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1.
Bone Joint J ; 102-B(1): 72-81, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31888363

RESUMO

AIMS: The early mortality in patients with hip fractures from bony metastases is unknown. The objectives of this study were to quantify 30- and 90-day mortality in patients with proximal femoral metastases, and to create a mortality prediction tool based on biomarkers associated with early death. METHODS: This was a retrospective cohort study of consecutive patients referred to the orthopaedic department at a UK trauma centre with a proximal femoral metastasis (PFM) over a seven-year period (2010 to 2016). The study group were compared to a matched control group of non-metastatic hip fractures. Minimum follow-up was one year. RESULTS: There was a 90-day mortality of 46% in patients with metastatic hip fractures versus 12% in controls (89/195 and 24/192, respectively; p < 0.001). Mean time to surgery was longer in symptomatic metastases versus complete fractures (9.5 days (SD 19.8) and 3.4 days (SD 11.4), respectively; p < 0.05). Albumin, urea, and corrected calcium were all independent predictors of early mortality and were used to generate a simple tool for predicting 90-day mortality, titled the Metastatic Early Prognostic (MEP) score. An MEP score of 0 was associated with the lowest risk of death at 30 days (14%, 3/21), 90 days (19%, 4/21), and one year (62%, 13/21). MEP scores of 3/4 were associated with the highest risk of death at 30 days (56%, 5/9), 90 days (100%, 9/9), and one year (100%, 9/9). Neither age nor primary cancer diagnosis was an independent predictor of mortality at 30 and 90 days. CONCLUSION: This score could be used to predict early mortality and guide perioperative counselling. The delay to surgery identifies a potential window to intervene and correct these abnormalities with the aim of improving survival. Cite this article: Bone Joint J. 2020;102-B(1):72-81.


Assuntos
Neoplasias Femorais/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/metabolismo , Estudos de Casos e Controles , Feminino , Neoplasias Femorais/secundário , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Escócia/epidemiologia , Índice de Gravidade de Doença , Análise de Sobrevida , Tempo para o Tratamento
2.
Bone Joint J ; 101-B(8): 1024-1031, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31362545

RESUMO

AIMS: The aim of this study was to determine the risk of local recurrence and survival in patients with osteosarcoma based on the proximity of the tumour to the major vessels. PATIENTS AND METHODS: A total of 226 patients with high-grade non-metastatic osteosarcoma in the limbs were investigated. Median age at diagnosis was 15 years (4 to 67) with the ratio of male to female patients being 1.5:1. The most common site of the tumour was the femur (n = 103) followed by tibia (n = 66). The vascular proximity was categorized based on the preoperative MRI after neoadjuvant chemotherapy into four types: type 1 > 5 mm; type 2 ≤ 5 mm, > 0 mm; type 3 attached; type 4 surrounded. RESULTS: Limb salvage rate based on the proximity type was 92%, 88%, 51%, and 0% for types 1 to 4, respectively, and the overall survival at five years was 82%, 77%, 57%, and 67%, respectively (p < 0.001). Local recurrence rate in patients with limb-salvage surgery was 7%, 8%, and 22% for the types 1 to 3, respectively (p = 0.041), and local recurrence at the perivascular area was observed in 1% and 4% for type 2 and 3, respectively. The mean microscopic margin to the major vessels was 6.9 mm, 3.0 mm, and 1.4 mm for types 1 to 3, respectively. In type 3, local recurrence-free survival with limb salvage was significantly poorer compared with amputation (p = 0.025), while the latter offered no overall survival benefit. In this group of patients, factors such as good response to chemotherapy or limited vascular attachment to less than half circumference or longitudinal 10 mm reduced the risk of local recurrence. CONCLUSION: The proximity of osteosarcoma to major blood vessels is a poor prognostic factor for local control and survival. Amputation offers better local control for tumours attached to the blood vessels but does not improve survival. Limb salvage surgery offers similar local control if the tumour attachment to blood vessels is limited. Cite this article: Bone Joint J 2019;101-B:1024-1031.


Assuntos
Vasos Sanguíneos/diagnóstico por imagem , Neoplasias Femorais/cirurgia , Imagem por Ressonância Magnética , Recidiva Local de Neoplasia/etiologia , Osteossarcoma/cirurgia , Cuidados Pré-Operatórios/métodos , Tíbia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Neoplasias Femorais/diagnóstico por imagem , Neoplasias Femorais/mortalidade , Neoplasias Femorais/patologia , Seguimentos , Humanos , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/mortalidade , Osteossarcoma/diagnóstico por imagem , Osteossarcoma/mortalidade , Osteossarcoma/patologia , Prognóstico , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Tíbia/diagnóstico por imagem , Tíbia/patologia , Tíbia/cirurgia , Adulto Jovem
3.
Rev Esp Cir Ortop Traumatol ; 63(3): 173-180, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30922597

RESUMO

OBJECTIVE: To analyze a series of patients with bone tumours reconstructed with modular prostheses and to evaluate: 1) Survival of the implant. 2) Causes of failure. 3) Complication rates. 4) Limb salvage overall survival. 5) Functional results and full weight bearing. MATERIALS AND METHODS: A retrospective study from longitudinally maintained oncology databases was undertaken. All patients with bone tumours reconstructed with endoprosthesis were analysed. A toal of 106patients matched the inclusion criteria. They were divided into groups: group 1, primary bone tumours; group 2, bone metastasis; group 3, osteoarticular allograft reconstruction revisions. The type of failures were classified according to Henderson et al. (2014) and functional results assessed by the Musculoskeletal Tumor Society (MSTS). Demographic analysis, survival and the differences between groups were recorded. RESULT: The mean follow-up of the patients was 68 months. Mean age was 43 years. Overall implant survival was 86.4% at 2 years (95% CI: 79-94) and 73% at 5 years (95% CI: 60-80). Nineteen patients (18%) developed a prosthetic failure. The limb salvage overall survival was 96% at 5 years (95% CI: 91-99). The mean functional results according to the MSTS was 24 and mean time to full weight bearing was 2.3 weeks. CONCLUSIONS: Limb conservation surgery and endosprosthetic reconstruction is a valid option for patients with bone tumours with failure rates similar to other reconstruction methods.


Assuntos
Neoplasias Ósseas/cirurgia , Neoplasias Femorais/cirurgia , Falha de Prótese , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/secundário , Feminino , Neoplasias Femorais/mortalidade , Neoplasias Femorais/secundário , Seguimentos , Humanos , Úmero , Estimativa de Kaplan-Meier , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão , Procedimentos Cirúrgicos Reconstrutivos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Tíbia , Resultado do Tratamento , Suporte de Carga , Adulto Jovem
4.
Clin Orthop Relat Res ; 477(4): 707-714, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30811363

RESUMO

BACKGROUND: Biologic agents may prolong survival of patients with certain kidney and lung adenocarcinomas that have metastasized to bone, and patient response to these agents should be considered when choosing between an endoprosthesis and internal fixation for surgical treatment of femoral metastases. QUESTIONS/PURPOSES: Among patients undergoing surgery for femoral metastases of lung or renal cell carcinoma, (1) Does survival differ between patients who receive only cytotoxic chemotherapy and those who either respond or do not respond to biologic therapy? (2) Does postsurgical incidence of local disease progression differ between groups stratified by systemic treatment and response? (3) Does implant survival differ among groups stratified by systemic treatment and response? METHODS: From our institutional longitudinally maintained orthopaedic database, patients were identified by a query initially identifying all patients who carried a diagnosis of renal cell carcinoma or lung carcinoma. Patients who underwent internal fixation or prosthetic reconstruction between 2000 and 2016 for pathologic fracture of the femur and who survived ≥ 1 year after surgery were studied. Patients who received either traditional cytotoxic chemotherapy or a biologic agent were included. Patients were classified as responders or nonresponders to biologic agents based on whether they had clinical and imaging evidence of a response recorded on two consecutive office visits over ≥ 6 months. Endpoints were overall survival from the time of diagnosis, survival after the femoral operation, evidence of disease progression in the femoral operative site, and symptomatic local disease progression for which revision surgery was necessary. Our analysis included 148 patients with renal (n = 26) and lung (n = 122) adenocarcinoma. Fifty-one patients received traditional chemotherapy only. Of 97 patients who received a biologic agent, 41 achieved a response (stabilization/regression of visceral metastases), whereas 56 developed disease progression. We analyzed overall patient survival with the Kaplan-Meier method and used the log-rank test to identify significant differences (p < 0.05) between groups. RESULTS: One-year survival after surgery among patients responsive to biologic therapy was 61% compared with 20% among patients nonresponsive to biologics (p < 0.001) and 10% among those who received chemotherapy only (p < 0.009). With the number of patients we had to study, we could not detect any difference in local progression of femoral disease associated with systemic treatment and response. Radiologic evidence of periimplant local disease progression developed in three (7%) of 41 patients who responded to biologic treatment, two (3%) of 56 patients nonresponsive to biologics, and one (2%) of 51 patients treated with traditional chemotherapy. With the numbers of patients we had, we could not detect a difference in patients who underwent revision. All three patients responsive to biologics who developed local recurrence underwent revision, whereas the two without a response to biologics did not. CONCLUSIONS: Biologic therapy improves the overall longevity of some patients with lung and renal metastases to the femur in whom a visceral disease response occurred. In our limited cohort, we could not demonstrate an implant survival difference between such patients and those with shorter survival who may have had more aggressive disease. However, an increased life expectancy beyond 1 year among patients responsive to biologics may increase risk of mechanical failure of fixation constructs. LEVEL OF EVIDENCE: Level III, therapeutic study.


Assuntos
Adenocarcinoma de Pulmão/terapia , Produtos Biológicos/uso terapêutico , Carcinoma de Células Renais/terapia , Fraturas do Fêmur/cirurgia , Neoplasias Femorais/cirurgia , Fixação Interna de Fraturas , Fraturas Espontâneas/cirurgia , Neoplasias Renais/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Implantação de Prótese , Adenocarcinoma de Pulmão/mortalidade , Adenocarcinoma de Pulmão/secundário , Adulto , Idoso , Idoso de 80 Anos ou mais , Produtos Biológicos/efeitos adversos , Carcinoma de Células Renais/mortalidade , Carcinoma de Células Renais/secundário , Tomada de Decisão Clínica , Bases de Dados Factuais , Progressão da Doença , Feminino , Fraturas do Fêmur/mortalidade , Fraturas do Fêmur/patologia , Neoplasias Femorais/mortalidade , Neoplasias Femorais/secundário , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/mortalidade , Fraturas Espontâneas/mortalidade , Fraturas Espontâneas/patologia , Humanos , Neoplasias Renais/mortalidade , Neoplasias Renais/patologia , Expectativa de Vida , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Implantação de Prótese/efeitos adversos , Implantação de Prótese/mortalidade , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
5.
Strahlenther Onkol ; 195(4): 335-342, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30215093

RESUMO

PURPOSE: To reinvestigate the functional recovery after combined treatment with surgery and postoperative irradiation of complete or impending pathologic fractures of long bones. METHODS: We retrospectively evaluated the results of external beam radiation therapy (EBRT) carried out after 68 orthopedic stabilization procedures (femur, n = 55, 80.8%; humerus, n = 13, 19.2%) for actual or impending pathological fracture of long bone in 61 patients with skeletal metastases. The mean normalized total dose was 34.7 ± 7.8 Gy. Endpoints were patient's functional status (FS; 1 = normal pain free status; 2 = normal use with pain; 3 = significantly limited used; 4 = nonfunctional status), a need for a secondary procedure to the same site and overall survival following surgery. RESULTS: Overall, 75% of patients achieved normal functional status (FS 1-2) within 12 weeks after surgery. Functional recovery in surviving patients reached 93%. Median survival was 17 months (95% confidence interval 13.7-20.2). Secondary surgical intervention at the same location was necessary in 3 patients (4.4%). On multivariate analysis, only general status (p = 0.011) and growing potential of primary tumor (p = 0.049) were associated with achieving normal functional status within 12 weeks after surgery and radiotherapy. The applied radiation schemes demonstrated a comparable impact on functional recovery. CONCLUSIONS: Our results confirm the effectiveness of stabilizing surgery and fractionated postoperative radiotherapy in terms of functional recovery, supporting prior results assessing postsurgical radiotherapy versus follow-up. The patient's general status is a strong prognostic factor for functional recovery. Rapidly growing tumors may hinder achievement of a normal functional status.


Assuntos
Neoplasias Ósseas/secundário , Neoplasias Ósseas/terapia , Neoplasias Femorais/secundário , Neoplasias Femorais/terapia , Úmero/cirurgia , Radioterapia Adjuvante , Recuperação de Função Fisiológica , Idoso , Terapia Combinada , Feminino , Neoplasias Femorais/mortalidade , Seguimentos , Fraturas Espontâneas/mortalidade , Fraturas Espontâneas/radioterapia , Fraturas Espontâneas/cirurgia , Humanos , Masculino , Análise Multivariada , Medição da Dor , Estudos Retrospectivos , Taxa de Sobrevida
6.
Clin Orthop Relat Res ; 476(5): 977-983, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29480890

RESUMO

BACKGROUND: The majority of metastatic bone lesions to the femoral bone can be treated without surgery or with minimally invasive intramedullary nailing. In rare patients with extensive metastatic disease to the femur, total femur replacement may be the only surgical alternative to amputation; however, little is known about this approach. QUESTIONS/PURPOSES: In a highly selected small group of patients with metastatic carcinoma of the femur, we asked: (1) What was the patient survivorship after this treatment? (2) What was the implant survivorship free from all-cause revision and amputation, and what complications were associated with this treatment? (3) What functional outcomes were achieved by patients after total femur replacement for this indication? METHODS: Eleven patients (three men, eight women) with a mean age of 64 years (range, 41-78 years) received total femur replacements between 1986 and 2016; none were lost to followup. The most common primary disease was breast cancer. In general, during this period, our indications for this procedure were extensive metastatic disease precluding internal fixation or isolated proximal or distal femur replacement, and an anticipated lifespan exceeding 6 months. Our contraindication for this procedure during this time was expected lifespan less than 6 months. Patient survival was assessed by Kaplan-Meier analysis; implant survival free from revision surgery and amputation were assessed by competing risk analysis. Function was determined preoperatively and 6 to 12 weeks postoperatively with the Musculoskeletal Tumor Society (MSTS) score normalized to a 100-point scale, with higher scores representing better function from a longitudinally maintained institutional database. RESULTS: Eleven patients died at a median of 5 months (range, 1-31 months) after surgery. One-year revision-free and limb survival were 82% (95% CI, 51%-98%) and 91% (95% CI, 61%-99%), respectively. Reasons for reoperation were hip dislocation, infection and local recurrence in one patient each. The latter two complications resulted in amputation in two patients. The median MSTS score was 32 (range, 13-57). CONCLUSIONS: Despite attempts to select patients who might have anticipated greater life expectancy, eight of 11 patients died by 6 months after surgery, and an additional two patients had undergone an amputation at 8 and at 17 months postoperatively. Most patients undergoing total femur replacement in this series did not recover from the procedure by the time they died, despite our best attempts to perform the procedure in patients whom we thought would live at least 6 months. Based on this, we believe that most patients with extensive metastatic disease to the femur should be offered palliative care, rather than major reconstruction. LEVEL OF EVIDENCE: Level IV, therapeutic study.


Assuntos
Carcinoma/cirurgia , Neoplasias Femorais/cirurgia , Osteotomia , Implantação de Prótese , Adulto , Idoso , Amputação , Carcinoma/mortalidade , Carcinoma/secundário , Tomada de Decisão Clínica , Bases de Dados Factuais , Progressão da Doença , Feminino , Neoplasias Femorais/mortalidade , Neoplasias Femorais/secundário , Humanos , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Osteotomia/efeitos adversos , Osteotomia/mortalidade , Seleção de Pacientes , Intervalo Livre de Progressão , Implantação de Prótese/efeitos adversos , Implantação de Prótese/instrumentação , Implantação de Prótese/mortalidade , Reoperação , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
7.
J Arthroplasty ; 32(12): 3607-3610, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28735800

RESUMO

BACKGROUND: The hip is a common location for metastatic tumors. Due to the high loads placed through the proximal femur, surgery is often indicated to provide pain relief and restore function. Historically, these lesions are reconstructed with a hemiarthroplasty; however, there are few reports on the outcome of these reconstructions. The purpose of this study is to evaluate the outcome of hemiarthroplasty for the treatment of proximal femur metastatic disease, with a specific focus on the rates of conversion to total hip arthroplasty (THA). METHODS: One hundred ninety-nine patients (102 women, 97 men) were treated using a hemiarthroplasty to reconstruct the proximal femur for metastatic disease between 1992 and 2014. Mean age and body mass index were 62 years and 27.4 kg/m2, respectively. The most common site of primary disease was the breast (n = 63). The most common location for the metastatic disease was the femoral neck (n = 148). Mean follow-up for surviving patients was 4 years. RESULTS: Over the course of the study, 2 (1%) patients underwent conversion to a THA due to groin pain and degenerative changes. In addition, complications occurred in 12% of patients, most commonly a deep venous thrombosis (n = 5). Following the procedure, mean Harris Hip Score and Musculoskeletal Tumor Society 1993 scores were 73 and 63%, respectively. CONCLUSION: Reconstruction of the proximal femur with a hemiarthroplasty endoprosthesis provides a majority of patients with a durable means of reconstruction, with a low rate of conversion to THA.


Assuntos
Neoplasias Femorais/complicações , Hemiartroplastia/estatística & dados numéricos , Fraturas do Quadril/etiologia , Fraturas do Quadril/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/estatística & dados numéricos , Criança , Feminino , Neoplasias Femorais/mortalidade , Neoplasias Femorais/secundário , Fêmur/cirurgia , Colo do Fêmur/cirurgia , Hemiartroplastia/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Minnesota/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
8.
Orthop Surg ; 9(2): 221-228, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28598582

RESUMO

OBJECTIVE: To evaluate the clinical outcomes and complications of segmental prosthetic reconstruction for pathological diaphyseal femoral fractures secondary to metastatic tumors. METHODS: Between 2011 and 2015, we retrospectively evaluated 16 patients (6 men and 10 women; 64.5 ± 11.4 years old at diagnosis) who underwent prosthetic reconstruction after segmental resection of diaphyseal femoral fractures due to metastatic lesions. Visual analog scale (VAS), functional outcomes, implant-related complications, and Mean postoperative Musculoskeletal Tumor Society (MSTS) score for each patient were collected. RESULTS: The mean length of bone defect was 10.2 ± 2.6 cm (range, 8-16 cm); follow-up was 9 ± 6.8 months (range, 2-25 months) for all patients, and 24 months (23 and 25 months) for the 2 patients still alive. At final follow-up, 14 patients were dead, indicating a mean survival of 6.9 ± 3.6 months (range, 2-14 months). Mean preoperative VAS score was 8.5 ± 1.0, which decreased to 2.5 ± 1.3 at day 2 postoperatively, indicating significant pain relief (P < 0.05). The MSTS score for lower extremities was 84.6% (range, 73%-90%). The range of motion and function of adjacent joints was within the normal limits in all cases. Three patients (33%) developed complications, including aseptic loosening because of disease progression (1), infection (1), and peri-prosthesis fracture (1). CONCLUSION: These findings demonstrated that this approach greatly relieves pain, and yields satisfactory functional outcomes with fewer complications in patients with pathological femoral fractures secondary to metastatic tumors; however, survival was not significantly improved.


Assuntos
Fraturas do Fêmur/cirurgia , Neoplasias Femorais/secundário , Fraturas Espontâneas/cirurgia , Feminino , Fraturas do Fêmur/etiologia , Fraturas do Fêmur/mortalidade , Neoplasias Femorais/mortalidade , Seguimentos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Desenho de Prótese , Estudos Retrospectivos , Resultado do Tratamento
9.
Orthop Traumatol Surg Res ; 103(7): 1011-1015, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28647623

RESUMO

BACKGROUND: The proximal femuris is an uncommon site of osteosarcoma. The unusual manifestations at this site may lead to diagnostic and therapeutic mistakes. We therefore performed a retrospective study to estimate the proportions of patients with imaging study findings and/or clinical manifestations typical for osteosarcoma and/or inappropriate treatment decisions. HYPOTHESIS: Proximal femoral osteosarcoma often produces atypical clinical and radiological presentations. MATERIAL AND METHODS: Consecutive patients who underwent surgery at our center to treat proximal femoral osteosarcoma were included. For each patient, we collected the epidemiological characteristics, clinical symptoms, imaging study findings, treatment, and tumor outcome. Proportions were computed with their confidence intervals. RESULTS: Twelve patients had surgery for proximal femoral osteosarcoma between 1986 and 2015. Imaging findings were typical in 1 (8%) patient; they consisted of ill-defined osteolysis in 11/12 (92%) patients, a periosteal reaction in 1/12 (8%) patient, soft tissue involvement in 7/12 (58%) patients, and immature osteoid matrix in 11/12 (92%) patients. No patient had the typical combination of pain with a soft tissue swelling. Management was inappropriate in 2/12 (17%) patients, who did not undergo all the recommended imaging studies before surgery and were treated in another center before the correct diagnosis was established. At last follow-up, 4 patients had died (after a mean of 7 years) and 8 were alive (after a mean of 4 years). CONCLUSION: Proximal femoral osteosarcoma is uncommon and rarely produces the typical clinical and imaging study findings. The atypical presentation often results in diagnostic errors and inappropriate treatments. Ill-defined osteolysis on standard radiographs should prompt computed tomography or magnetic resonance imaging of the proximal femur. Treatment in a specialized center is imperative. LEVEL OF EVIDENCE: IV, retrospective study.


Assuntos
Neoplasias Femorais/diagnóstico , Osteossarcoma/diagnóstico , Adolescente , Adulto , Diagnóstico Tardio , Erros de Diagnóstico , Feminino , Neoplasias Femorais/mortalidade , Neoplasias Femorais/cirurgia , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Osteossarcoma/mortalidade , Osteossarcoma/cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
10.
Int Orthop ; 41(11): 2237-2244, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28361217

RESUMO

PURPOSE: Oncologic resections or complications of segmental femoral prostheses can result in severe bone loss of the femur for which a total femoral prosthesis (TFP) is required. This study assesses whether the loss of stability and function caused by the loss of muscle attachments can be improved by using a push-through total femoral endoprosthesis (PTTF), because it saves parts of the femur and its muscle attachments. METHODS: In this retrospective case series, ten patients aged 25-77 (mean 54) who received a PTTF between 2005 and 2014 were included for baseline, complications and survival analysis with a mean follow-up of 5.3 (1.1-9.6) years. Functional outcome was assessed in six patients using the Musculoskeletal Tumor Society (MSTS) score, WHO performance scale, Toronto Extremity Salvage Score (TESS), SF36, EQ-5D, NRS pain score, fatigue score and satisfaction score. RESULTS: The mean MSTS score was 64% (23-93%). Five patients had a WHO performance scale of 1, one patient of 3. Mean TESS was 69% (13-90%). SF36 was most notably limited by physical functioning (mean 48), vitality (68) and general health (67). NRS score was 1.9, 1.8 and 8.3 for pain, fatigue and satisfaction, respectively. There were four failures: two infections (one resulting in amputation and one in a minor revision) and two mechanical failures (which required one revision to a TFP and one minor revision). Patient survival was 100%, limb survival 90%, and prosthesis survival 80%. CONCLUSION: The push-through total femoral endoprosthesis allows preservation of muscle attachments and offers a good alternative to total femoral prostheses.


Assuntos
Neoplasias Femorais/cirurgia , Fêmur/cirurgia , Implantação de Prótese/efeitos adversos , Adulto , Idoso , Feminino , Neoplasias Femorais/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Complicações Pós-Operatórias/epidemiologia , Desenho de Prótese/efeitos adversos , Falha de Prótese , Implantação de Prótese/métodos , Reimplante , Estudos Retrospectivos , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento
11.
PLoS One ; 12(2): e0172155, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28196121

RESUMO

BACKGROUND: Among various reconstruction methods after wide excision for osteosarcoma, pasteurized autograft is often preferred. While the whole area of the tumor can be assessed for chemotherapy-induced necrosis, one of the important prognostic factors, in other reconstructive techniques, only a portion removed from a wide-resection specimen is available when using pasteurized autograft method. The assessment, therefore, may be unreliable. We analyzed the prognostic significance of the chemotherapy-induced necrosis in osteosarcoma patients who underwent reconstruction with pasteurized autografts. PATIENTS AND METHODS: We reviewed the records of osteosarcoma patients who underwent treatment in our institution from 1998 to 2013. Cases of reconstruction with pasteurized autografts were defined as the patient group, and the same number of patients who underwent other reconstruction methods served as controls. Chemotherapy-induced necrosis was evaluated for removed extra-osseous and curetted intramedullary tumor tissues. RESULTS: A total of 22 patients were identified; the median age was 15.5 years, and there were 12 males. The most common tumor location was the distal femur. The most common histological subtype was osteoblastic. Median size was 8.1 cm. Disease status was stage IIB in 13 patients and IIA in 9. Median follow-up was 76 months. No differences between the patient and control groups were observed in potential prognostic factors, overall survival, metastasis-free survival, or recurrence-free survival. Univariate analyses demonstrated that histological response was a significant prognostic factor for metastasis-free survival and also significant for recurrence-free survival. CONCLUSION: Chemotherapy-induced necrosis grading, using only available tumor tissues, could be a prognostic factor for osteosarcoma patients receiving pasteurized autografts for reconstructive surgery.


Assuntos
Transplante Ósseo , Neoplasias Femorais , Osteonecrose , Osteossarcoma , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Autoenxertos , Criança , Intervalo Livre de Doença , Feminino , Neoplasias Femorais/mortalidade , Neoplasias Femorais/patologia , Neoplasias Femorais/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Osteonecrose/etiologia , Osteonecrose/mortalidade , Osteonecrose/patologia , Osteossarcoma/mortalidade , Osteossarcoma/patologia , Osteossarcoma/cirurgia , Pasteurização , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
12.
Clin Orthop Relat Res ; 475(3): 745-756, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27052019

RESUMO

BACKGROUND: Traditional treatments for pathological fractures of the proximal femur resulting from metastatic bone disease include fixation with intramedullary nailing supplemented with polymethylmethacrylate, osteosynthesis with a plate-screw construct and polymethylmethacrylate, or endoprosthetic reconstruction. Despite the frequent practice of these treatments, treatment outcomes have not been rigorously compared. In addition, very few studies examine specific approaches to endoprosthetic reconstruction such as long stem hemiarthroplasty. QUESTIONS/PURPOSES: This study examines survival, functional outcomes, and complications associated with long stem hemiarthroplasty in a small group of patients treated for impending and actual pathologic fractures of the proximal femur resulting from metastatic bone disease. METHODS: Between 2012 and 2015, 21 patients were treated with long stem cemented hemiarthroplasty in 22 limbs. During that time, indications for this approach included lesions from metastases, myeloma, or lymphoma involving the proximal femur that resulted in an impending or actual pathological fracture. An impending fracture was classified as a painful lesion with at least 50% cortical erosion. During the study period, six patients with proximal femoral metastases not deemed to meet these indications were treated with other surgical approaches such as intramedullary nailing supplemented with polymethylmethacrylate and osteosynthesis with a plate-screw construct and polymethylmethacrylate. Mortality was tracked through medical records and phone calls to the patients and their families. Followup for the entire group of patients (n = 22) ranged from 1 to 27 months with a mean duration of 11 months. For patients with at least 1 year of followup (n = 11), the mean duration was 18 months (range, 12-27 months) and for patients with less than 1 year of followup (n = 11), the mean duration was 3 months (range, 1-11 months). Functional outcomes were evaluated according to the Musculoskeletal Tumor Society (MSTS) scoring system for lower extremities, the Eastern Cooperative Oncology Group (ECOG) Scale of Performance Status, and the Karnofsky Performance Scale (KPS) Index. Scores and complications were determined by direct patient examination, retrospective chart review, review of a longitudinally maintained institutional database, and followup phone calls. RESULTS: Ten patients died of disease within the followup period. Before surgery, the median total MSTS score for the entire group of patients (n = 22) was 4.5 (range, 0-23), the median ECOG score was 3.5 (range, 1-4), and the median KPS score was 40 (range, 30-70). Postoperatively, the median total MSTS score (measured at most recent followup) for the entire group of patients was 21 (range, 5-30), the median ECOG score was 2 (range, 0-3, 68% ≤ 2), and the median KPS score was 60 (range, 40-100). For the 11 patients with at least 1 year of followup, the median total MSTS score (measured at most recent followup) was 27 (range, 21-30), the median ECOG score was 1 (range, 0-2, 100% ≤ 2), and the median KPS score was 80 (range, 60-100). For the remaining 11 patients with less than 1 year of followup, the median total MSTS score (measured at most recent followup) was 11 (range, 5-25), the median ECOG score was 3 (range, 1-3, 36% ≤ 2), and the median KPS score was 40 (range, 40-80). Complications included one periprosthetic fracture resulting from a fall, three cases of radiation-induced edema, and two cases of sciatica that developed unrelated to the procedure. CONCLUSIONS: Long stem cemented hemiarthroplasty results in fair levels of function in a complex population of patients whose prognosis is sometimes measured only in months and who otherwise might be disabled by their metastatic lesions. Comparative trials applying consistent indications and inclusion criteria should be performed between this approach and fixation with intramedullary nailing supplemented with polymethylmethacrylate as well as osteosynthesis with a plate-screw construct and polymethylmethacrylate. LEVEL OF EVIDENCE: Level IV, therapeutic study.


Assuntos
Artroplastia de Quadril/instrumentação , Fraturas do Fêmur/cirurgia , Neoplasias Femorais/cirurgia , Fêmur/cirurgia , Fraturas Espontâneas/cirurgia , Hemiartroplastia/instrumentação , Prótese de Quadril , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/mortalidade , Fenômenos Biomecânicos , Bases de Dados Factuais , Avaliação da Deficiência , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/mortalidade , Fraturas do Fêmur/fisiopatologia , Neoplasias Femorais/diagnóstico por imagem , Neoplasias Femorais/mortalidade , Neoplasias Femorais/secundário , Fêmur/diagnóstico por imagem , Fêmur/patologia , Fêmur/fisiopatologia , Fraturas Espontâneas/diagnóstico por imagem , Fraturas Espontâneas/mortalidade , Fraturas Espontâneas/fisiopatologia , Hemiartroplastia/efeitos adversos , Hemiartroplastia/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Desenho de Prótese , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
13.
Sci Rep ; 6: 38783, 2016 12 08.
Artigo em Inglês | MEDLINE | ID: mdl-27929143

RESUMO

Unplanned therapy for extremity osteosarcoma can result in erroneous surgical procedures and lack of neoadjuvant chemotherapy before the first operation. Our aim was to compare the prognosis between patients with extremity osteosarcoma who received unplanned therapy and those who received standard treatment. This was a retrospective review of patients with extremity osteosarcoma who received appropriate surgical treatment and neoadjuvant chemotherapy (n = 79) and those who received unplanned therapy (n = 24) between June 2000 and October 2014. Survival rate, local recurrence rate and metastasis rate were compared between the two groups. We found that patients who had unplanned therapy had a higher local recurrence rate (41.7% vs. 21.5%; P = 0.049) and a shorter mean time for recurrence (8.90 vs. 14.59 months; P = 0.018). There was no significant difference between groups in the 5-year survival rate (56.3% vs.67.8%; P = 0.356), metastasis rate (45.8% vs. 30.4%; P = 0.125) and mean time to metastasis (23.18 vs.18.24 months; P = 0.396). Our findings suggest that unplanned therapy for extremity osteosarcoma can result in failure of local control. The use of supplementary interventions after unplanned therapy, such as neoadjuvant chemotherapy and limb salvage surgery, may explain the similar survival and metastasis rates between patients receiving unplanned therapy and those receiving standard treatment.


Assuntos
Neoplasias Femorais/mortalidade , Neoplasias Femorais/terapia , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/terapia , Osteossarcoma/mortalidade , Osteossarcoma/terapia , Adolescente , Adulto , Intervalo Livre de Doença , Feminino , Neoplasias Femorais/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Metástase Neoplásica , Recidiva Local de Neoplasia/patologia , Osteossarcoma/patologia , Estudos Retrospectivos , Terapia de Salvação , Taxa de Sobrevida , Fatores de Tempo
14.
J Surg Oncol ; 114(4): 501-6, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27353406

RESUMO

BACKGROUND: Cemented endoprosthetic replacement is an option for reconstruction of the proximal femur to achieve limb salvage. Existing outcome studies combine benign and malignant conditions, or group endoprostheses from multiple areas into one cohort. We sought to examine a series of endoprosthetic replacements of the proximal femur for a malignant process. METHODS: We reviewed 204 patients who underwent an endoprosthesis for a malignant process of the proximal femur with at least 2-year follow-up. Mean age was 59 years, with 55% being male. The most common pathology was metastatic disease (n = 120, 59%). Mean follow-up was 7 years (2-22 years). Mean time to death was 2 years (range 2 weeks-18 years). A bipolar component was used in 93% of patients. RESULTS: 5-year survival was 8% in patients with metastatic disease and 54% for patients with primary disease. Local recurrence and metastatic disease developed in 5 and 19 patients with a primary sarcoma. Following the procedure the mean Harris Hip and Musculoskeletal Tumor Society Scores were 75 and 18. CONCLUSION: Patients typically succumb to their disease prior to implant failure; however, endoprosthetic replacement provides patients with an acceptable means of functional recovery with an acceptable complication profile. J. Surg. Oncol. 2016;114:501-506. © 2016 Wiley Periodicals, Inc.


Assuntos
Neoplasias Femorais/cirurgia , Fêmur/cirurgia , Implantação de Prótese/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Neoplasias Femorais/mortalidade , Neoplasias Femorais/fisiopatologia , Humanos , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Reoperação
15.
PLoS One ; 11(4): e0153601, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27074014

RESUMO

Carcinoembryonic antigen related cell adhesion molecule 1 (CEACAM1) is a trans-membrane multifunctional cell adhesion molecule associated with tumor cell proliferation, apoptosis, angiogenesis, invasion, and migration during tumor development. In the present study, we evaluated serum CEACAM1 level in osteosarcoma patients to explore its diagnostic and prognostic value for this particular malignancy. Sera from 113 patients with primary osteosarcoma, 98 patients with benign bone tumors and 126 healthy controls were obtained. Serum CEACAM1 level was measured with ELISA and correlation with clinicopathological characteristics was further analyzed. Receiver operating curves (ROC), Kaplan-Meier curves, and log-rank analyses as well as Cox proportional hazard models were used to evaluate diagnostic and prognostic significance. The results revealed that serum CEACAM1 level was significantly higher in osteosarcoma patients compared to benign bone tumors and healthy controls (455.2 ± 179.9 vs 287.4 ± 103.2, 260.8 ± 109.7 pg/ml, respectively). Osteosarcoma patients with larger tumors, later-tumor stages, low tumor grades, and distant metastases had much higher CEACAM1 compared to those with smaller tumors, earlier tumor stages, high tumor grades and non-distant metastases (P < 0.05 for all). Multivariate logistic regression analysis confirmed that high serum CEACAM1 level was an independent risk factor for distant metastases (OR = 3.02, 95%CI 1.65-4.17). To distinguish osteosarcoma patients from those with benign bone tumor and healthy controls, ROC/AUC analysis indicated an AUC of 0.81 (sensitivity 0.61; specificity 0.89) and an AUC of 0.77 (sensitivity 0.57; specificity 0.92), respectively. Osteosarcoma patients with higher CEACAM1 had relatively lower survival compared to those with low CEACAM1 (P < 0.01), and multivariate analyses for overall survival revealed that high serum CEACAM1 level was an independent prognostic factor for osteosarcoma (HR = 1.56, 95%CI 1.23-3.28). The present study suggested that elevated serum CEACAM1 level might be a novel diagnostic and prognostic biomarker for osteosarcoma patients.


Assuntos
Antígenos CD/sangue , Neoplasias Ósseas/diagnóstico , Moléculas de Adesão Celular/sangue , Osteossarcoma/diagnóstico , Adolescente , Adulto , Neoplasias Ósseas/sangue , Neoplasias Ósseas/mortalidade , Intervalo Livre de Doença , Feminino , Neoplasias Femorais/sangue , Neoplasias Femorais/diagnóstico , Neoplasias Femorais/mortalidade , Humanos , Masculino , Gradação de Tumores , Estadiamento de Neoplasias , Osteossarcoma/sangue , Osteossarcoma/mortalidade , Prognóstico , Taxa de Sobrevida , Tíbia/patologia , Adulto Jovem
16.
Eur J Orthop Surg Traumatol ; 26(4): 415-21, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27040404

RESUMO

BACKGROUND: Various megaprostheses are currently available for reconstruction of the proximal femur after tumor resection. This study evaluates the survival and complications of a modular megaprosthesis for reconstruction of the proximal femur. MATERIALS AND METHODS: We studied the medical files of 109 tumor patients (age range 16-86 years) who underwent proximal femoral reconstruction with the MRP(®) megaprosthesis from 2002 to 2011. There were 70 patients with metastases, 34 patients with bone sarcomas, and five patients with hematological malignancies; 82 were primary and 27 were revision reconstructions. Mean follow-up was 2.5 years; 31 patients had a minimum five-year follow-up. We evaluated the survival and function of the patients, and the survival and complications of the megaprostheses. RESULTS: Survival was significantly higher for the patients with bone sarcomas compared to those with metastases and hematological malignancies. Mean MSTS functional score was similar between patients with bone sarcomas and those with hematological malignancies and metastases, and between patients with primary and those with revision reconstructions. Overall survival of the MRP(®) megaprostheses was 74 % at 5 and 9 years. Fourteen (13.6 %) major complications occurred at a mean period of 1.4 years (range 3 months to 4.5 years); these included infection (5.8 %), dislocation (3.9 %), local recurrence (2.9 %), and acetabular fracture (1 %). CONCLUSION: MRP(®) megaprostheses are a valuable reconstruction option after tumor resection of the proximal femur.


Assuntos
Neoplasias Femorais/cirurgia , Osteossarcoma/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/mortalidade , Feminino , Neoplasias Femorais/mortalidade , Prótese de Quadril , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Osteossarcoma/mortalidade , Desenho de Prótese , Falha de Prótese , Estudos Retrospectivos , Terapia de Salvação/métodos , Terapia de Salvação/mortalidade , Adulto Jovem
17.
Clin Orthop Relat Res ; 473(5): 1789-96, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25352262

RESUMO

BACKGROUND: Bone tumor resections for limb salvage have become the standard treatment. Recently, intercalary tumor resection with epiphyseal sparing has been used as an alternative in patients with osteosarcoma. The procedure maintains normal joint function and obviates some complications associated with osteoarticular allografts or endoprostheses; however, long-term studies analyzing oncologic outcomes are scarce, and to our knowledge, the concern that a higher local recurrence rate may be an issue has not been addressed. QUESTIONS/PURPOSES: We wanted to assess (1) the overall survival in patients treated with this surgical technique; (2) the percentage of local recurrence and limb survival, specifically the incidence of recurrence in the remaining epiphysis; (3) the frequency of orthopaedic complications, and, (4) the functional outcomes in patients who have undergone intercalary tumor resection. METHODS: We analyzed all 35 patients with osteosarcomas about the knee (distal femur and proximal tibia) treated at our center between 1991 and 2008 who had resection preserving the epiphysis and reconstruction with intercalary allografts. Minimum followup was 5 years, unless death occurred earlier (mean, 9 years; range, 1-16 years), and no patients were lost to followup. During the study period, our indications for this approach included patients without metastases, with clinical and imaging response to neoadjuvant chemotherapy, that a residual epiphysis of at least 1 cm thickness could be available after a surgical margin width in bone of 10 mm was planned, and 16% of patients (35 of 223) meeting these indications were treated using this approach. Using a chart review, we ascertained overall survival of patients, oncologic complications such as local recurrence and tumor progression, limb survival, and orthopaedic complications including infection, fracture, and nonunion. Survival rates were estimated using the Kaplan-Meier method. Patient function was evaluated using the Musculoskeletal Tumor Society (MSTS)-93 scoring system. RESULTS: Overall survival rate of the patients was 86% (95% CI, 73%-99%) at 5 and 10 years. Five patients died of disease. No patient had a local recurrence in the remaining bony epiphysis, but three patients (9%; 95% CI, 0%-19%) had local recurrence in the soft tissue. The limb survival rate was 97% (95% CI, 89%-100%) at 5 and 10 years. Complications treated with additional surgical procedures were recorded for 19 patients (54%), including three local recurrences, two infections, 11 fractures, and three nonunions. In 10 of these 19 patients, the allograft was removed. Only five of the total 35 study patients (14%) lost the originally preserved epiphysis owing to complications. The mean functional score was 26 points (range, 10-30 points, with a higher score representing a better result) at final followup. CONCLUSIONS: Although the recurrence rate was high in this series, the small sample size means that even one or two fewer recurrences might have resulted in a much more favorable percentage. Because of this, future, larger studies will need to determine whether this is a safe approach, and perhaps should compare epiphyseal preservation with other possible approaches, including endoprosthetic reconstruction and/or osteoarticular allografts. LEVEL OF EVIDENCE: Level IV, therapeutic study.


Assuntos
Neoplasias Ósseas/cirurgia , Transplante Ósseo , Epífises/cirurgia , Neoplasias Femorais/cirurgia , Recidiva Local de Neoplasia , Osteossarcoma/cirurgia , Osteotomia , Procedimentos Cirúrgicos Reconstrutivos , Tíbia/cirurgia , Adolescente , Adulto , Aloenxertos , Argentina , Fenômenos Biomecânicos , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/patologia , Neoplasias Ósseas/fisiopatologia , Transplante Ósseo/efeitos adversos , Transplante Ósseo/mortalidade , Criança , Pré-Escolar , Epífises/patologia , Epífises/fisiopatologia , Feminino , Neoplasias Femorais/mortalidade , Neoplasias Femorais/patologia , Neoplasias Femorais/fisiopatologia , Humanos , Estimativa de Kaplan-Meier , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Osteossarcoma/mortalidade , Osteossarcoma/patologia , Osteossarcoma/fisiopatologia , Osteotomia/efeitos adversos , Osteotomia/métodos , Osteotomia/mortalidade , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/mortalidade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Tíbia/patologia , Tíbia/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
18.
Bone Joint J ; 96-B(2): 263-9, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24493195

RESUMO

We reviewed the outcome of 69 uncemented, custom-made, distal femoral endoprosthetic replacements performed in 69 patients between 1994 and 2006. There were 31 women and 38 men with a mean age at implantation of 16.5 years (5 to 37). All procedures were performed for primary malignant bone tumours of the distal femur. At a mean follow-up of 124.2 months (4 to 212), 53 patients were alive, with one patient lost to follow-up. All nine implants (13.0%) were revised due to aseptic loosening at a mean of 52 months (8 to 91); three implants (4.3%) were revised due to fracture of the shaft of the prosthesis and three patients (4.3%) had a peri-prosthetic fracture. Bone remodelling associated with periosteal cortical thinning adjacent to the uncemented intramedullary stem was seen in 24 patients but this did not predispose to failure. All aseptically loose implants in this series were diagnosed to be loose within the first five years. The results from this study suggest that custom-made uncemented distal femur replacements have a higher rate of aseptic loosening compared to published results for this design when used with cemented fixation. Loosening of uncemented replacements occurs early indicating that initial fixation of the implant is crucial.


Assuntos
Materiais Revestidos Biocompatíveis , Durapatita , Neoplasias Femorais/cirurgia , Previsões , Implantação de Prótese/métodos , Adolescente , Adulto , Cimentos para Ossos , Criança , Pré-Escolar , Feminino , Neoplasias Femorais/diagnóstico por imagem , Neoplasias Femorais/mortalidade , Seguimentos , Humanos , Masculino , Desenho de Prótese , Radiografia , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Resultado do Tratamento , Reino Unido/epidemiologia , Adulto Jovem
19.
Injury ; 45(2): 399-404, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24183391

RESUMO

Vascularised fibular grafts (VFGs) are widely used for primary reconstruction of long bones after bone tumour resections. The biological properties of VFGs are such that they can be a useful option even in failed intercalary reconstructions. The purpose of the current study was to investigate the results and the morbidity of VFGs as a salvage procedure in failed previous reconstructions after intercalary bone tumour resection of the femur. Our series included 12 patients, treated from April 1989 to March 2005, with an average age of 23 years (range 10-43 years) at presentation. The initial diagnosis was osteosarcoma in 10 cases and Ewing's sarcoma in two cases. All patients received chemotherapy and none received radiation therapy. Seven patients received VFG as biologic augmentation in intercalary allograft non-union and in the other five patients, a combination of allograft and VFG was used to replace a cement spacer with hardware failure (four patients) and a failed intercalary prosthesis (one patient). Three patients died during follow-up, in all cases because of metastatic disease. At an average follow-up of 147 months (range 11-260 months), the remaining nine patients were continuously disease-free. Complete healing of the osteotomy of both allograft and VFG was observed in 10 patients at final follow-up. Two major complications were observed that required surgical revision, eventually healing in one case and leading to a poor functional outcome in one case. Significant hypertrophy of the VFG was detected in seven of nine evaluable patients. At final follow-up the mean Musculoskeletal Tumour Society (MSTS)'93 functional score of the nine evaluable patients was 90% (range 66-100%). These results indicate that VFG is a valid salvage procedure in failed intercalary reconstructions of the femur after bone resection.


Assuntos
Neoplasias Ósseas/cirurgia , Neoplasias Femorais/cirurgia , Fíbula/transplante , Salvamento de Membro/métodos , Osteossarcoma/cirurgia , Osteotomia , Procedimentos Cirúrgicos Reconstrutivos , Sarcoma de Ewing/cirurgia , Adolescente , Adulto , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/mortalidade , Transplante Ósseo , Criança , Feminino , Neoplasias Femorais/diagnóstico por imagem , Neoplasias Femorais/mortalidade , Fíbula/irrigação sanguínea , Humanos , Masculino , Osteossarcoma/diagnóstico por imagem , Osteossarcoma/mortalidade , Radiografia , Reoperação , Estudos Retrospectivos , Sarcoma de Ewing/diagnóstico por imagem , Sarcoma de Ewing/mortalidade , Resultado do Tratamento
20.
Artigo em Chinês | MEDLINE | ID: mdl-23427490

RESUMO

OBJECTIVE: To evaluate the effectiveness of bipolar prosthetic replacement for proximal femoral tumors from the perspectives of patient survival, prosthesis survival, functional outcomes, and complication rates. METHODS: Between July 2001 and July 2010, 96 patients with proximal femoral tumors underwent wide resection and bipolar prosthetic replacement, including 83 cases of primary femoral tumors and 13 cases of soft tissue sarcomas involving the proximal femur. There were 50 male and 46 female patients with a mean age of 43.2 years (range, 15-69 years). Prosthetic replacement for proximal femoral tumors was used in 85 patients and deactivated bone-prosthetic complex was used in 11 patients. According to Enneking staging, the patients were divided into 3 groups: group A, 24 patients at stages IA, IB, and benign lesion; group B, 56 patients at stages IIA and IIB; and group C, 16 patients at stage III, myeloma, and lymphoma. The American Musculoskeletal Tumor Society 1993 version (MSTS93) functional score was used to evaluate the lower limb function. RESULTS: Primary healing of incision was obtained in 93 patients; 3 patients had poor healing, which was cured after debridement. Of the patients, 89 were followed up 6.5 years on average (range, 1-10 years). During follow-up, 28 patients died of tumor. The 5- and 10-year survival rates of patients were 100% in group A, and were 56.5% and 41.5% in group B respectively, and the 5-year survival rate was 18.4% in group C; there was significant difference among 3 groups (P < 0.01). The 5- and 10-year survival rates of prosthesis were 74.4% and 62.5%, which were significantly higher than those of patients in groups B and C (P < 0.01). Sixty-one patients were followed up 1-10 years (mean, 4.7 years) for functional evaluation. The mean MSTS93 score of the survival patients was 79% (range, 63%-95%) at last follow-up. Complications were observed in 15 patients (16.9%): hip dislocation in 2, delayed infection in 2, aseptic loosening in 8, severe acetabulum wear in 1, and hip pain in 2. CONCLUSION: Bipolar proximal femoral prosthetic replacement for proximal femoral tumors can provide a satisfactory functional outcome, especially for tumors at stage II or III and myeloma and lymphorma patients. Revision is needed because of main late complications of aseptic loosening, hip pain, and acetabulum wear.


Assuntos
Artroplastia de Quadril/métodos , Neoplasias Femorais/cirurgia , Prótese de Quadril , Osteossarcoma/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Idoso , Condrossarcoma/mortalidade , Condrossarcoma/patologia , Condrossarcoma/cirurgia , Feminino , Neoplasias Femorais/mortalidade , Neoplasias Femorais/patologia , Luxação do Quadril/epidemiologia , Luxação do Quadril/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Osteossarcoma/mortalidade , Osteossarcoma/patologia , Complicações Pós-Operatórias/etiologia , Desenho de Prótese , Falha de Prótese , Taxa de Sobrevida , Resultado do Tratamento , Adulto Jovem
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