Velázquez-Rodríguez S, Clara-Altamirano M, García-Ortega D, Lizcano-Suárez A, Martínez-Said H, Villavicencio-Valencia V, Cuellar-Hubbe M

Language: Spanish
References: 29
Page: 15-21
PDF size: 170.05 Kb.

ABSTRACT

Introduction: reconstruction of large bone defects using modular knee arthroplasty (MKA) presents a significant challenge in terms of functionality. The objective of the present work was to identify the different prognostic factors associated with failure of MKA in cancer patients. Material and methods: a retrospective cohort study was conducted, including patients with a diagnosis of musculoskeletal tumor in the distal femur or proximal tibia, who underwent MKA between January 1, 2010, and December 31, 2021. Results: 49 patients were included, of which 25 (51.02%) were women and 24 (48.98%) men, with a mean age of 29.57 years. Of these, 14 (28.57%) patients experienced some type of MKA failure. The most frequent complication that led to failure was periprosthetic infection, observed in seven (14.29%) patients. Variables associated with MKA failure included biopsies performed outside our hospital (HR 3.2, 95% CI 1.4-6.4, p = 0.02), the length of the long axis of the tumor (HR 2.1, 95% CI 1.2-4.6, p = 0.01) and a prolonged surgical time (HR 3.37, 95% CI 1.1-8.6, p = 0.04). Conclusion: the most significant prognostic factors associated with MKA failure in our cohort were tumor size, prolonged surgical time, and performance of the diagnostic biopsy in a center not specialized in the management of this type of patient. These findings highlight the importance of considering these variables to improve outcomes in patients undergoing MKA.

REFERENCES

1. Walczak BE, Rose PS, Post JM, Sim FH. Surgical treatment of tumors and tumorlike lesions of bone. In: Santini-Araujo E, Kalil R, Bertoni F, Park YK (eds). Tumors and tumor-like lesions of bone. London: Springer; 2020. pp. 103-119.

2. Grimer RJ, Carter SR, Pynsent PB. The cost-effectiveness of limb salvage for bone tumours. J Bone Joint Surg Br. 1997; 79(4): 558-61.

3. Bus MP, van de Sande MA, Fiocco M, Schaap GR, Bramer JA, Dijkstra PD. What are the long-term results of MUTARS^® modular endoprostheses for reconstruction of tumor resection of the distal femur and proximal tibia? Clin Orthop Relat Res. 2017; 475(3): 708-18.

4. Albergo JI, Gaston CL, Aponte-Tinao LA, Ayerza MA, Muscolo DL, Farfalli GL, et al. Proximal tibia reconstruction after bone tumor resection: are survivorship and outcomes of endoprosthetic replacement and osteoarticular allograft similar? Clin Orthop Relat Res. 2017; 475(3): 676-82.

5. Pang CG, Yang XG, Zhao YL, Liu YC, Hu YC. A novel tool for predicting the survival of endoprosthesis used for reconstruction of the knee following tumor resection: a retrospective cohort study. BMC Cancer. 2021; 21: 986.

6. Windhager R. Tumour arthroplasty. Orthopade. 2021; 50(10): 839-42.

7. Linares-González LM. Tratamiento quirúrgico del osteosarcoma. En: Clara-Altamirano MA, García-Ortega DY (eds.). Clínicas oncológicas de Iberoamérica: tumores óseos. PyDESA; 2022. Vol. 12. pp. 139-50.

8. Gautam D, Malhotra R. Megaprosthesis versus allograft prosthesis composite for massive skeletal defects. J Clin Orthop Trauma. 2018; 9(1): 63-80.

9. Henderson ER, Groundland JS, Pala E, Dennis JA, Wooten R, Cheong D, et al. Failure mode classification for tumor endoprostheses: retrospective review of five institutions and a literature review. J Bone Joint Surg Am. 2011; 93(5): 418-29.

10. Kinkel S, Lehner B, Kleinhans JA, Jakubowitz E, Ewerbeck V, Heisel C. Medium to long-term results after reconstruction of bone defects at the knee with tumor endoprostheses. J Surg Oncol. 2010; 101(2): 166-9.

11. Goldman LH, Morse LJ, O'Donnell RJ, Wustrack RL. How often does spindle failure occur in compressive osseointegration endoprostheses for oncologic reconstruction? Clin Orthop Relat Res. 2016; 474(7): 1714-23.

12. Perez JR, Jose J, Mohile NV, Boden AL, Greif DN, Barrera CM, et al. Limb salvage reconstruction: radiologic features of common reconstructive techniques and their complications. J Orthop. 2020; 21: 183-91.

13. Müller D, Kaiser D, Sairanen K, Studhalter T, Uckay I. Antimicrobial prophylaxis for the prevention of surgical site infections in orthopaedic oncology - a narrative review of current concepts. J Bone Jt Infect. 2019; 4 (6): 254-63.

14. Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, et al. The Eighth Edition AJCC Cancer staging manual: continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging. CA Cancer J Clin. 2017; 67(2): 93-9.

15. González-Quevedo D, Moriel-Garceso D. Metástasis óseas: del diagnóstico al tratamiento. Actual Med. 2019; 104(808): 192-4.

16. Clara-Altamirano MA, Garcia-Ortega DY, Martinez-Said H, Caro-Sánchez CHS, Herrera-Gomez A, Cuellar-Hubbe M. Surgical treatment in bone metastases in the appendicular skeleton. Rev Esp Cir Ortop Traumatol (Engl Ed). 2018; 62(3): 185-9.

17. Saglam F, Baysal O, Sofulu O, Baykan SE, Erol B. The impact of pathological fractures on surgery, morbidity, functional and oncological outcomes in patients with primary bone sarcomas. Injury. 2021; 52(7): 1740-7.

18. Pala E, Trovarelli G, Calabro T, Angelini A, Abati CN, Ruggieri P. Survival of modern knee tumor megaprostheses: failures, functional results, and a comparative statistical analysis. Clin Orthop Relat Res. 2015; 473(3): 891-9.

19. Papagelopoulos PJ, Mavrogenis AF, Savvidou OD, Benetos IS, Galanis EC, Soucacos PN. Pathological fractures in primary bone sarcomas. Injury. 2008; 39(4): 395-403.

20. Salunke AA, Chen Y, Tan JH, Chen X, Khin LW, Puhaindran ME. Does a pathological fracture affect the prognosis in patients with osteosarcoma of the extremities?: a systematic review and meta-analysis. Bone Joint J. 2014; 96-B(10): 1396-403.

21. Cates JM. Pathologic fracture a poor prognostic factor in osteosarcoma: Misleading conclusions from meta-analyses? Eur J Surg Oncol. 2016; 42(6): 883-8.

22. Linares RF. Complicaciones del tratamiento quirúrgico de los sarcomas óseos. En: Clara-Altamirano MA, García-Ortega DY (eds.). Clínicas oncológicas de Iberoamérica: tumores óseos. PyDESA; 2022. Vol. 18. pp. 213-220.

23. Liu Y, Deng X, Wen Z, Huang J, Wang C, Chen C, et al. The effect of perioperative blood transfusion on survival after renal cell carcinoma nephrectomy: A systematic review and meta-analysis. Front Oncol. 2023; 13: 1092734.

24. Zhang W, Xu H, Huang B, Xu Y, Huang J. Association of perioperative allogeneic blood transfusions and long-term outcomes following radical surgery for gastric and colorectal cancers: systematic review and meta-analysis of propensity-adjusted observational studies. BJS Open. 2023; 7(4): zrad075.

25. Kulkarni S, Parina R, Henderson R, Derek E, Selby T, Kwon Y, et al. Transfusion-free strategies in liver and pancreatic surgery: a predictive model of blood conservation for transfusion avoidance in mainstream populations. Ann Surg. 2023; 277(3): 469-74.

26. Hu L, Li Z, Qiao Y, Wang A. Does perioperative allogeneic blood transfusion worsen the prognosis of patients with hepatocellular carcinoma? A meta-analysis of propensity score-matched studies. Front Oncol. 2023; 13: 1230882.

27. Haijie L, Dasen L, Tao J, Yi Y, Xiaodong T, Wei G. Implant survival and complication profiles of endoprostheses for treating tumor around the knee in adults: a systematic review of the literature over the past 30 years. J Arthroplasty. 2018; 33(4): 1275-87.e3.

28. Liang H, Guo W. Reconstruction in orthopaedic oncology: frontier and horizon. Ann Joint. 2020; 5: 19.

29. Theil C, Roder J, Gosheger G, Deventer N, Dieckmann R, Schorn D, et al. What is the likelihood that tumor endoprostheses will experience a second complication after first revision in patients with primary malignant bone tumors and what are potential risk factors? Clin Orthop Relat Res. 2019; 477(12): 2705-14.

EVIDENCE LEVEL

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