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Chun, Baek, Lee, Lee, and Han: Limb Salvage Surgery with Tumor Prosthesis for the Malignant Bone Tumors Involving the Proximal Femur
Original Article

J Korean Bone Joint Tumor Soc 2014;20(1):7-13.

Published online: 10 June 2014

DOI: https://doi.org/10.5292/jkbjts.2014.20.1.7

Limb Salvage Surgery with Tumor Prosthesis for the Malignant Bone Tumors Involving the Proximal Femur

Young Soo Chun*, †, Jong Hun Baek*, ‡, Seung Hyuk Lee*, †, Chung Hwan Lee*, †, Chung Soo Han*, ‡

*Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Korea

†Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea

‡Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Korea

Correspondence to: Young Soo Chun Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, Seoul 134-727, Korea TEL: +82-2-440-6155 FAX: +82-2-440-7498 E-mail: mozart13@khu.ac.kr

Received 31 March 2014       Revised 28 May 2014       Accepted 3 June 2014

Copyright © 2014 The Korean Bone and Joint Tumor Society

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

As well as patient survival, the restoration of postoperative function such as ambulation is important in limb salvage operations for treatment of malignant bone tumors involving the proximal femur. The authors analyzed clinical outcomes of limb salvage operations using tumor prostheses for metastatic or primary malignant bone tumors in the proximal femur.

Materials and Methods

From February 2005 to January 2014, 20 cases (19 patients) with malignant bone tumor involving the proximal femur with pain or complicated pathologic fracture were treated with segmental resection and limb salvage operations with tumor prostheses. Mean age was 63.1 years (range 35–86). Fourteen patients were male and six ones were female. The mean follow-up period was 20 months (1–94 months). There were 15 cases of metastatic bone tumor, 4 cases of osteosarcoma, and 1 case of multiple myeloma. The primary tumors of the metastatic bone tumors included 4 lung cancers, 3 hepatocellular carcinomas, and 3 renal cell carcinomas. Other primary tumors were breast cancer, thyroid cancer, colon cancer, prostate cancer, and malignant spindle cell tumor, each in 1 case. Modular tumor prostheses were used in all cases; (Kotz's® Modular Tumor prosthesis (Howmedica, Rutherford, New Jersey) in 3 cases, MUTARS® proximal femur system (Implantcast, Munster, Germany) in 17 cases). Perioperative pain was assessed with Visual Analogue Scales (VAS). Postoperative functional outcome was assessed with Musculoskeletal Tumor Society (MSTS) grading system.

Results

Out of 20 cases (19 patients), 11 cases (10 patients) survived at the last follow-up. Average postoperative survival of the 9 deceased patients was 10.1 months (1–38 months). VAS score improved from pre-operative average of 8.40 (5–10) to 1.35 (0–3) after operation. Average postoperative MSTS function score was 19.65 (65.50%, 7–28). The associated complications were 2 local recurrences, 3 hematomas, 3 infections, 2 scrotal swellings, and 1 dislocation. There was no case of periprosthetic fracture or loosening.

Conclusion

Limb salvage operation with tumor prosthesis is an appropriate treatment for early pain reduction and functional restoration in malignant bone tumors in the proximal femur with pain an/or complicated pathologic fractures.

Keywords: proximal femur, malignant bone tumor, limb salvage surgery, tumor prosthesis

References

1. Bell RS. Treatment of axial skeleton bone metastases. Clin Orthop Relat Res. 2003; (415 Suppl):S198–200.
crossref
2. Menendez LR, Ahlmann ER, Kermani C, Gotha H. Endoprosthetic reconstruction for neoplasms of the proximal femur. Clin Orthop Relat Res. 2006; 450:46–51.
crossref
3. Sung KS, Chang MJ. Tumor prosthetic replacement for the metastatic bone tumors involving the proximal femur. J Korean Bone & Joint Tumor Soc. 2007; 13:48–53.
4. 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; 68:1331–7.
crossref
5. Eckardt JJ, Eilber FR, Dorey FJ, Mirra JM. The UCLA experience in limb salvage surgery for malignant tumors. Orthopedics. 1985; 8:612–21.
crossref
6. Donati D, Giacomini S, Gozzi E, Mercuri M. Proximal femur reconstruction by an allograft prosthesis composite. Clin Orthop Relat Res. 2002; 394:192–200.
crossref
7. Damron TA, Sim FH. Surgical treatment for metastatic disease of the pelvis and the proximal end of the femur. Instr Course Lect. 2000; 49:461–70.
8. Gainor BJ, Buchert P. Fracture healing in metastatic bone disease. Clin Orthop Relat Res. 1983; 178:297–302.
crossref
9. 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.
crossref
10. Lin PP, Mirza AN, Lewis VO, et al. Patient survival after surgery for osseous metastases from renal cell carcinoma. J Bone Joint Surg Am. 2007; 89:1794–801.
crossref
11. Rompe JD, Eysel P, Hopf C, Heine J. Metastatic instability at the proximal end of the femur. Comparison of endoprosthetic replacement and plate osteosynthesis. Arch Orthop Trauma Surg. 1994; 113:260–4.
12. Wedin R, Bauer HC. Surgical treatment of skeletal metastatic lesions of the proximal femur: endoprosthesis or reconstruction nail? J Bone Joint Surg Br. 2005; 87:1653–7.
13. Wedin R, Bauer HC, Wersäll P. Failures after operation for skeletal metastatic lesions of long bones. Clin Orthop Relat Res. 1999; 358:128–39.
crossref
14. Yazawa Y, Frassica FJ, Chao EY, Pritchard DJ, Sim FH, Shives TC. Metastatic bone disease. A study of the surgical treatment of 166 pathologic humeral and femoral fractures. Clin Orthop Relat Res. 1990; 251:213–9.
15. Steensma M, Healey JH. Trends in the surgical treatment of pathologic proximal femur fractures among Musculoskeletal Tumor Society members. Clin Orthop Relat Res. 2013; 471:2000–6.
crossref
16. Farid Y, Lin PP, Lewis VO, Yasko AW. Endoprosthetic and allograft-prosthetic composite reconstruction of the proximal femur for bone neoplasms. Clin Orthop Relat Res. 2006; 442:223–9.
crossref
17. McGoveran BM, Davis AM, Gross AE, Bell RS. Evaluation of the allograft-prosthesis composite technique for proximal femoral reconstruction after resection of a primary bone tumour. Can J Surg. 1999; 42:37–45.
18. Zehr RJ, Enneking WF, Scarborough MT. Allograft-prosthesis composite versus megaprosthesis in proximal femoral reconstruction. Clin Orthop Relat Res. 1996; 322:207–23.
crossref
19. 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.
crossref
20. Holzer G, Windhager R, Kotz R. One-stage revision surgery for infected megaprostheses. J Bone Joint Surg Br. 1997; 79:31–5.
crossref
21. 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 a longterm follow-up. J Bone Joint Surg Br. 2001; 83:1156–60.
22. Finstein JL, King JJ, Fox EJ, Ogilvie CM, Lackman RD. Bipolar proximal femoral replacement prostheses for musculoskeletal neoplasms. Clin Orthop Relat Res. 2007; 459:66–75.
crossref
23. Potter BK, Chow VE, Adams SC, Letson GD, Temple HT. Endoprosthetic proximal femur replacement: metastatic versus primary tumors. Surg Oncol. 2009; 18:343–9.
crossref
24. 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.
crossref
25. Lee SH, Oh JH, Lee KS, Yoo KH, Kim HS. Infection after prosthetic reconstruction in limb salvage surgery. Int Orthop. 2002; 26:179–84.
26. McDonald DJ, Capanna R, Gherlinzoni F, et al. Influence of chemotherapy on perioperative complications in limb salvage surgery for bone tumors. Cancer. 1990; 65:1509–16.
crossref

Figure 1.
58-year-old man with metastatic cancer (A) Pre-operative radiograph of right proximal femur shows irregular osteolytic lesion. (B) Coronal T2WI MRI of right proximal femur reveals high signal intensity with heterogeneous enhancement. (C) Wide resection and reconstruction with tumor prosthesis (MUTARS®) was performed.
jkbjts-20-7f1.tif
Figure 2.
Intra-operative photograph shows (A) resected proximal femur and (B) Implanted tumor prosthesis (MUTARS®) and (C) repaired abductor tendon using attachment tube.
jkbjts-20-7f2.tif
Table 1.
Summary of Cases
Case no. Sex* Age Primary tumor Location Pathologic fracture Implant Complication Patient survival
1 M 66 Osteosarcoma Neck-intertroch + KOTZ® Hematoma CDF
2 M 54 Osteosarcoma Head-subtroch   MUTARS®   DOD
3 M 66 Osteosarcoma Neck-intertroch + MUTARS® Recurrence DOD
4 M 35 Osteosarcoma Subtroch   MUTARS®   CDF
5 M 61 Lung ca. Head-intertroch   KOTZ®   DOD
6 F 51 HCC Intertroch-subtroch   KOTZ® ® Infection AWD
7 F 74 Breast ca. Neck-subtroch + MUTARS®   DOD
8 M 42 HCC Intertroch   MUTARS® Infection DOD
9 M 84 Lung ca. Neck-subtroch + MUTARS® Dislocation DOD
10 F 67 RCC Intertroch + MUTARS® ®   AWD
11 F 67 RCC Intertroch + MUTARS®   AWD
12 M 63 Lung ca. Intertroch   MUTARS®   DOD
13 F 49 MPNST Subtroch + MUTARS® Hematoma CDF
14 M 65 Lung ca. Neck-intertroch   MUTARS® Recurrence NA
15 F 56 Colon ca. Neck-intertroch   MUTARS® Infection DOD
16 M 59 HCC Neck-subtroch + MUTARS® ®   DOD
17 M 86 MM Intertroch-subtroch + MUTARS® ® Scrotal swelling AWD
18 M 58 RCC Head-intertroch + MUTARS®   AWD
19 M 75 Thyroid ca. Intertroch-subtroch   MUTARS®   CDF
20 M 84 Prostate ca. Intertroch   MUTARS® Scrotal swelling CDF

* F, female; M, male; HCC, hepatocellular carcinoma; RCC, renal cell carcinoma; MPNST, malignant spindle cell tumor; MM, multiple myeloma; AWD, alive with disease; CDF, continuous disease free; DOD, dead of disease; NA, not available.

Table 2.
Functional Result (Musculoskeletal Tumor Society Functiona Score)
Case Pain Function Emotional acceptance Support Walking ability Gait Total (%)
1 5 4 5 4 3 4 83.3
2 4 2 4 1 2 2 50.0
3 4 4 4 4 4 4 80.0
4 5 4 5 5 4 4 90.0
5 4 2 2 0 1 0 30.0
6 5 4 5 4 5 5 93.3
7 4 1 1 0 1 0 23.3
8 5 2 3 0 2 1 43.3
9 4 3 3 3 3 3 63.3
10 4 3 3 4 3 3 66.7
11 4 3 3 4 3 3 66.7
12 4 2 3 3 2 2 53.3
13 4 3 4 1 3 2 56.7
14 5 3 3 3 3 3 66.7
15 5 4 3 4 4 4 80.0
16 3 2 2 0 1 0 26.7
17 4 4 4 4 3 4 76.7
18 5 4 5 5 4 4 90.0
19 5 3 5 4 4 4 83.3
20 5 4 5 4 4 4 86.7
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