Welcome!
To use the personalized features of this site, please log in or register.
If you have forgotten your username or password, we can help.
|
 |
Megaprosthesis versus Condyle-sparing Intercalary Allograft: Distal Femoral Sarcoma
| |
|
Symposium: Selected Papers Presented at the 2008 Meeting of the Musculoskeletal Tumor Society
Megaprosthesis versus Condyle-sparing Intercalary Allograft: Distal Femoral Sarcoma
Melissa N. Zimel1, Amy M. Cizik2  , Timothy B. Rapp3, Jason S. Weisstein2 and Ernest U. Conrad III2
| (1) |
William Beaumont Hospital, Royal Oak, MI, USA |
| (2) |
Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Box 356500, 959 NE Pacific Street, Seattle, WA 98195-6500, USA |
| (3) |
Department of Orthopaedics, Loyola University Medical Center, Chicago, IL, USA |
Received: 6 January 2009 Accepted: 22 July 2009 Published online: 7 August 2009
Abstract Although functionally appealing in preserving the native knee, the condyle-sparing intercalary allograft of the distal femur
may be associated with a higher risk of tumor recurrence and endoprosthetic replacement for malignant distal femoral bone
tumors. We therefore compared the risk of local tumor recurrence between patients in these two types of reconstruction groups.
We retrospectively reviewed 85 patients (mean age, 22 years; range, 4–82 years), 38 (45%) of whom had a condyle-sparing allograft
and 47 (55%) of whom had endoprostheses. The minimum followup for both groups was 2 years (mean, 7 years; range, 2–19 years).
Local recurrences occurred in 11% (five of 47) of the patients having implants versus 18% (seven of 38) of the patients having
allografts. Using time to local recurrence as an end point, the Kaplan-Meier survivorship of the implant group was similar
to that of the condyle-sparing allograft group at 2, 5, and 10 years (93% versus 87% at 2 years, 87% versus 81% at 5 years,
and 87% versus 81% at 10 years, respectively). The condyle-sparing allograft procedure offers the potential advantage of retaining
the native knee in a young patient population while incurring no greater risk of local recurrence as those offered the endoprosthetic
procedure.
Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
One of the authors (EUC) has received funding from Stryker Orthopaedics (Mahwah, NJ).
Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations
were conducted in conformity with ethical principles of research, and that informed consent for participation in the study
was obtained.
This work was performed at the University of Washington Medical Center, Seattle, WA.
References
| 1. |
Alman BA, De Bari A, Krajbich JI. Massive allografts in the treatment of osteosarcoma and Ewing sarcoma in children and adolescents.
J Bone Joint Surg Am. 1995;77:54–64.
|
| |
| 2. |
Bickels J, Wittig JC, Kollender Y, Henshaw RM, Kellar-Graney KL, Meller I, Malawer MM. Distal femur resection with endoprosthetic
reconstruction: a long-term followup study. Clin Orthop Relat Res. 2002;400:225–235.
|
| |
| 3. |
Bradish CF, Kemp HB, Scales JT, Wilson JN. Distal femoral replacement by custom-made prostheses. Clinical follow-up and survivorship
analysis. J Bone Joint Surg Br. 1987;69:276–284.
|
| |
| 4. |
Brien E, Terek R, Healey J, Lane J. Allograft reconstruction after proximal tibial resection for bone tumors. An analysis
of function and outcome comparing allograft and prosthetic reconstructions. Clin Orthop Relat Res. 1994;303:116–127.
|
| |
| 5. |
Dubousset J, Missenard G, Kalifa C. Management of osteogenic sarcoma in children and adolescents. Clin Orthop Relat Res. 1991;270:52–59.
|
| |
| 6. |
Eckardt JJ, Eilber FR, Rosen G, Mirra JM, Dorey FJ, Ward WG, Kabo JM. Endoprosthetic replacement for stage IIB osteosarcoma.
Clin Orthop Relat Res. 1991;270:202–213.
|
| |
| 7. |
Finn HA, Simon MA. Limb-salvage surgery in the treatment of osteosarcoma in skeletally immature individuals. Clin Orthop Relat Res. 1991;262:108–118.
|
| |
| 8. |
Ham SJ, Schraffordt Koops H, Veth RP, van Horn JR, Molenaar WM, Hoekstra HJ. Limb salvage surgery for primary bone sarcoma
of the lower extremities: long-term consequences of endoprosthetic reconstructions. Ann Surg Oncol. 1998;5:423–436.
|
| |
| 9. |
Harris IE, Leff AR, Gitelis S, Simon MA. Function after amputation, arthrodesis, or arthroplasty for tumors about the knee.
J Bone Joint Surg Am. 1990;72:1477–1485.
|
| |
| 10. |
Hillmann A, Hoffmann C, Gosheger G, Krakau H, Winkelmann W. Malignant tumor of the distal part of the femur or the proximal
part of the tibia: endoprosthetic replacement or rotationplasty. Functional outcome and quality-of-life measurements. J Bone Joint Surg Am. 1999;81:462–468.
|
| |
| 11. |
Horowitz SM, Glasser DB, Lane JM, Healey JH. Prosthetic and extremity survivorship after limb salvage for sarcoma. How long
do the reconstructions last? Clin Orthop Relat Res. 1993;293:280–286.
|
| |
| 12. |
Kawai A, Backus SI, Otis JC, Healey JH. Interrelationships of clinical outcome, length of resection, and energy cost of walking
after prosthetic knee replacement following resection of a malignant tumor of the distal aspect of the femur. J Bone Joint Surg Am. 1998;80:822–831.
|
| |
| 13. |
Kawai A, Healey JH, Boland PJ, Athanasian EA, Jeon DG. A rotating-hinge knee replacement for malignant tumors of the femur
and tibia. J Arthroplasty. 1999;14:187–196.
|
| |
| 14. |
Kawai A, Lin PP, Boland PJ, Athanasian EA, Healey JH. Relationship between magnitude of resection, complication, and prosthetic
survival after prosthetic knee reconstructions for distal femoral tumors. J Surg Oncol. 1999;70:109–115.
|
| |
| 15. |
Kawai A, Muschler GF, Lane JM, Otis JC, Healey JH. Prosthetic knee replacement after resection of a malignant tumor of the
distal part of the femur. Medium to long-term results. J Bone Joint Surg Am. 1998;80:636–647.
|
| |
| 16. |
Krepler P, Dominkus M, Toma CD, Kotz R. Endoprosthesis management of the extremities of children after resection of primary
malignant bone tumors [in German]. Orthopade. 2003;32:1013–1019.
|
| |
| 17. |
Liptak J, Dernell W, Ehrhart N, Lafferty M, Monteith G, Withrow S. Cortical allograft and endoprosthesis for limb-sparing
surgery in dogs with distal radial osteosarcoma: a prospective clinical comparison of two different limb-sparing techniques.
Vet Surg. 2006;35:518–533.
|
| |
| 18. |
Lucas D, Kshirsagar M, Biermann J, Hamre M, Thomas D, Schuetze S, Baker L. Histologic alterations from neoadjuvant chemotherapy
in high-grade extremity soft tissue sarcoma: clinicopathological correlation. Oncologist. 2008;13:451–458.
|
| |
| 19. |
Malawer MM, Chou LB. Prosthetic survival and clinical results with use of large-segment replacements in the treatment of high-grade
bone sarcomas. J Bone Joint Surg Am. 1995;77:1154–1165.
|
| |
| 20. |
Mankin HJ. The changes in major limb reconstruction as a result of the development of allografts. Chir Organi Mov. 2003;88:101–113.
|
| |
| 21. |
Mankin HJ, Gebhardt MC, Jennings LC, Springfield DS, Tomford WW. Long-term results of allograft replacement in the management
of bone tumors. Clin Orthop Relat Res. 1996;324:86–97.
|
| |
| 22. |
Morgan HD, Cizik AM, Leopold SS, Hawkins DS, Conrad EU 3rd. Survival of tumor megaprostheses replacements about the knee.
Clin Orthop Relat Res. 2006;450:39–45.
|
| |
| 23. |
Muscolo DL, Ayerza MA, Aponte-Tinao LA, Ranalletta M. Partial epiphyseal preservation and intercalary allograft reconstruction
in high-grade metaphyseal osteosarcoma of the knee. J Bone Joint Surg Am. 2004;86:2686–2693.
|
| |
| 24. |
Ortiz-Cruz E, Gebhardt MC, Jennings LC, Springfield DS, Mankin HJ. The results of transplantation of intercalary allografts
after resection of tumors. A long-term follow-up study. J Bone Joint Surg Am. 1997;79:97–106.
|
| |
| 25. |
Renard AJ, Veth RP, Schreuder HW, van Loon CJ, Koops HS, van Horn JR. Function and complications after ablative and limb-salvage
therapy in lower extremity sarcoma of bone. J Surg Oncol. 2000;73:198–205.
|
| |
| 26. |
Rougraff BT, Simon MA, Kneisl JS, Greenberg DB, Mankin HJ. Limb salvage compared with amputation for osteosarcoma of the distal
end of the femur. A long-term oncological, functional, and quality-of-life study. J Bone Joint Surg Am. 1994;76:649–656.
|
| |
| 27. |
Safran MR, Kody MH, Namba RS, Larson KR, Kabo JM, Dorey FJ, Eilber FR, Eckardt JJ. 151 endoprosthetic reconstructions for
patients with primary tumors involving bone. Contemp Orthop. 1994;29:15–25.
|
| |
| 28. |
Simon MA, Aschliman MA, Thomas N, Mankin HJ. Limb-salvage treatment versus amputation for osteosarcoma of the distal end of
the femur. J Bone Joint Surg Am. 1986;68:1331–1337.
|
| |
| 29. |
Simon MA, Aschliman MA, Thomas N, Mankin HJ. Limb-salvage treatment versus amputation for osteosarcoma of the distal end of
the femur. 1986. J Bone Joint Surg Am. 2005;87:2822.
|
| |
| 30. |
Tunn PU, Schmidt-Peter P, Pomraenke D, Hohenberger P. Osteosarcoma in children: long-term functional analysis. Clin Orthop Relat Res. 2004;421:212–217.
|
| |
| 31. |
Weiner SD, Scarborough M, Vander Griend RA. Resection arthrodesis of the knee with an intercalary allograft. J Bone Joint Surg Am. 1996;78:185–192.
|
| |
| 32. |
Wittig JC, Bickels J, Priebat D, Jelinek J, Kellar-Graney K, Shmookler B, Malawer MM. Osteosarcoma: a multidisciplinary approach
to diagnosis and treatment. Am Fam Physician. 2002;65:1123–1132.
|
| |
| 33. |
Zeegen EN, Aponte-Tinao LA, Hornicek FJ, Gebhardt MC, Mankin HJ. Survivorship analysis of 141 modular metallic endoprostheses
at early followup. Clin Orthop Relat Res. 2004;420:239–250.
|
| |
|
|
|
|
|
|