1,721,108 research outputs found
The role of dual mobility hip prosthesis in the management of intracapsular neck of femur fractures
No full textThe mean worldwide annual incidence of femoral neck fractures is
more than 1 million, and this number is expected to rise over 4 million
by 2050.
Intracapsular fractures of the femoral neck are the most common
fracture types and their incidence is ranging between 45 % and 53 % of
all hip fractures. Treatment for these displaced fractures in elderly
people include hemiarthroplasty (HA) and total hip arthroplasty (THA).
In active healthy elderly patient, the choice between HA and THA is
still debated
A long-term experience with Mutars tumor megaprostheses: analysis of 187 cases
No full textPurpose Modular megaprostheses have widely replaced allografts, as a reconstructive option; however, failures of these devices remain high. Aim of this study was to analyze outcomes, survival of the implants, incidence and types of complica- tions with Mutars modular endoprostheses at long term.
Methods Between 2000 and 2019, 187 Mutars prostheses were implanted in two dedicated centers: 72 upper limbs and 115 lower limbs reconstructions. Diagnoses included 107 primary malignant bone or soft tissue tumors, 65 metastases, 8 benign bone tumors and 7 non-oncologic cases. Silver-coated prostheses were used in 118/187 (63%) cases.
Results At last follow-up, 76.5% of patients had retained their implant. The overall failure rate was 23.5% at a mean of
1.7 years. There were 22 mechanical failures and 22 non-mechanical failures. The overall implant survival to all types of failure was 68% and 52% at 5 and 10 years, respectively. Infection was the most common mode of failure with an incidence of 6.9%. Implant survival to infection was better for silver-coated implants than for standard implants even if with no significant difference (p = 0.56). Functional results were satisfactory in 97% of patients.
Conclusions The overall implant survival at long term was satisfactory with Mutars prostheses. The incidence of compli- cations with Mutars prosthesis is in line with the incidence reported in the literature with other types of tumor prosthesis. The most frequent cause of failure was infection with a lower incidence in silver-coated prostheses; silver coating seems to prevent infection in distal femur and proximal tibia. The silver coating seems to be particularly useful in two-stage revisions with a lower incidence of secondary amputation. In higher risk patients, silver-coated prostheses are the preferable choice for the reduction of the reinfection rate. The functional results of Mutars prostheses were excellent or good in most of cases. The current paper is design to enhance the literature on megaprosthesis in tumor surgery, proven that this system is one of the most used all over the word and one of the best performing
Infections in Orthopedic Oncology
No full textThis chapter focuses on Infections in Orthopedic
Oncology in those cases when there is no reconstruction
after tumor resection, after curettage
surgeries, and when the reconstruction after
resection is not a prosthetic reconstruction. The
wider topic of infections in Megaprosthesis is
discussed in another chapter of this boo
Is still effective massive allograft reconstruction in parosteal osteosarcoma of the distal femur? Review of the literature and advantages of newer technologies
Full text linkPurpose: Parosteal Osteosarcoma is a well-differentiated, low-grade bone sarcoma. It most commonly occurs in the third decade of life, usually in the distal femur. This study aims to perform a literature review about the types of reconstructions reported and to analyze the results of an updated technique of resection using custom-made 3D-printed cutting guides. Methods: We perform a systematic literature review about parosteal osteosarcoma, evaluating treatments, margins, local recurrence, complications, and functional results when available. We also report a case treated in our Center with a revisited technique introducing custom-made 3D-printed cutting guides. Results: We analyzed 12 studies with a total of 151 patients. The distal femur was the most frequently reported site (81.5%). After distal femur resection, reconstruction was performed with graft in most cases (48%), followed by prosthetic reconstruction (40%). Margins were wide in 85.5% of cases. The total incidence of local recurrence was 11%. Functional results were excellent in all cases, with a mean MSTS score of 86%. In our case, with the help of the jigs, the surgical technique was relatively easy, graft fusion excellent and fast, margins wide, and functional results excellent. Conclusions: In the literature, the most commonly used type of reconstruction after resection is biological with graft. Indeed, despite the increasing number of prosthetic reconstructions, the historical diaphysometaphyseal hemiresection and graft is still indicated in parosteal osteosarcoma of the distal femur. New technologies, such as the jigs we used, allow significant advantages during the procedure: reduce the resection and graft preparation time, allow a better match between components, and help to obtain safer margins, sparing as much bone as possible
Distal femur reconstruction with modular tumour prostheses: a single Institution analysis of implant survival comparing fixed versus rotating hinge knee prostheses
No full textTo evaluate the incidence of complications in distal femur reconstructions with modular prostheses, comparing fixed vs rotating hinge knee.
METHODS:
Retrospective analysis of implant survival, complications, and functional results of the Rizzoli series on distal femur megaprosthesis. Between 1983 and 2010, 687 distal femur tumour modular prostheses were implanted: 491 fixed hinge and 196 rotating hinge knee prostheses. Failures of the prostheses were classified in five types: type 1, soft tissue failure; type 2, aseptic loosening; type 3, structural failure; type 4, infection; type 5, tumour progression.
RESULTS:
Failure rate was 27 % (185/687). Implant survival to all types of failure was 70 % at ten years and 50 % at 20 years with no significant difference between fixed and rotating hinge knee prostheses (p = 0.0928). When excluding type 5 and type 1 failures, the overall survival was 78 % and 58 % at ten and 20 years. There was not a significant difference in implant survival to aseptic loosening (p = 0.5) and infection (p = 0.2) between fixed and rotating hinge knee prostheses. All cases of breakage of prosthetic components occurred in fixed hinge knee prostheses. Functional results, evaluated in 536 pts, were satisfactory in 91.4 % of cases with a mean score of 23.3 with a significantly better function for rotating hinge knee prostheses (p < 0.001).
CONCLUSIONS:
The most frequent cause of failure was infection followed by aseptic loosening. Even if better results were expected for rotating hinge knee prostheses, there is no significant difference in overall implant survival. No cases of breakage of prosthetic components occurred in rotating hinge knee prosthesis. Functional results were significantly better for the rotating hinge knee prostheses.
LEVEL OF EVIDENCE:
Therapeutic study, level IV (case series
A rare case of anterior shoulder dislocation in 1-year- and 10-month-old toddler: case report and literature review
Full text linkWe report our clinical experience of a 1 year and 10 month child with traumatic anterior shoulder dislocation who underwent non-operative reduction and Desault's bandage immobilization for 10 days. No associated fractures were found and after bandage removal, full ROM of the shoulder was immediately assessed. Further research is needed to unified guideline of treatment and the time of immobilization for this type of injury in pediatric population
A systematic review of multicentric giant cell tumour with the presentation of three cases at long-term follow-up
No full textAims
We performed a systematic literature review to define features of patients, treatment, and
biological behaviour of multicentric giant cell tumour (GCT) of bone.
Methods
The search terms used in combination were “multicentric”, “giant cell tumour”, and
“bone”. Exclusion criteria were: reports lacking data, with only an abstract; papers not
reporting data on multicentric GCT; and papers on multicentric GCT associated with other
diseases. Additionally, we report three patients treated under our care.
Results
A total of 52 papers reporting on 104 patients were included in the analysis, with our addition of
three patients. Multicentric GCT affected predominantly young people at a mean age of 22 years
(10 to 62), manifesting commonly as metachronous tumours. The mean interval between the
first and subsequent lesions was seven years (six months to 27 years). Synchronous lesions
were observed in one-third
of the patients. Surgery was curettage in 63% of cases (163 lesions);
resections or amputation were less frequent. Systemic treatments were used in 10% (n = 14) of
patients. Local recurrence and distant metastases were common.
Conclusion
Multicentric GCT is rare, biologically aggressive, and its course is unpredictable. Patients
with GCT should be followed indefinitely, and referred promptly if new symptoms, particularly
pain, emerge. Denosumab can have an important role in the treatment
Proximal Tibial Resection for Bone Tumor and Prosthetic Reconstruction Combined with Medial Gastrocnemius Flap
Full text linkBackground: Primary bone tumors frequently occur in the proximal tibia, ranking as the second most common location after the distal femur1. Challenges to treatment include the proximity of neurovascular structures, limited soft-tissue coverage, compromised knee extension, and postoperative complications1-8. The present video article describes proximal tibial resection for the treatment of a bone tumor and prosthetic reconstruction combined with a medial gastrocnemius flap. Description: Proximal tibial resection is performed with use of an anteromedial approach. After defining the resection level, the tumor is removed en bloc with wide free margins. Reconstruction is performed with use of a megaprosthesis, and the medial gastrocnemius flap is utilized for covering the prosthesis and for reconstruction of the extensor apparatus. Alternatives: Osteoarticular allografts and allograft-prosthesis composites allow restoration of bone stock and direct biological reattachment of host tendons, ligaments, and capsule. Autografting is performed using the fibula as a donor site. Custom-made implants can be designed according to the patient's anatomy. Amputation should be considered when the neurovascular bundle is widely involved by the tumor. Rationale: In contrast to alternative treatments, megaprosthetic reconstructions offer several advantages: technical simplicity, immediate weight-bearing, and shorter immobilization. Additionally, megaprostheses do not carry the risk of allograft-related complications, such as nonunion, fracture, subchondral collapse, articular cartilage degeneration, and instability. Expected outcomes: Patients with metallic endoprostheses demonstrate lower rates of complications and amputation, as well as higher patient survival rates, compared with those treated with allograft reconstructions7,9,10. The advancements in technology and design since 1977 have contributed to reduced mechanical stress at the bone-prosthesis interface and decreased rates of mechanical or structural failure3,11,12. However, despite advancements in design, proximal tibial prosthetic reconstructions continue to exhibit the least favorable outcomes and function among all limb-salvage procedures, accompanied by the highest rate of complications1,9-11. Studies report survival rates ranging from 45% to 82% at 5 years and 45% to 78% at 10 years1,13, with rates of revision for infection and loosening ranging from 40% at 5 years to 73% at 15 years1,10,13. Various techniques are utilized for attaching the extensor mechanism of the knee and providing coverage for proximal tibial reconstructions7,8,10,14,15. Various studies have emphasized the importance of direct attachment of the extensor mechanism to the megaprosthesis, which facilitates initial mechanical stability crucial for healing and scarring7,10,16. Pedicled muscle flaps, particularly the medial or lateral gastrocnemius, have commonly been utilized to supply blood to aid wound healing and to biologically reconstruct the extensor mechanism7-9. Despite some patients experiencing increased extension lag, gradual improvement in function17 was observed during follow-up. In our experience with 225 proximal tibial resections, survival of megaprosthetic reconstructions was 82% and 78% at 5 and 10 years, respectively, without any difference between the use of a fixed versus rotating hinge1. However, the rate of good or excellent functional outcomes, as measured according to the Musculoskeletal Tumor Society (MSTS) system17, was significantly higher with use of a rotating hinge. Infection was, as expected, the most frequent complication, occurring in 27 patients (12%), followed by aseptic loosening (13 patients, 6%), rupture of the extensor mechanism (6 patients, 3%), breakage of the prostheses (4 patients, 1.6%), and wound dehiscence (4 patients, 1.6%)1. Important tips: Preoperative evaluation and imaging. Perform a thorough history and physical examination, assess for evidence of a syndrome or family history, and utilize imaging studies to evaluate the tumor.Patient positioning and incision planning. Position the patient supine to ensure full access to the proximal tibia. Prepare and drape the patient; center the incision on the mass through an anteromedial approach including the biopsy tract and perform a longitudinal incision.Harvest the gastrocnemius flap. After identifying the proximal vessels, proceed to dissect the gastrocnemius flap, which is typically straightforward and rapid (even after tumor removal).Dissection of soft tissue and definition of the tumor resection margin. Protect and retract the medial gastrocnemius flap and then isolate and protect the popliteal and posterior tibial vessels.Deep dissection and articular resection. If staging and preoperative planning indicated no evidence of tumor inside the joint, intra-articular knee resection should be conducted. Arthrotomy is performed through a parapatellar approach, and the cruciate ligaments are cut close to the femoral attachment.Tumor removal. After the specimen with the tumor is freed circumferentially, identify the osteotomy level and dissect any remaining structures connected with proximal tibia to remove the entire tumor.Inspection and hemostasis. Evaluate for hemostasis and send the specimen for pathologic analysis. Prepare for the reconstructive phase and close the surgical site.Proximal tibial reconstruction with a modular endoprosthesis. Tumor mega-endoprostheses are appealing because of their versatility, ability to yield favorable functional outcomes, ability to allow immediate weight-bearing, and possible cost-effectiveness.Reconstruction of the extensor mechanism. The commonly utilized approach involves employing a medial gastrocnemius flap.Monitoring and postoperative care. Postoperative monitoring is crucial. A strict rehabilitation protocol with immobilization in full extension for 4 weeks followed by progressive mobilization for 3 months is critical to guarantee better functional results. Acronyms and abbreviations: GCT = giant cell tumorHIV = human immunodeficiency virusHBV = hepatitis B virusHCV = hepatitis C virusf-up = follow-upCT = computed tomographyMRI = magnetic resonance imagingPET = positron emission tomographySUV = standardized uptake valueCht (ISG/OS2) = chemotherapyMTX-HD = high-dose methotrexateCDP = cisplatinADM = doxorubicinKMFTR = Kotz Modular Femur-Tibia Reconstruction systemHMRS = Howmedica Modular Resection SystemGMRS = Global Modular Replacement System
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