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Long-term Results of Intercalary Endoprosthetic Short Segment Fixation Following Extended Diaphysectomy.

Abstract

Intercalary endoprosthetic reconstruction following diaphyseal resection of osseous tumors offers functional advantages through preservation of native joints adjacent to the resected defect. Use of such implants is restricted by the amount of bone available for stem fixation adjacent to the defect. This study aimed to determine whether short osseous segment fixation with acceptable outcomes and complication rate can be reliably achieved with a customized intercalary endoprosthesis following extended diaphysectomy. A retrospective review of prospectively collected data was performed on 6 patients receiving customized anchor plugs for short segment fixation with a double compressive osseointegration intercalary implant to reconstruct segmental defects. Five of the implants were augmented with cement to support fixation in metaphyseal bone. Patient age at surgery ranged from 12 to 86 years. At mean follow-up of 39 months, mean Musculoskeletal Tumor Society functional score was 26.3, with 5 of 6 patients achieving scores of 27 or greater. Stable fixation was achieved in all patients, with the shortest segment of bone 3.7 cm in length. Three mechanical implant failures requiring revision surgery occurred. No patient required revision of the entire implant, secondary adjacent joint replacement, or secondary amputation. No patient exhibited aseptic loosening, and no case was complicated by infection. Excellent functional outcomes were seen with follow-up out to 9 years. This suggests that cement-augmented double compressive osseointegration intercalary endoprosthetic reconstruction can extend the benefits of intercalary replacement to many patients who otherwise might require adjacent joint or physeal sacrifice. However, patients should be counseled on the high risk of implant failure with subsequent need for revision surgery. [Orthopedics. 2017; 40(6):e964-e970.].

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  • Authors

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    Source

    Orthopedics 40:6 2017 Nov 01 pg e964-e970

    MeSH

    Adolescent
    Bone Cements
    Bone Neoplasms
    Bone Transplantation
    Child
    Diaphyses
    Female
    Femoral Neoplasms
    Humans
    Limb Salvage
    Male
    Middle Aged
    Osseointegration
    Osteotomy
    Prospective Studies
    Prosthesis Design
    Reoperation
    Retrospective Studies
    Tibia
    Treatment Outcome
    Young Adult

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    28934543

    Citation

    Tedesco, Nicholas S., et al. "Long-term Results of Intercalary Endoprosthetic Short Segment Fixation Following Extended Diaphysectomy." Orthopedics, vol. 40, no. 6, 2017, pp. e964-e970.
    Tedesco NS, Van Horn AL, Henshaw RM. Long-term Results of Intercalary Endoprosthetic Short Segment Fixation Following Extended Diaphysectomy. Orthopedics. 2017;40(6):e964-e970.
    Tedesco, N. S., Van Horn, A. L., & Henshaw, R. M. (2017). Long-term Results of Intercalary Endoprosthetic Short Segment Fixation Following Extended Diaphysectomy. Orthopedics, 40(6), pp. e964-e970. doi:10.3928/01477447-20170918-04.
    Tedesco NS, Van Horn AL, Henshaw RM. Long-term Results of Intercalary Endoprosthetic Short Segment Fixation Following Extended Diaphysectomy. Orthopedics. 2017 Nov 1;40(6):e964-e970. PubMed PMID: 28934543.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Long-term Results of Intercalary Endoprosthetic Short Segment Fixation Following Extended Diaphysectomy. AU - Tedesco,Nicholas S, AU - Van Horn,Alexandra L, AU - Henshaw,Robert M, Y1 - 2017/09/22/ PY - 2017/03/11/received PY - 2017/07/31/accepted PY - 2017/9/22/pubmed PY - 2018/5/23/medline PY - 2017/9/22/entrez SP - e964 EP - e970 JF - Orthopedics JO - Orthopedics VL - 40 IS - 6 N2 - Intercalary endoprosthetic reconstruction following diaphyseal resection of osseous tumors offers functional advantages through preservation of native joints adjacent to the resected defect. Use of such implants is restricted by the amount of bone available for stem fixation adjacent to the defect. This study aimed to determine whether short osseous segment fixation with acceptable outcomes and complication rate can be reliably achieved with a customized intercalary endoprosthesis following extended diaphysectomy. A retrospective review of prospectively collected data was performed on 6 patients receiving customized anchor plugs for short segment fixation with a double compressive osseointegration intercalary implant to reconstruct segmental defects. Five of the implants were augmented with cement to support fixation in metaphyseal bone. Patient age at surgery ranged from 12 to 86 years. At mean follow-up of 39 months, mean Musculoskeletal Tumor Society functional score was 26.3, with 5 of 6 patients achieving scores of 27 or greater. Stable fixation was achieved in all patients, with the shortest segment of bone 3.7 cm in length. Three mechanical implant failures requiring revision surgery occurred. No patient required revision of the entire implant, secondary adjacent joint replacement, or secondary amputation. No patient exhibited aseptic loosening, and no case was complicated by infection. Excellent functional outcomes were seen with follow-up out to 9 years. This suggests that cement-augmented double compressive osseointegration intercalary endoprosthetic reconstruction can extend the benefits of intercalary replacement to many patients who otherwise might require adjacent joint or physeal sacrifice. However, patients should be counseled on the high risk of implant failure with subsequent need for revision surgery. [Orthopedics. 2017; 40(6):e964-e970.]. SN - 1938-2367 UR - https://www.unboundmedicine.com/medline/citation/28934543/Long-term_Results_of_Intercalary_Endoprosthetic_Short_Segment_Fixation_Following_Extended_Diaphysectomy L2 - http://www.healio.com/doiresolver?doi=10.3928/01477447-20170918-04 DB - PRIME DP - Unbound Medicine ER -