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J Knee Surg 2023; 36(01): 068-078
DOI: 10.1055/s-0041-1729623
Original Article

Outcomes of Fixed-Hinged Knee Prosthesis for Distal Femoral Osteosarcoma in Skeletally Immature Patients: First Results

Zhiqing Zhao‡   *
1   Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, P.R. China
,
Yi Yang‡   *
1   Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, P.R. China
,
Taiqiang Yan
1   Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, P.R. China
,
Xiaodong Tang
1   Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, P.R. China
,
Rongli Yang
1   Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, P.R. China
,
Wei Guo
1   Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, P.R. China
› Author Affiliations Funding The study was funded by the Beijing Municipal Science and Technology Project (Z181100001918025).
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Abstract

The best surgical choice for distal femur osteosarcoma in skeletally immature patients remains controversial. A fixed hinged knee prosthesis has been designed to preserve the growth plates in the adjacent tibia, expecting tibial growth to be continued. This study aims to report the (1) clinical outcomes after prosthetic replacement, (2) postoperative complications, and (3) length of discrepancy of the operative tibia with the unaffected tibia. Thirty-four skeletally immature patients (averaged 9 years at surgery; range, 5–12 years) with distal femoral osteosarcoma underwent placement of this hinged knee prosthesis between January 2015 and August 2018. Postoperative function and complications were assessed. Length discrepancy was measured using a series of full-length standing anteroposterior radiographs of the bilateral lower extremity. The average follow-up duration was 34 months (2.8 years). In the last follow-up, four patients expired because of pulmonary metastasis. Two patients presented with local recurrence of the soft tissue. Postoperatively, the flexion range of the knee joint range was between 100 and 130 degrees, with an average of 115.2 degrees. The mean functional score of living patients evaluated using the Musculoskeletal Tumor Society scoring system was 89.2% (range, 76.7–100%). Types 1 (three patients), 2 (one patient), 3 (two patients), and 5 (two patients) complications exist. Among them, three patients received revision surgery. The proximal tibial physis still grew after surgery, with an average of 74.3% (range, 30–100%) growth potential compared with the unaffected proximal tibial physis. Moreover, 27 children exhibited tibial length discrepancy compared with the contralateral tibia, and the mean discrepancy in tibial length was 1.1 cm (range, 0.2–3.1 cm). This hinged knee prosthesis can keep the growth potential in the adjacent tibia, provides satisfying functional outcomes, and has a lower postoperative complication rate. Thus, it could serve as an alternative intervention for distal femoral osteosarcoma in skeletally immature patients.

Keywords

osteosarcoma - tumor prosthesis - limb salvage - children

Note

The Ethical Review Committee (ERC) of Peking University People's Hospital has approved the human protocol for this study. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript. All the authors reviewed the literature and wrote the initial draft of the manuscript.


* Zhiqing Zhao and Yi Yang contributed equally to this study.




Publication History

Received: 04 January 2021

Accepted: 12 March 2021

Article published online:
29 June 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Ottaviani G, Jaffe N. The epidemiology of osteosarcoma. Cancer Treat Res 2009; 152: 3-13
    CrossrefPubMedGoogle Scholar
  • 2 DiCaprio MR, Friedlaender GE. Malignant bone tumors: limb sparing versus amputation. J Am Acad Orthop Surg 2003; 11 (01) 25-37
    CrossrefPubMedGoogle Scholar
  • 3 Dotan A, Dadia S, Bickels J. et al. Expandable endoprosthesis for limb-sparing surgery in children: long-term results. J Child Orthop 2010; 4 (05) 391-400
    CrossrefPubMedGoogle Scholar
  • 4 Finn HA, Simon MA. Limb-salvage surgery in the treatment of osteosarcoma in skeletally immature individuals. Clin Orthop Relat Res 1991; (262) 108-118
    PubMedGoogle Scholar
  • 5 Nagarajan R, Neglia JP, Clohisy DR, Robison LL. Limb salvage and amputation in survivors of pediatric lower-extremity bone tumors: what are the long-term implications?. J Clin Oncol 2002; 20 (22) 4493-4501
    CrossrefPubMedGoogle Scholar
  • 6 Saghieh S, Abboud MR, Muwakkit SA, Saab R, Rao B, Haidar R. Seven-year experience of using Repiphysis expandable prosthesis in children with bone tumors. Pediatr Blood Cancer 2010; 55 (03) 457-463
    CrossrefPubMedGoogle Scholar
  • 7 Tsuda Y, Tsoi K, Stevenson JD, Fujiwara T, Tillman R, Abudu A. Extendable endoprostheses in skeletally immature patients: a study of 124 children surviving more than 10 years after resection of bone sarcomas. J Bone Joint Surg Am 2020; 102: 151-162
    CrossrefPubMedGoogle Scholar
  • 8 Beebe K, Benevenia J, Kaushal N, Uglialoro A, Patel N, Patterson F. Evaluation of a noninvasive expandable prosthesis in musculoskeletal oncology patients for the upper and lower limb. Orthopedics 2010; 33 (06) 396
    CrossrefPubMedGoogle Scholar
  • 9 Arteau A, Lewis VO, Moon BS, Satcher RL, Bird JE, Lin PP. Tibial growth disturbance following distal femoral resection and expandable endoprosthetic reconstruction. J Bone Joint Surg Am 2015; 97 (22) e72
    CrossrefPubMedGoogle Scholar
  • 10 Henderson ER, Pepper AM, Marulanda G, Binitie OT, Cheong D, Letson GD. Outcome of lower-limb preservation with an expandable endoprosthesis after bone tumor resection in children. J Bone Joint Surg Am 2012; 94 (06) 537-547
    CrossrefPubMedGoogle Scholar
  • 11 Portney DA, Bi AS, Christian RA, Butler BA, Peabody TD. Outcomes of expandable prostheses for primary bone malignancies in skeletally immature patients: a systematic review and pooled data analysis. J Pediatr Orthop 2020; 40 (06) e487-e497
    CrossrefPubMedGoogle Scholar
  • 12 Cipriano CA, Gruzinova IS, Frank RM, Gitelis S, Virkus WW. Frequent complications and severe bone loss associated with the Repiphysis expandable distal femoral prosthesis. Clin Orthop Relat Res 2015; 473 (03) 831-838
    CrossrefPubMedGoogle Scholar
  • 13 Eckardt JJ, Kabo JM, Kelley CM. et al. Expandable endoprosthesis reconstruction in skeletally immature patients with tumors. Clin Orthop Relat Res 2000; (373) 51-61
    CrossrefPubMedGoogle Scholar
  • 14 Grimer RJ, Belthur M, Carter SR, Tillman RM, Cool P. Extendible replacements of the proximal tibia for bone tumours. J Bone Joint Surg Br 2000; 82 (02) 255-260
    CrossrefPubMedGoogle Scholar
  • 15 Henderson ER, Pepper AM, Letson GD. What are estimated reimbursements for lower extremity prostheses capable of surgical and nonsurgical lengthening?. Clin Orthop Relat Res 2012; 470 (04) 1194-1203
    CrossrefPubMedGoogle Scholar
  • 16 Anderson M, Green WT, Messner MB. Growth and predictions of growth in the lower extremities. J Bone Joint Surg Am 1963; 45-A: 1-14
    CrossrefPubMedGoogle Scholar
  • 17 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) 241-246
    PubMedGoogle Scholar
  • 18 Green WT, Wyatt GM, Anderson M. Orthoroentgenography as a method of measuring the bones of the lower extremities. J Bone Joint Surg Am 1946; 28: 60-65
    PubMedGoogle Scholar
  • 19 Henderson ER, O'Connor MI, Ruggieri P. et al. Classification of failure of limb salvage after reconstructive surgery for bone tumours : a modified system including biological and expandable reconstructions. Bone Joint J 2014; 96-B (11) 1436-1440
    CrossrefPubMedGoogle Scholar
  • 20 Raab P, Wild A, Seller K, Krauspe R. Correction of length discrepancies and angular deformities of the leg by Blount's epiphyseal stapling. Eur J Pediatr 2001; 160 (11) 668-674
    CrossrefPubMedGoogle Scholar
  • 21 Abudu A, Grimer R, Tillman R, Carter S. The use of prostheses in skeletally immature patients. Orthop Clin North Am 2006; 37 (01) 75-84
    CrossrefPubMedGoogle Scholar
  • 22 Wilkins RM, Camozzi AB, Gitelis SB. Reconstruction options for pediatric bone tumors about the knee. J Knee Surg 2005; 18 (04) 305-309
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Kong CB, Lee SY, Jeon DG. Staged lengthening arthroplasty for pediatric osteosarcoma around the knee. Clin Orthop Relat Res 2010; 468 (06) 1660-1668
    CrossrefPubMedGoogle Scholar
  • 24 Ness KK, Neel MD, Kaste SC. et al. A comparison of function after limb salvage with non-invasive expandable or modular prostheses in children. Eur J Cancer 2014; 50 (18) 3212-3220
    CrossrefPubMedGoogle Scholar
  • 25 Torner F, Segur JM, Ullot R. et al. Non-invasive expandable prosthesis in musculoskeletal oncology paediatric patients for the distal and proximal femur. First results. Int Orthop 2016; 40 (08) 1683-1688
    CrossrefPubMedGoogle Scholar
  • 26 Neel MD, Wilkins RM, Rao BN, Kelly CM. Early multicenter experience with a noninvasive expandable prosthesis. Clin Orthop Relat Res 2003; (415) 72-81
    CrossrefPubMedGoogle Scholar
  • 27 Dukan R, Mascard E, Langlais T. et al. Long-term outcomes of non-invasive expandable endoprostheses for primary malignant tumors around the knee in skeletally-immature patients. Arch Orthop Trauma Surg 2021
    PubMedGoogle Scholar
  • 28 Kang S, Lee JS, Park J, Park SS. Staged lengthening and reconstruction for children with a leg-length discrepancy after excision of an osteosarcoma around the knee. Bone Joint J 2017; 99-B (03) 401-408
    CrossrefPubMedGoogle Scholar
  • 29 Chung SH, Jeon DG, Cho WH. et al. Temporary hemiarthroplasty with a synthetic device in children with osteosarcoma around the knee as a bridging procedure until skeletal maturity. J Surg Oncol 2015; 112 (01) 107-114
    CrossrefPubMedGoogle Scholar
  • 30 Groundland JS, Binitie O. Reconstruction after tumor resection in the growing child. Orthop Clin North Am 2016; 47 (01) 265-281
    CrossrefPubMedGoogle Scholar
  • 31 Groundland JS, Ambler SB, Houskamp LD, Orriola JJ, Binitie OT, Letson GD. Surgical and functional outcomes after limb-preservation surgery for tumor in pediatric patients: a systematic review. JBJS Rev 2016;4(02):01874474-201602000-00002
    PubMedGoogle Scholar
  • 32 Staals EL, Colangeli M, Ali N, Casanova JM, Donati DM, Manfrini M. Are Complications associated with the Repiphysis(®) expandable distal femoral prosthesis acceptable for its continued use?. Clin Orthop Relat Res 2015; 473 (09) 3003-3013
    CrossrefPubMedGoogle Scholar
  • 33 Walsh M, Connolly P, Jenkinson A, O'Brien T. Leg length discrepancy--an experimental study of compensatory changes in three dimensions using gait analysis. Gait Posture 2000; 12 (02) 156-161
    CrossrefPubMedGoogle Scholar
  • 34 Neel MD, Heck R, Britton L, Daw N, Rao BN. Use of a smooth press-fit stem preserves physeal growth after tumor resection. Clin Orthop Relat Res 2004; (426) 125-128
    CrossrefPubMedGoogle Scholar
  • 35 Ji T, Yang Y, Li DS, Tang XD, Guo W. Limb salvage using non-hinged endoprosthesis and staged correction of leg-length discrepancy for children with distal femoral malignant tumors. Orthop Surg 2019; 11 (05) 819-825
    CrossrefPubMedGoogle Scholar
  • 36 Ruggieri P, Mavrogenis AF, Pala E, Romantini M, Manfrini M, Mercuri M. Outcome of expandable prostheses in children. J Pediatr Orthop 2013; 33 (03) 244-253
    CrossrefPubMedGoogle Scholar
  • 37 Arkader A, Viola DC, Morris CD, Boland PJ, Healey JH. Coaxial extendible knee equalizes limb length in children with osteogenic sarcoma. Clin Orthop Relat Res 2007; 459 (459) 60-65
    CrossrefPubMedGoogle Scholar
  • 38 Cool WP, Carter SR, Grimer RJ, Tillman RM, Walker PS. Growth after extendible endoprosthetic replacement of the distal femur. J Bone Joint Surg Br 1997; 79 (06) 938-942
    CrossrefPubMedGoogle Scholar
  • 39 Schindler OS, Cannon SR, Briggs TW, Blunn GW. Stanmore custom-made extendible distal femoral replacements. Clinical experience in children with primary malignant bone tumours. J Bone Joint Surg Br 1997; 79 (06) 927-937
    CrossrefPubMedGoogle Scholar
  • 40 Unwin PS, Walker PS. Extendible endoprostheses for the skeletally immature. Clin Orthop Relat Res 1996; (322) 179-193
    CrossrefPubMedGoogle Scholar
  • 41 Kim W, Han I, Cho HS, Kang S, Kim HS. Cortical atrophy related to tumor prosthesis in skeletally immature osteosarcoma patients. J Pediatr Orthop 2018; 38 (01) 60-68
    CrossrefPubMedGoogle Scholar