Dong Joon Kang; Jeung Il Kim; Jong Seok Oh; Tae Yong Moon; In Sook Lee

doi:10.5292/jkbjts.2011.17.1.36

Journal List > J Korean Bone Joint Tumor Soc > v.17(1) > 1051990

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kang, Kim, Oh, Moon, and Lee: Functional and Radiological Results of Intermediate-term Follow Up in MUTARS® Tumor Endoprostheses

Original Article

J Korean Bone Joint Tumor Soc 2011;17(1):36-43.

Published online: 7 January 2011

DOI: https://doi.org/10.5292/jkbjts.2011.17.1.36

Functional and Radiological Results of Intermediate-term Follow Up in MUTARS^® Tumor Endoprostheses

Dong Joon Kang, Jeung Il Kim, Jong Seok Oh, Tae Yong Moon^∗, In Sook Lee^∗

Department of Orthopaedic Surgery, College of Medicine, Pusan National University, Busan, Korea

^∗Department of Radiology, College of Medicine, Pusan National University, Busan, Korea

Correspondence to: Jeung Il Kim, M.D. Department of Orthopaedic Surgery, Pusan National University Hospital, 10, Ami-dong 1-ga, Seo-gu, Busan 602-739, Korea TEL: +82-51-240-7248 FAX: +82-51-247-8395 E-mail: Osteokim@yahoo.co.kr

Received 21 March 20113 May 2011 Accepted 30 May 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study was designed to verify intermediate-term functional and radiological results of limb salvage operation using endoprosthetic replacement system (MUTARS^®) used in patients with a malignant bone tumor.

Materials and Methods

Thirty one cases which used MUTARS^® tumor prosthesis were reviewed. The mean age of the patients was 49.2 years and the mean follow up was 39.8 months. We retrospectively reviewed complications, and evaluated functionally and radiologically by Enneking functional score, ISOLS radiological implants evaluation system at last followup.

Results

3 patients had died of disease, distant metastasis was seen in 4 patients and local recurrence was seen in 1 patients. Complications were developed in 12 patients. (infection 6, leg length discrepancy 2, aseptic loosening 2, periprosthetic femoral fracture 1, screw loosening 1) Mean value of total functional scores were 81.2% in proximal femur, 77.4% in distal femur, 78.1% in proximal tibia, and 80.2% in proximal humerus. The overall radiological result was relatively satisfactory.

Conclusion

Our results suggest limb salvage with the MUTARS^® endoprosthesis is successful with good functional and radiological results. But we should be careful with complications such as infection.

Keywords: extremities, bone tumor, prosthetic reconstruction, functional and radiologic evalutation

REFERENCES

1. Mittermayer F, Krepler P, Dominkus M, et al. Long-term follow up of uncemented tumor endoprostheses for the lower extremity. Clin Orthop Relat Res. 2001; 388:167–77.

2. Sluga M, Windhager R, Lang S, Heinzl H, Bielack S, Kotz R. Local and systemic control after ablative and limb sparing surgery in patients with osteosarcoma. Clin Orthop Relat Res. 1999; 358:120–7.

3. Eckardt JJ, Kabo MK, Kelly CM, et al. Expandable endoprosthesis reconstruction in skeletally immature patients with tumors. Clin Orthop Relat Res. 2000; 373:51–61.

4. Hornicek FJ, Gebhardt MC, Sorger JI, Mankin HJ. Tumor reconstruction. Orthop Clin N Am. 1999; 30:673–84.

5. Kneisl JS, Finn HA, Simon MA. Mobile knee reconstructions after resection of maligant tumors of the distal femur. Orthop Clin N Am. 1991; 22:105–19.

6. Lindner NJ, Ramm O, Hillmann A, et al. Limb salvage and outcome of osteosarcoma. Clin Orthop Relat Res. 1999; 358:83–9.

7. Rougraft RT, Simon MA, Kneisl JS, Greenberg DB, Mankin HJ. Limb salvage compared with amputation for osteosarcoma of the distal end of the femur. J Bone Joint Surg Am. 1994; 76:649–56.

8. Sanjay BK, Moreau PG. Limb salvage surgery in bone tumor with modular endoprosthesis. Int Orthop. 1999; 23:41–6.

9. Donati D, Zavatta M, Gozzi E, Giacomini S, Campanacci L, Mercuri M. Modular prosthetic replacement of the proximal femur after resection of a bone tumour. J Bone Joint Surg Br. 2001; 83:1156–60.

10. Eckardt JJ, Eilber FR, Dorey FJ, Mirra JM. The UCLA experience in limb salvage surgery for malignant tumors. Orthopedics. 1985; 8:612–21.

11. Safran MR, Kody MH, Namba RS, et al. 151 endoprosthetic reconstructions for patients with primary tumors involving bone. Contemp Orthop. 1994; 29:15–25.

12. Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 1993; 286:241–6.

13. Capanna R, Morris HG, Campanacci D, Del Ben M, Campanacci M. Modular uncemented prosthetic reconstruction after resection of tumours of the distal femur. J Bone Joint Surg Br. 1994; 76:178–86.

14. Mittermayer F, Windhager R, Dominkus M, et al. Revision of the Kotz type of tumour endoprosthesis for the lower limb. J Bone Joint Surg Br. 2002; 84:401–6.

15. Georg Gosheger, Carsten Gebert, Helmut Ahrens, Arne St-reitbuerger, Winfried Winkelmann, Jendrik Hardes. Endoprosthetic Reconstruction in 250 Patients with Sarcoma. Clin Orthop Relat Res. 2006; 450:164–71.

16. Kabukcuoglu Y, Grimmer RJ, Tillmann RM, Carter SR. Endoprosthetic replacement for primary maligant tumors of the proximal femur. Clin Orthop Relat Res. 1999; 358:8–14.

17. Kawai A, Muschler GF, Lane JM, Otis JC, Healey JH. Prosthetic knee replacement after resection of maligant tumor of the distal part of the femur. J Bone Joint Surg Am. 1998; 80:636–47.

18. Quill G, Gitelis S, Morton T, Piasecki P. Complications associated with limb salvage for extremity sarcomas and their management. Clin Orthop Relat Res. 1990; 260:242–50.

19. Grimer RJ, Carter SR, Tillmann RM, et al. Endoprosthetic replacement of the proximal tibia. J Bone Joint Surg Br. 1999; 81:488–94.

20. Ilyas I, Pant R, Kurar A, Moreau PG, Younge DA. Modular megaprosthesis for proximal femoral tumors. Int Orthop. 2002; 26:170–3.

21. Plotz W, Rechl H, Burgkart R, et al. Limb salvage with tumor endoprostheses for malignant tumors of the knee. Clin Orthop Relat Res. 2002; 405:207–15.

22. Weber KL, Lin PP, Yasko A. Complex segmental elbow reconstruction after tumor resection. Clin Orthop Relat Res. 2003; 415:31–44.

23. Wirganowicz PZ, Eckardt JJ, Dorey FJ, Eilber FR, Kabo JM. Etiology and results of tumor endoprosthesis revision surgery in 64 patients. Clin Orthop Relat Res. 1999; 358:64–74.

24. 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; 420:239–50.

25. 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: longterm consequences of endoprosthetic reconstructions. Ann Surg Oncol. 1998; 5:423–36.

26. Shin DS, Weber KL, Chao EYS, An KN, Sim FH. Reoperation for failed prosthetic replacement used for limb salvage. Clin Orthop Relat Res. 1999; 358:53–63.

27. Unwin PS, Cannon SR, Grimer RJ, Kemp HB, Sneath RS, Walker PS. Aseptic loosening in cemented custom-made re-placements for bone tumours of the lower limb. J Bone Joint Surg Br. 1996; 78:5–13.

28. Bickels J, Wittig JC, Kollender Y, et al. Distal femur resection with endoprosthetic reconstruction: a longterm followup study. Clin Orthop Relat Res. 2002; 400:225–35.

29. Choong PFM, Sim FH, Pritchard DJ, Rock MG, Chao EYS. Megaprostheses after resection of distal femur tumors: a rotating hinge design in 30 patients followed for 2-7 years. Acta Orthop Scand. 1996; 67:345–51.

30. Robert P, Chan D, Grimmer RJ, Sneath RS, Scales JT. Prosthetic replacement of the distal femur for primary bone tumors. J Bone Joint Surg Br. 1991; 73:762–9.

31. Capanna R, Guerra A, Ruggieri P, Biagini R, Campanacci M. The kotz modular prosthesis in massive osteo-articular resections for bone tumours: preliminary results in 27 cases. Ital J Orthop Traumatol. 1985; 11:271–81.

32. Rechl H, Schittich I, Plotz W, et al. Custom made total knee-replacement in patients with primary and secondary bone tumors. Acta Chir Cechosl. 1994; 61:92–6.

33. Bickels J, Meller I, Henshaw RM, Malawer MM. Reconstruction of hip stability after proximal and total femur resections. Clin Orthop Relat Res. 2000; 375:218–30.

34. Ward WG, Dorey F, Eckardt JJ. Total femur endoprosthetic reconstruction. Clin Orthop Relat Res. 1995; 316:195–206.

35. Asavamongkolkul A, Eckardt JJ, Eilber FR, et al. Endoprosthetic reconstruction for malignant upper extremity tumors. Clin Orthop Relat Res. 1999; 360:207–20.

36. Bos G, Sim F, Pritchard D, et al. Prosthetic replacement of the proximal humerus. Clin Orthop Relat Res. 1987; 224:178–91.

37. Kumar D, Grimer RJ, Abudu A, Carter SR, Tillman RM. Endoprosthetic replacement of the proximal humerus: longterm results. J Bone Joint Surg Br. 2003; 85:717–22.

38. Ross AC, Wilson JN, Scales JT. Endoprosthetic replacement of the proximal humerus. J Bone Joint Surg Br. 1987; 69:656–61.

39. Hillmann A, Hoffmann C, Gosheger G, Krakau H, Winkelmann W. Malignant tumor of the distal part of the femur os the proximal part of the tibia: Endoprosthetic replacement or rotationplasty. J Bone Joint Surg Am. 1999; 81:462–8.

Figure 1.

(A) An AP radiograph with digital planning of a MUTARS^® tumor prosthesis is shown for a 67-year-old man with an malignant fibrous histiocytoma of the left distal femur. (B) Anteroposterior and (C) lateral radiographs show a cemented distal femur replacement.

Figure 2.

An intraoperative photograph shows a proximal tibia replacement and the Trevira^® (Implantcast) tube placed around the prosthesis. The patellar tendon was refixated to the tube by sutures.

Figure 3.

(A) An intraoperative photograph shows a antibiotic-impregnated cement spacer (B) Anteroposterior and (C) lateral radiographs.

Figure 4.

Aseptic loosening after cemented fixation of MUTARS^®.

Figure 5.

Roentgenographic findings after femoral shaft periprosthetic fracture (Vancouver classification B1). (A) Preoperative anteroposterior view. (B) Postoperative anteroposterior view. (C) The radiograph taken 5 months later shows healing of the fracture.

Table 1.

Primary Tumors and Metastases Before MUTARS^® Implantation

Diagnosis	Tumor entity	Frequency
Primary tumor	Osteosarcoma	12
	Malignant fibrous histiocytoma	4
	Chondrosarcoma	2
	Giant cell tumor	1
Metastasis	Hepatocellular cancer	3
	Renal cell cancer	2
	Prostate cancer	2
	Lung cancer	2
	Stomach cancer	1
	Breast cancer	1
	Thyroid cancer	1
Total		31

Table 2.

Complications in All 31 Patients

	Infection		Stem loosening	Periprosthetic fracture	Mechanica failure
	Tube (+)	Tube (-)	Stem loosening	Periprosthetic fracture	Mechanica failure
Distal femur		1	2
Proximal femur	2			1	1
Proximal tibia	3
Proximal humerus
Total	5/11 (45.5%)	1/20 (5%)	2/31 (6.9%)	1/31 (3.2%)	1/31 (3.2%)

Table 3.

Radiographic Analysis by ISOLS Radiologic Implant Evaluation System

	Bone remodeling	Interface	Anchorage	Implant body problem	Implant articular problem
Poor	1 (3.5%)	2 (6.9%)	1 (3.5%)	0 (0%)	0 (0%)
Fair	8 (27.6%)	5 (17.2%)	1 (3.5%)	1 (3.5%)	2 (6.9%)
Good	17 (58.6%)	17 (58.6%)	7 (24.1%)	3 (10.3%)	4 (13.8%)
Excellent	3 (10.3%)	5 (17.2%)	20 (68.9%)	25 (86.2%)	23 (79.3%)

TOOLS

Similar articles