Document Detail


Surgical technique: Unicondylar osteoallograft prosthesis composite in tumor limb salvage surgery.
MedLine Citation:
PMID:  22752800     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: After resecting tumors confined to one femoral condyle, a unicondylar osteoarticular allograft can be used for reconstruction without sacrificing the uninvolved condyle. However, unicondylar osteoarticular allografts have been associated with a high rate of joint degeneration. We describe a unicondylar osteoallograft prosthesis composite reconstruction replacing only one side of the joint to reduce compartment degeneration and avoid contamination of the tibia, but the survival, function, and complications of a unicondylar osteoallograft prosthesis composite are unclear.
DESCRIPTION OF TECHNIQUE: We located a bone resection plane intraoperatively as planned before surgery using a computer-assisted navigation system. The tumor then was removed en bloc and the unicondylar defect filled with a size-matched allogeneic unicondyle. The allograft cartilage was removed. Thereafter, the condyle of the femoral component was resurfaced with a unicompartmental knee prosthesis to form a unicondylar osteoallograft prosthesis composite, however the tibia was left undisturbed. Navigation allowed precise apposition between the unicondylar osteoallograft prosthesis composite and host bone to ensure mechanical alignment and congruency of the joint surface before fixation with a plate.
METHODS: We retrospectively reviewed 12 patients who underwent unicondylar osteoallograft prosthesis composite reconstructions after unicondylar resection for tumors. One patient died from tumor-related causes without unicondylar osteoallograft prosthesis composite failure after 18 months. We observed the survival rate of unicondylar osteoallograft prosthesis composite reconstruction and related complications. Function and radiographs also were documented according to the Musculoskeletal Tumor Society (MSTS) functional scoring system and the International Society of Limb Salvage radiographic scoring system. The minimum followup was 8 months (median, 37 months; range, 8-65 months).
RESULTS: At last followup, 10 of the 12 unicondylar osteoallograft prosthesis composite reconstructions were still in place. Three reconstructions failed owing to two local recurrences (both treated with amputation) and there was one infection (treated with revision and maintenance of the implant at last followup). The average MSTS functional score at last followup was 27 points and the radiographic score 91%.
CONCLUSIONS: Our observations suggest unicondylar osteoallograft prosthesis composite reconstruction might be a reliable technique with relatively few major complications and at least short-term maintenance of the tibial cartilage.
LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Authors:
Hongbin Fan; Zheng Guo; Zhen Wang; Jing Li; Xiangdong Li
Publication Detail:
Type:  Journal Article     Date:  2012-07-03
Journal Detail:
Title:  Clinical orthopaedics and related research     Volume:  470     ISSN:  1528-1132     ISO Abbreviation:  Clin. Orthop. Relat. Res.     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-08     Completed Date:  2013-01-22     Revised Date:  2013-12-05    
Medline Journal Info:
Nlm Unique ID:  0075674     Medline TA:  Clin Orthop Relat Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  3577-86     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Amputation
Arthroplasty, Replacement, Knee / adverse effects,  instrumentation*
Biomechanical Phenomena
Bone Neoplasms / diagnosis,  surgery*
Bone Transplantation* / adverse effects
Female
Femur / pathology,  physiopathology,  radiography,  surgery*
Humans
Knee Prosthesis*
Limb Salvage*
Magnetic Resonance Imaging
Male
Neoplasm Recurrence, Local
Osteotomy
Predictive Value of Tests
Reconstructive Surgical Procedures / adverse effects,  instrumentation*
Recovery of Function
Reoperation
Retrospective Studies
Surgery, Computer-Assisted
Time Factors
Tomography, X-Ray Computed
Transplantation, Homologous
Treatment Outcome
Young Adult
Comments/Corrections
Comment In:
Clin Orthop Relat Res. 2013 Jun;471(6):2039-40   [PMID:  23553073 ]
Clin Orthop Relat Res. 2013 Jun;471(6):2037-8   [PMID:  23553072 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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