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Revision of tumor prosthesis of the knee joint.

Yoshida Y, Osaka S, Kojima T, Taniguchi M, Osaka E, Tokuhashi Y - Eur J Orthop Surg Traumatol (2011)

Bottom Line: The mean stem diameters were 11.2 and 10.2 mm in the non-revision and revision groups.The respective resection rates were 36 and 45%.The mean functional evaluation was 70.1% before and 76.2% after revision.

View Article: PubMed Central - PubMed

ABSTRACT
BACKGROUND: Among 40 patients with primary malignant tumors of the knee joint who underwent reconstruction of the affected limb with tumor prosthesis, revision was required in 7 due to stem breakage or loosening. SUBJECTS AND METHODS: In the 7 cases undergoing revision, conditions and background factors at the time of breakage, the breakage site, time of revision, models of previous and new prostheses, stem diameters before and after revision, details of the revision (blood loss, operative time), and the presence or absence of adjuvant therapy were determined. RESULTS: The replacement site was the distal femur in 5 and proximal tibia in 2. Revision was performed 6 years and 2 months after the previous prosthesis placement on average. The broken prosthesis model was KMFTR in 4 and HMRS and the physio-hinge type in one each. Revision due to loosening was performed in a case requiring replacement with Growing Kotz prosthesis. The model was switched to HMRS in 3, and the stem diameter was changed to 12 mm in 3 KMFTR breakage cases. The mean stem diameters were 11.2 and 10.2 mm in the non-revision and revision groups. The respective resection rates were 36 and 45%. The mean functional evaluation was 70.1% before and 76.2% after revision. CONCLUSION: To reduce the risk of tumor prosthesis breakage, the amount of bone resection should be limited to 30% or less in the affected bone, the stem diameter should be at least 12 mm, and the stem shape should be fitted to the anatomical shape of the femur.

No MeSH data available.


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After placement of the new stem, bone grafting is performed around the stem as shown. The use of a cable should also be considered for achieving stronger fixation
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Fig2: After placement of the new stem, bone grafting is performed around the stem as shown. The use of a cable should also be considered for achieving stronger fixation

Mentions: We experienced 6 cases requiring revision for stem breakage. The shortest and longest operative times in the 7 revision cases were 3 h and 20 min and 6 h and 11 min, respectively, with a mean of 4 h and 7 min, and the minimum, maximum, and mean blood losses were 155, 600, and 369 g, respectively. The levels of surgical stress may have been similar to that in the first wide resection with regard to the operative time and blood loss. Tang and Sim reported the revision procedures for stem breakage [19, 20]. The goals of distal femoral revision are to cut-off the femoral bone cortex using a Surge Airtome or drill following the shape of the stem. This requires great care to avoid breakage of the cut-out bone cortex upon removal of the broken stem. A new stem must also be inserted, followed by returning the cut-off bone cortex block to its original position. Concerning reaming, we ream the femoral medullary cavity to a diameter 1 mm larger than that determined by preoperative measurement in principle. However, when the medullary cavity is narrow, reaming is performed to the stem diameter selected based on preoperative measurement. When a trial stem can be inserted, the real stem is inserted. When a trial stem cannot be inserted, over-reaming by 1 mm is performed. In revision surgery, since a thicker stem is inserted, over-reaming by 1 mm is always performed. Firm fixation is then with a cable. At this point, it is also necessary to add autologous or artificial bone grafting to assure sufficient future strength [21] (Figs. 1, 2).Fig. 1


Revision of tumor prosthesis of the knee joint.

Yoshida Y, Osaka S, Kojima T, Taniguchi M, Osaka E, Tokuhashi Y - Eur J Orthop Surg Traumatol (2011)

After placement of the new stem, bone grafting is performed around the stem as shown. The use of a cable should also be considered for achieving stronger fixation
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3376781&req=5

Fig2: After placement of the new stem, bone grafting is performed around the stem as shown. The use of a cable should also be considered for achieving stronger fixation
Mentions: We experienced 6 cases requiring revision for stem breakage. The shortest and longest operative times in the 7 revision cases were 3 h and 20 min and 6 h and 11 min, respectively, with a mean of 4 h and 7 min, and the minimum, maximum, and mean blood losses were 155, 600, and 369 g, respectively. The levels of surgical stress may have been similar to that in the first wide resection with regard to the operative time and blood loss. Tang and Sim reported the revision procedures for stem breakage [19, 20]. The goals of distal femoral revision are to cut-off the femoral bone cortex using a Surge Airtome or drill following the shape of the stem. This requires great care to avoid breakage of the cut-out bone cortex upon removal of the broken stem. A new stem must also be inserted, followed by returning the cut-off bone cortex block to its original position. Concerning reaming, we ream the femoral medullary cavity to a diameter 1 mm larger than that determined by preoperative measurement in principle. However, when the medullary cavity is narrow, reaming is performed to the stem diameter selected based on preoperative measurement. When a trial stem can be inserted, the real stem is inserted. When a trial stem cannot be inserted, over-reaming by 1 mm is performed. In revision surgery, since a thicker stem is inserted, over-reaming by 1 mm is always performed. Firm fixation is then with a cable. At this point, it is also necessary to add autologous or artificial bone grafting to assure sufficient future strength [21] (Figs. 1, 2).Fig. 1

Bottom Line: The mean stem diameters were 11.2 and 10.2 mm in the non-revision and revision groups.The respective resection rates were 36 and 45%.The mean functional evaluation was 70.1% before and 76.2% after revision.

View Article: PubMed Central - PubMed

ABSTRACT
BACKGROUND: Among 40 patients with primary malignant tumors of the knee joint who underwent reconstruction of the affected limb with tumor prosthesis, revision was required in 7 due to stem breakage or loosening. SUBJECTS AND METHODS: In the 7 cases undergoing revision, conditions and background factors at the time of breakage, the breakage site, time of revision, models of previous and new prostheses, stem diameters before and after revision, details of the revision (blood loss, operative time), and the presence or absence of adjuvant therapy were determined. RESULTS: The replacement site was the distal femur in 5 and proximal tibia in 2. Revision was performed 6 years and 2 months after the previous prosthesis placement on average. The broken prosthesis model was KMFTR in 4 and HMRS and the physio-hinge type in one each. Revision due to loosening was performed in a case requiring replacement with Growing Kotz prosthesis. The model was switched to HMRS in 3, and the stem diameter was changed to 12 mm in 3 KMFTR breakage cases. The mean stem diameters were 11.2 and 10.2 mm in the non-revision and revision groups. The respective resection rates were 36 and 45%. The mean functional evaluation was 70.1% before and 76.2% after revision. CONCLUSION: To reduce the risk of tumor prosthesis breakage, the amount of bone resection should be limited to 30% or less in the affected bone, the stem diameter should be at least 12 mm, and the stem shape should be fitted to the anatomical shape of the femur.

No MeSH data available.


Related in: MedlinePlus