Surgical Technique: Porous Tantalum Reconstruction for Destructive Nonprimary Periacetabular Tumors
| Autor: | Michiro Yanagisawa, Fazel A. Khan, Peter S. Rose, Franklin H. Sim, David G. Lewallen |
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| Rok vydání: | 2012 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Arthroplasty Replacement Hip Minnesota Radiography medicine.medical_treatment Bone Screws Treatment outcome Bone Neoplasms Kaplan-Meier Estimate Tantalum Prosthesis Design Curettage Young Adult Clinical Research Humans Medicine Orthopedics and Sports Medicine Registries Range of Motion Articular Aged Pain Measurement Retrospective Studies Aged 80 and over Pain Postoperative business.industry Porous tantalum Acetabulum Irradiated bone Recovery of Function General Medicine Middle Aged Arthralgia Arthroplasty Surgery Bone screws Treatment Outcome Orthopedic surgery Female Hip Joint Hip Prosthesis Radiology business Porosity |
| Zdroj: | Clinical Orthopaedics & Related Research. 470:594-601 |
| ISSN: | 0009-921X |
| DOI: | 10.1007/s11999-011-2117-2 |
| Popis: | Large bone loss and frequently irradiated existing bone make reconstructing metastatic and other nonprimary periacetabular tumors challenging. Although existing methods are initially successful, they may fail with time. Given the low failure rates of porous tantalum acetabular implants in other conditions with large bone loss or irradiated bone, we developed a technique to use these implants in these neoplastic cases where others might fail.After local tumor curettage, a large uncemented tantalum shell (sometimes with tantalum augments) was fixed to remaining bone using numerous screws. When substantial medial bone loss was present, an antiprotrusio cage was placed over the top of the cup and secured to remaining ilium and ischium.We retrospectively reviewed 20 patients who underwent THAs for neoplastic bone destruction with the described technique. Their mean age was 60 years (range, 22-80 years). We recorded pain and ambulatory status, pain medication use, and Harris hip scores. We assessed for progressive radiolucent lines and component migration on followup radiographs. Eleven of the 20 patients died at a mean of 17 months after surgery. The minimum followup for surviving patients was 26 months (mean, 56 months; range, 26-85 months).Harris hip scores improved from a mean 32 preoperatively to a mean 74 postoperatively. We observed no cases of progressive radiolucent lines or component migration. Complications included one perioperative death, two superficial infections, one deep vein thrombosis, and one dislocation.Our initial experience has made tantalum reconstruction our preferred method for dealing with major periacetabular neoplastic bone loss. Additional studies comparing this technique with alternatives are required.Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. |
| Databáze: | OpenAIRE |
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