumour-like lesions in 4 (4.4 %) and non-tumour-related destruction of the femur in 4 patients (4.4%). High-grade tumours were found in the majority of malignant bone tumours (70.7%). Treatment complications, which occurred in 26 patients, were: local recurrence of the tumour, deep infection, acetabular destruction following hemiarthroplasty, recurrent dislocations of endoprosthesis, periprosthetic fracture and hardware problems. In total, 23 patients (25.6%) died due to tumours. Endoprostheses should be considered as a treatment of choice for bone tumours in the hip and knee joint region. Advances in limb salvage surgery are, and will long continue to be, a great challenge for orthopaedic oncologists of the 21st century.
Résumé
Nous avons analysé de façon rétrospective 90 patients sur une période s’étendant de 1987 à 2003 et ayant bénéficié d’une résection au bloc avec reconstruction du membre inférieur par une endoprothèse modulaire. Cette reconstruction a été réalisée avec une endoprothèse de type Howmedica KFTR (Kotz), une endoprothèse médulaire de Link Lima-Lto (Wagner). La reconstruction articulaire du genou étant réalisée avec l’endoprothèse modulaire Howmedica KFTR (Kotz) après une résection du fémur distal ou du tibia proximal. Cinquante-huit patients (64.5%) présentaient une tumeur maligne, 16 (17.8%) une tumeur bénigne, 8 (8.9%) une métastase et 4 (4.4%) une tumeur tissue-like. Enfin, quatre patients ont été traités après une destruction fémorale non tumourale (4.4%). Une tumeur de haut grade a été trouvée dans la majorité des patients présentant une tumeur maligne (70.7%). Des complications sont survenues chez 26 patients avec récidive de la tumeur, infection profonde, destruction acétabulaire après hémiarthroplastie, luxation récidivante, fracture périprothétique. Au total, 23 patients (25.6%) sont morts de leur tumeur. L’endoprothèse a été considérée comme un traitement de choix pour les tumeurs osseuses de la hanche et du genou. Néanmoins, des progrès doivent être encore réalisés par les chirurgiens au cours du 21ème siècle.
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References
Abudu A, Grimer R, Tillman R, Carter S (2006) The use of prostheses in skeletally immature patients. Orthop Clin North Am 37:75–84
Bacci G, Picci P, Ferrari S, Ruggieri P, Casadei R, Tienghi A, Brach del Prever A, Gherlinzoni F, Mercuri M, Monti C (1993) Primary chemotherapy and delayed surgery for nonmetastatic osteosarcoma of the extremities. Results in 164 patients preoperatively treated with high doses of methotrexate followed by cisplatin and doxorubicin. Cancer 72:3227–3238
Bickels J, Meller I, Henshaw RM, Malawer MM (2000) Reconstruction of hip stability after proximal and total femur reconstruction. Clin Orthop 375:218–230
Cara JA, Canadell J (1994) Limb salvage for malignant bone tumours in young children J Pediatr Orthop 14:112–118
Cool WP, Carter SR, Grimer RJ, Tillman RM, Walker PS (1997) Growth after extendible endoprosthetic replacement of the distal femur. J Bone Joint Surg (Br) 79:938–942
Donati D, Giacomini S, Gozzi E, Mercuri M (2002) Proximal femur reconstruction by an allograft prosthesis composite. Clin Orthop 394:192–200
Eckardt JJ, Eilber FR, Dorey FJ, Mirra JM (1985) The UCLA experience in limb salvage surgery for malignant tumours. Orthopedics 8:612–621
Enneking WF, Spanier SS, Goodman MA (1980) A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop 153:106–120
Futani H, Minamizaki T, Nishimoto Y, Abe S, Yabe H, Ueda T (2006) Long-term follow-up after limb salvage in skeletally immature children with a primary malignant tumour of the distal end of the femur. J Bone Joint Surg (Am) 88:595–603
Gibbs CP Jr, Weber K, Scarborough MT (2001) Malignant bone tumours. J Bone Joint Surg (Am) 83:1728–1745
Grimmer RJ, Carter SR, Tillman RM, Sneath RS, Walker PS, Unwin PS, Shewell PC (1999) Endoprosthetic replacement of proximal tibia. J Bone Joint Surg (Br) 81:488–494
Ham SJ, Schraffordt Koops H, Veth RP, van Horn JR, Molenaar WM, Hoekstra HJ (1998) Limb salvage surgery for primary bone sarcoma of the lower extremities: long-term consequences of endoprosthetic reconstructions. Ann Surg Oncol 5:423–436
Kawai A, Muschler GF, Lane JM, Otis JC, Healey JH (1998) Prosthetic knee replacement after resection of a malignant tumour of the distal part of the femur. Medium to long-term results. J Bone Joint Surg (Am) 80:636–647
Kotz R, Dominkus M, Zettl T, Ritschl P, Windhager R, Gadner H, Zielinski C, Salzer-Kuntschik M (2002) Advances in bone tumour treatment in 30 years with respect to survival and limb salvage. A single institution experience. Int Orthop 26:197–202
Link MP, Goorin AM, Horowitz M, Meyer WH, Belasco J, Baker A, Ayala A, Shuster J (1991) Adjuvant chemotherapy of high-grade osteosarcoma of the extremity. Updated results of the multi-institutional osteosarcoma study. Clin Orthop Relat Res 270:8–14
Malawer MM, Chou LB (1995) Prosthetic survival and clinical results with use of large-segment replacements in the treatment of high-grade bone sarcomas. J Bone Joint Surg (Am) 77:1154–1165
Manfrini M, Innocenti M, Ceruso M, Mercuri M (2003) Original biological reconstruction of the hip in a 4-year-old girl. Lancet 361:140–142
Natarajan M, Bose JC, Rajkumar G (2003) Proximal femoral reconstruction with custom mega prosthesis. Int Orthop 27:175–179
Orlic D, Baebler B, Smerdelj M (1991) Complications of non-cemented tumoural endoprostheses. Brown K (ed) Complications of limb salvage. Prevention, management an outcome. ISOLS, Montreal, pp 421–424
Orlic D, Smerdelj M, Kolundzic R, Bergovec M (2005) Acetabular complications after resection of bone tumour localized in proximal femur in growing children with partial hip endoprosthesis-biomechanical consideration. In: Program and abstracts of the 7th EFORT Congress, 4–7 June 2005, Lisboa, Portugal
Posinkovic B, Orlic D (1983) Prosthetic replacement of the knee in the treatment of infected and recurring giant cell tumour of the distal femur. Arch Orthop Trauma Surg 102:131–134
Sanjay BK, Moreau PG (1999) Limb salvage surgery in bone tumour with modular endoprosthesis. Int Orthop 23:41–46
Wedin R (2001) Surgical treatment for pathologic fracture. Acta Orthop Scand Suppl 72:2:1–29
Weisstein JS, Goldsby RE, O’Donnell RJ (2005) Oncologic approaches to pediatric limb preservation. J Am Acad Orthop Surg 13:544–554
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Orlic, D., Smerdelj, M., Kolundzic, R. et al. Lower limb salvage surgery: modular endoprosthesis in bone tumour treatment. International Orthopaedics (SICOT) 30, 458–464 (2006). https://doi.org/10.1007/s00264-006-0193-9
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DOI: https://doi.org/10.1007/s00264-006-0193-9