Limb Salvage : Major Reconstructions in Oncologic and Nontumoral Conditions 5th International Symposium, St. Malo ISOLS-GETO

An international group ofresearchers has met every 2 years since 1981 to examine the progress made in limb salvage techniques and the perspectives of this field of surgery. In 1989 the Fifth International Symposium On Limb Salvage (ISOLS) was held in Saint Malo and was attended by more than 300 participants from 34 different countries. The 105 papers presented, grouped under eleven main headings, have been included in this book. Limb salvage has indeed progressed in the years since the first symposium. Initially it essentially concerned tumours and the main aim was to salvage the diseased limb through non-mutilating surgery without jeopardizing the patient's prospects of survival. Now, with a confirmed high rate of 5-year disease-free survival, new goals can be set: improvement of the functional results and of the survival of our reconstructions. How can this be achieved: - By favouring muscle reattachment on the prosthesis, for instance through the use of a bone allograft-sleeved composite prosthesis? - By improving the survival of the arthroplasty through the develop­ ment of a more biological fixation of its stems? - By limiting the side effects of the necessary adjuvant treatments on the function of the allograft as well as on the fixation of the prosthesis? In addition, limb salvage procedures now concern not only primary tumours (and metastases, which must be treated using the same osteosynthetic and prosthetic techniques), but also reconstructive orthopaedic surgery as a whole. Front Matter....Pages i-xxxi Front Matter....Pages 1-1 The Clinical Use of Frozen Cadaveric Allografts in the Management of Bone Tumors: An Overview....Pages 3-7 Morphological Investigations of Osteochondral Allografts....Pages 9-15 Isotope Metabolism and Biochemistry of Massive Osteoarticular Allografts....Pages 17-23 The Development of a Size and Shape Matching Index for Osteochondral Allografts....Pages 25-31 Radiation Sterilized Bone Allografts: Banking Procedure and Clinical Results After 150 Massive Allografts....Pages 33-39 Allograft Replacement in Aggressive and Malignant Bone Tumors: A Long-Term Study....Pages 41-45 Massive Intercalary Allografts in the Reconstruction of Segmental Bone Defects....Pages 47-55 Osteoarticular Allograft Reconstruction of the Proximal Humerus Following Limb-Sparing Surgery....Pages 57-65 Allografts in Bone Tumor Surgery: Short-Term Results....Pages 67-73 Technical Aspects and Surgical Complications of Segmental Allografts Following Segmental Resections of Malignant Bone Tumors....Pages 75-87 Complications of Fresh Frozen Bone Allografts for Tumor Reconstruction and Their Management....Pages 89-94 Segmental Allograft Reconstruction Concomitant with Neoadjuvant Chemotherapy....Pages 95-99 Evaluation of Allograft Fixation....Pages 101-105 Chemotherapy Effect on the Clinical Results of Allograft Transplantation in the Treatment of Malignant Bone Tumors....Pages 107-115 Bone Union in Allografts: Chemotherapy Considerations....Pages 117-119 Treatment of Complications in Intercalary and Terminal Allografts....Pages 121-124 Complications in Hemipelvic Resection/Allograft Reconstruction for Bone Sarcomas: Are They Prohibitive to Limb Salvage?....Pages 125-138 Front Matter....Pages 139-139 Benign Aggressive Bone Lesions: Marginal Resection plus Methylmethacrylate — A Long-Term Appraisal....Pages 141-145 Polymethylmethacrylation in the Treatment of Giant Cell Tumors....Pages 147-153 Acrylic Cementation Techniques in the Treatment of Metaphyseal Tumors of Bone....Pages 155-161 Front Matter....Pages 139-139 Antimitotic-Loaded Acrylic Cement....Pages 163-167 Bioartificial Hydroxyapatite Implants....Pages 169-173 Reconstruction of Bone Defects....Pages 175-183 Calcium Hydroxyapatite Ceramic: Use in Bone Tumor Surgery....Pages 185-191 Implant of Biphasic Ceramic (Tricalcium Phosphate/Hydroxyapatite) in Cystic Cavities After Bone Tumor Curettage: Preliminary Results....Pages 193-195 Front Matter....Pages 197-197 Orthopaedic and Plastic Reconstruction of Large Bone and Soft Tissue Defects....Pages 199-206 Functional Coverage of the Shoulder Through Transfer of a Latissimus Dorsi Musculocutaneous Flap After Wide Excision of Malignant Bone Tumors....Pages 207-211 Free Tissue Transfer in Conjunction with Limb-Sparing Prosthetic Replacement for Sarcomas Around the Knee....Pages 213-218 Reconstructive Plastic Procedures in Recurrent Soft Tissue Sarcomas of the Extremities....Pages 219-223 Free Vascularized Fibular Graft for Skeletal Defect Reconstruction After Tumor Resection....Pages 225-231 Local Pedicular Vascularized Bone Graft in Reconstruction Around the Knee....Pages 233-240 Treatment of Tibial Defects and Nonunions Using Ipsilateral Vascularized Fibular Transposition....Pages 241-246 Front Matter....Pages 247-247 Introduction....Pages 249-249 Intramedullary Fixation of Massive Prostheses Using Acrylic Cement: A Retrieval Study....Pages 251-256 Long-Term Radiographic Evaluation of Massive Proximal Femoral Replacements....Pages 257-262 Segmental Total Hip and Knee Replacement:A Long-Term Review....Pages 263-270 Polyethylene Endoprostheses for the Treatment of Malignant Bone Tumors: A Long-Term Follow-Up Study....Pages 271-275 Long-Term Follow-Up of Walldius-Hinged Total Knee Arthroplasties....Pages 277-284 Endoprosthetic Replacements of the Proximal Tibia....Pages 285-292 The Effect of Chemotherapy on Uncemented Prosthetic Replacement....Pages 293-301 Front Matter....Pages 247-247 Effects of Adjuvant Local X-Ray Therapy on the Functional Result of Prosthetic Knee Replacement for Malignant Bone Tumors....Pages 303-305 Summary....Pages 307-307 Front Matter....Pages 309-309 A Challenge to Osteointegrable Tumor Prosthesis....Pages 311-317 The Bone-Cement Interface in Long-Standing Prosthetic Implants....Pages 319-328 Histomorphological Findings in Different Cementless Anchored Humerus Prostheses....Pages 329-334 Comparison of Autogenous Cortical Graft and Demineralized Allogenic Bone Matrix (DABM) in the Fixation of Segmental Prosthesis....Pages 335-343 Experience with Extracortical Fixation of Large Segmental Prostheses and Description of a Modular Segmental Replacement System (MSRS)....Pages 345-354 Design Characteristics of Knee Joints for Limb Salvage Devices....Pages 355-361 Effect of Therapeutic Irradiation on Extracortical Fixation and Bone Ingrowth in an Autogenously Bone Grafted Segmental Defect Prosthesis....Pages 363-368 Telemetry of Strain In Vivo from a Proximal Femoral Replacement....Pages 369-377 Hemipelvic Endoprosthetic Replacement....Pages 379-384 Front Matter....Pages 385-385 Composite Prostheses in Malignant Tumors: Rationale and Preliminary Results of 42 Cases....Pages 387-394 Muscle Reattachment — Especially the Gluteal Muscles — After Proximal Femoral Resection and Replacement by Tumor Prosthesis....Pages 395-398 Dacron Fabric Enveloped Alumina Ceramic Prosthesis for Large Bone Defects....Pages 399-405 Allograft Prosthetic Composite Arthroplasty for Limb Salvage and Revision Arthroplasty....Pages 407-414 Radiation Sterilized Proximal Femur Massive Allografts After Tumor Surgery: A Preliminary Report....Pages 415-421 Allograft-Prosthesis Combinations in Limb Salvage Surgery....Pages 423-427 Contribution of Allografts in Prosthetic Surgery....Pages 429-433 Allograft with Patellar Tendon in Reconstructive Procedures After Upper Tibia Resection....Pages 435-437 Incidence of Adjuvant Radiotherapy and Chemotherapy and Infection in Massive Composite Allograft Prostheses....Pages 439-443 Front Matter....Pages 445-445 Introduction: Reoperation Following Prosthetic Replacement....Pages 447-448 Reoperation of Failed Prosthetic Replacement for Limb Salvage....Pages 449-455 Salvage Procedures for Failed Total Hip Prostheses Implanted After Tumor Resection....Pages 457-463 Management of the Failed Segmental Knee Replacement....Pages 465-470 An Individualized Design Approach for Revising Total Knee Hinges....Pages 471-478 Management of Failed Endoprosthetic Implants: The UCLA Experience....Pages 479-486 Management of Failed Segmental Hip and Knee Implants....Pages 487-492 Management of Failed Megaprostheses After Limb-Saving Surgery....Pages 493-495 Influence of Chemotherapy on Perioperative Complications in Limb-Salvage Surgery for Bone Tumors....Pages 497-507 Conclusion: Reoperation Following Prosthetic Replacement....Pages 509-510 Front Matter....Pages 511-511 Limb Salvage in Pediatric Patients (Round Table)....Pages 513-515 Effect of Chemotherapy on Growth in the Skeletally Immature Individual....Pages 517-525 Van Nes Rotationplasty in Skeletally Immature Patients with Malignant Sarcoma of the Lower Extremity....Pages 527-529 Lymph Scintigraphy in Patients After Rotationplasty....Pages 531-535 Adaptation of the Ankle Joint After Rotationplasty in Children....Pages 537-541 Arthrodeses After Malignant Bone Tumor Resection in Children....Pages 543-551 Reconstruction After Large Bone Shaft Resection for Humerus, Femur, and Tibia Sarcomas: Autograft or Allograft Reconstitution?....Pages 553-556 Cemented Prosthetic Replacement for Children with Primary Bone Sarcomas: Results and Growth Problems....Pages 557-560 Bone Allografts for Tumors and Other Reconstructions in Children....Pages 561-572 Growing Endoprosthetic Replacements for Malignant Tumours....Pages 573-578 Front Matter....Pages 511-511 The Expandable Adjustable Prosthesis: An Alternative to Amputation in Growing Children with Malignant Tumors of the Extremities....Pages 579-584 Expandable Endoprostheses for the Skeletally Immature: The Initial UCLA Experience....Pages 585-590 Endoprostheses in Children — First Results....Pages 591-599 Remodelling of Bone Around Massive Prostheses Used in Growing Patients....Pages 601-608 In Vitro and In Vivo Experiments of a Lengthening Element for a Modular Femur Endoprosthetic System....Pages 609-612 Conclusions of Limb Salvage in Pediatric Patients (Round Table)....Pages 613-615 Front Matter....Pages 617-617 Limb Salvage with the Intraoperatively Irradiated Tumor Tissues Preserved In Situ in Osteosarcoma....Pages 619-625 Limb Conservation in Primary Bone Tumors by Resection, Extracorporeal Irradiation and Reimplantation: Results and Complications of the Technique in 27 Patients....Pages 627-638 Developments of Interlocking Nailings in Limb Salvage Surgery: Endolock and TD Nails....Pages 639-644 Segmental Resection of Thigh for Osteosarcoma of Distal Part of Femur....Pages 645-654 En Bloc Sacral Resection or Total Sacrectomy....Pages 655-661 Prosthetic Reconstruction Following Internal Hemipelvectomy: Clinical Results and Improvement of Pelvic Tumor Prosthesis....Pages 663-669 Reconstruction of the Tibia by Dual Grafting: Report of Three Cases....Pages 671-674 Primary Stabilization Procedures for Large Osteoperiosteal Gaps Following Tumor Resections....Pages 675-686 Front Matter....Pages 687-687 Treatment of Metastatic Disease Involving the Proximal Femur and Hip Joint....Pages 689-696 Use of Megaprostheses in the Treatment of Metastatic Bone Disease....Pages 697-699 Pitfalls in the Management of Metastatic Disease of the Femur....Pages 701-709 Metastatic Carcinoma of the Spine with Neurological Complications: An Autopsy Review....Pages 711-715 Surgical Treatment of Vertebral Metastases....Pages 717-724 Score Assessment of Metastatic Bone Tumor for Operative Treatment....Pages 725-732 Front Matter....Pages 687-687 Allograft Reconstruction for Bone Metastases....Pages 733-740 Prosthetic Replacement in the Treatment of Bone Metastases....Pages 741-749 Vertebral Metastasis - Natural History and Treatment....Pages 751-756 Surgical Treatment of Bone Metastases....Pages 757-762 Front Matter....Pages 763-763 Role of Electroradiography in the Evaluation of Preoperative Treatment for Primary Malignant Bone Tumors....Pages 765-768 Magnetic Resonance Imaging in Evaluating In Vivo Response to Neoadjuvant Chemotherapy for Osteogenic Sarcomas....Pages 769-773 Radiographic Evaluation of the Response of Osteosarcoma to Induction Chemotherapy....Pages 775-780 Recurrence Detection of Malignant Mesenchymal Neoplasms in MRI and CT....Pages 781-787 Contribution of Magnetic Resonance Imaging in the Evaluation of Tumor Extension and in the Follow-Up During Chemotherapy in an Undifferentiated Osteogenic Sarcoma: A Case Report....Pages 789-793 Osteosarcoma: Evaluation of Prognosis by Flow Cytometry....Pages 795-798 High Resolution Radiography of Bone Tumor Resection Specimens....Pages 799-806 Single Photon Emission Computed Tomography (SPECT) Analysis of Allograft Revascularization....Pages 807-814 Suitability of MRI for the Selection of Osteochondral Allograft Bone....Pages 815-823 Back Matter....Pages 825-826 This book presents papers on topics which were selected as the most representative of new trends in major reconstructions by a renowned group of orthopaedic surgeons and scientists (among others): E. Chao, M. Campanacci, J. Dubousset, W. Enneking, R. Kotz, F. Langlais, M. Malawer, H. Mankin, U. Nilsonne, F. Sim, B. Tomeno and T. Yamamuro. Special attention is paid to the following themes: - the newest techniques, prostheses, materials, and devices such as allograft composite prostheses, growth prostheses and bone substitutes; - the influence of adjuvant treatments (especially chemotherapy) on surgical procedures such as allograft fusion and prosthesis fixation; - salvage techniques after the failure of prostheses and allografts, which are also of great interest in non oncologic cases such as prosthetic revisions; - the evaluation of recent imaging techniques such as MRI for the determination of margins and the surgical treatment of metastases. The book will be of intÄBest to oncologic surgeons, prosthesis manufacturers and biomaterial scientists as well as to general orthopedic surgeons, as the problems of major reconstructions now also have to be faced in nontumoral conditions Representing current trends in major orthopaedic reconstructions, this book examines developments in techniques, the influence of such adjuvant treatments as chemotherapy and evaluates recent imaging techniques for the determination of margins and the surgical treatment of metastases.