MASSIVE ENDOPROTHESES IN ORTHOPAEDIC SURGERY

Transcription

1 MASSIVE ENDOPROTHESES IN ORTHOPAEDIC SURGERY G.Zafiroski,S.Mladenovski,A.Dimova,D.Savev,M.Spirkoski, Z.Atanasov,M.Samardziski Special Hospital for Surgery Filip II; : Clinic for Orthopaedic Surgery-Skopje May, 2010

2 Introduction One of the most challenging problems in Orthopaedic Oncology is the reconstruction following resection of bone tumors. Endoprosthetic replacement for bone sarcomas and adjuvant chemotherapy is well established.

3 Introduction In our institutions there is en increased need to replace the bone defects with massive endoprostheses. Indications for reconstruction after resection of bone tumors have definitely broadened with the combination of early diagnosis,adjuvant chemotherapy, better surgical techique and replacement possibilities.

4 Introduction As part of the Macedonian limb salvage program we analyzed our patients with massive endoprostheses after resection of bone tumors. The specific long-term consequences of these endoprothetic reconstruction for the patient s affected limb were unknown. In the Special hospital for surgery Filip II we have good conditions for diagnosis and treatment of bone tumors.

5

6 Material and Methods The analysis included 30 consecutive patients with primary bone tumor or bone metastasis who had limb salvage reconstruction with a tumor endoprosthesis between The median age at the time of operation was 32 (11-76) years. There were 18 male and 12 female.

7 List of Histology Diagnosis Quantity Osteosarcoma 7 Parosteal osteosarcoma 2 Chondrosarcoma 10 Fibrosarcoma 1 Ewing s sarcoma 1 Synoviosarcoma 1 Myeloma 1 Giant cell tumor 2 Metastasis 5

8

9 Results Endoprosthetic replacement were: Proximal femur 19 Distal femur 6 Proximal humerus 4 Proximal tibia 1

10 Results Type of endoprosthesis Link special design-24 Lima- modular-3 Kotz- modular-3

11 Functional results Enneking evaluation score Excellent 10 Good 16 Fair 3 Poor 1 Function appeared to be location dependent Distal femoral endoprosthesis is in risc for long-term endoprosthetic complications.

12 Results Survival Median survival was 9,1 year(range (1,1 to 18,6) All of the 4 p. with benign aggressive and low grade malignant tumors survived Of the 21 p. with stage IIA-IIB- 52% survived 3 years and 42% 5 years. (Kaplan-Meier analysis) The Kaplan Meier analysis revealed that 90% of the prostheses survived 3 years and 80% survived 5 years.

13 Results Oncological outcome 7p.(33,3%) from 21(died)during follow-up of 2 years 2p.(9,5%) had systemic involvment 2p.(9,5%) had local recurrence 10p.(47,6%) showed the absence of a tu.

14 Complications Mechanical feilure in 2 patients- 6,6% Local recurrence in 2 patients- 6,6% Intraoperative haemorrhage in 3 p. (9,9%) Infection in 1 patient (3,3%) Transient nerve palcy in 1 patient (3,3%) Loosening in 1 p. (3,3%) Total: %

15

16 From the surgical and oncological point of view,control of the tumor disease is the most important issue. Recently reported results have demonstrated that limb salvage surgery in combination with chemotherapy, has achieved similar recurrence rates as amputation( Kotz,Lindner,Malawer Disccussion

17 On the other hand there are still a few serious problems associated with the implantation of tumor prostheses.(imfl) Discussion The complication rates in the literature range from 25 to 92% (Capanna, Gerrand,Kawai) The restored function of the limb is essential and good.

18

19 CONSLUSION The implantation of a megaprothesis seems to be a valuable treatment for major bone defects despite the existing problems with fixation to bone. Massive endoproprosthesis can offer realistic alternative to desarticulation for primary and metastatic bone tumors. Survival after resection and reconstruction with megaendoprosthesis is not significantly altered compared with amputation.

20