PubTransformer

A site to transform Pubmed publications into these bibliographic reference formats: ADS, BibTeX, EndNote, ISI used by the Web of Knowledge, RIS, MEDLINE, Microsoft's Word 2007 XML.

LUMiC® Endoprosthetic Reconstruction After Periacetabular Tumor Resection: Short-term Results.

Abstract Reconstruction of periacetabular defects after pelvic tumor resection ranks among the most challenging procedures in orthopaedic oncology, and reconstructive techniques are generally associated with dissatisfying mechanical and nonmechanical complication rates. In an attempt to reduce the risk of dislocation, aseptic loosening, and infection, we introduced the LUMiC® prosthesis (implantcast, Buxtehude, Germany) in 2008. The LUMiC® prosthesis is a modular device, built of a separate stem (hydroxyapatite-coated uncemented or cemented) and acetabular cup. The stem and cup are available in different sizes (the latter of which is also available with silver coating for infection prevention) and are equipped with sawteeth at the junction to allow for rotational adjustment of cup position after implantation of the stem. Whether this implant indeed is durable at short-term followup has not been evaluated.
PMID
Related Publications

Outcomes of a Modular Intercalary Endoprosthesis as Treatment for Segmental Defects of the Femur, Tibia, and Humerus.

Constrained total hip megaprosthesis for primary periacetabular tumors.

What Are the Long-term Results of MUTARS® Modular Endoprostheses for Reconstruction of Tumor Resection of the Distal Femur and Proximal Tibia?

Reconstruction After Hemipelvectomy With the Ice-Cream Cone Prosthesis: What Are the Short-term Clinical Results?

Acetabular Reconstruction With Femoral Head Autograft After Intraarticular Resection of Periacetabular Tumors is Durable at Short-term Followup.

Authors

Mayor MeshTerms

Hip Prosthesis

Osteotomy

Keywords
Journal Title clinical orthopaedics and related research
Publication Year Start




PMID- 27020434
OWN - NLM
STAT- MEDLINE
DCOM- 20170320
LR  - 20170817
IS  - 1528-1132 (Electronic)
IS  - 0009-921X (Linking)
VI  - 475
IP  - 3
DP  - 2017 Mar
TI  - LUMiC((R)) Endoprosthetic Reconstruction After Periacetabular Tumor Resection:
      Short-term Results.
PG  - 686-695
LID - 10.1007/s11999-016-4805-4 [doi]
AB  - BACKGROUND: Reconstruction of periacetabular defects after pelvic tumor resection
      ranks among the most challenging procedures in orthopaedic oncology, and
      reconstructive techniques are generally associated with dissatisfying mechanical 
      and nonmechanical complication rates. In an attempt to reduce the risk of
      dislocation, aseptic loosening, and infection, we introduced the LUMiC((R))
      prosthesis (implantcast, Buxtehude, Germany) in 2008. The LUMiC((R)) prosthesis
      is a modular device, built of a separate stem (hydroxyapatite-coated uncemented
      or cemented) and acetabular cup. The stem and cup are available in different
      sizes (the latter of which is also available with silver coating for infection
      prevention) and are equipped with sawteeth at the junction to allow for
      rotational adjustment of cup position after implantation of the stem. Whether
      this implant indeed is durable at short-term followup has not been evaluated.
      QUESTIONS/PURPOSES: (1) What proportion of patients experience mechanical
      complications and what are the associated risk factors of periacetabular
      reconstruction with the LUMiC((R)) after pelvic tumor resection? (2) What
      proportion of patients experience nonmechanical complications and what are the
      associated risk factors of periacetabular reconstruction with the LUMiC((R))
      after pelvic tumor resection? (3) What is the cumulative incidence of implant
      failure at 2 and 5 years and what are the mechanisms of reconstruction failure?
      (4) What is the functional outcome as assessed by Musculoskeletal Tumor Society
      (MSTS) score at final followup? METHODS: We performed a retrospective chart
      review of every patient in whom a LUMiC((R)) prosthesis was used to reconstruct a
      periacetabular defect after internal hemipelvectomy for a pelvic tumor from July 
      2008 to June 2014 in eight centers of orthopaedic oncology with a minimum
      followup of 24 months. Forty-seven patients (26 men [55%]) with a mean age of 50 
      years (range, 12-78 years) were included. At review, 32 patients (68%) were
      alive. The reverse Kaplan-Meier method was used to calculate median followup,
      which was equal to 3.9 years (95% confidence interval [CI], 3.4-4.3). During the 
      period under study, our general indications for using this implant were
      reconstruction of periacetabular defects after pelvic tumor resections in which
      the medial ilium adjacent to the sacroiliac joint was preserved; alternative
      treatments included hip transposition and saddle or custom-made prostheses in
      some of the contributing centers; these were generally used when the medial ilium
      was involved in the tumorous process or if the LUMiC((R)) was not yet available
      in the specific country at that time. Conventional chondrosarcoma was the
      predominant diagnosis (n = 22 [47%]); five patients (11%) had osseous metastases 
      of a distant carcinoma and three (6%) had multiple myeloma. Uncemented fixation
      (n = 43 [91%]) was preferred. Dual-mobility cups (n = 24 [51%]) were mainly used 
      in case of a higher presumed risk of dislocation in the early period of our
      study; later, dual-mobility cups became the standard for the majority of the
      reconstructions. Silver-coated acetabular cups were used in 29 reconstructions
      (62%); because only the largest cup size was available with silver coating, its
      use depended on the cup size that was chosen. We used a competing risk model to
      estimate the cumulative incidence of implant failure. RESULTS: Six patients (13%)
      had a single dislocation; four (9%) had recurrent dislocations. The risk of
      dislocation was lower in reconstructions with a dual-mobility cup (one of 24
      [4%]) than in those without (nine of 23 [39%]) (hazard ratio, 0.11; 95% CI,
      0.01-0.89; p = 0.038). Three patients (6%; one with a preceding structural
      allograft reconstruction, one with poor initial fixation as a result of an
      intraoperative fracture, and one with a cemented stem) had loosening and
      underwent revision. Infections occurred in 13 reconstructions (28%). Median
      duration of surgery was 6.5 hours (range, 4.0-13.6 hours) for patients with an
      infection and 5.3 hours (range, 2.8-9.9 hours) for those without (p = 0.060);
      blood loss was 2.3 L (range, 0.8-8.2 L) for patients with an infection and 1.5 L 
      (range, 0.4-3.8 L) for those without (p = 0.039). The cumulative incidences of
      implant failure at 2 and 5 years were 2.1% (95% CI, 0-6.3) and 17.3% (95% CI,
      0.7-33.9) for mechanical reasons and 6.4% (95% CI, 0-13.4) and 9.2% (95% CI,
      0.5-17.9) for infection, respectively. Reasons for reconstruction failure were
      instability (n = 1 [2%]), loosening (n = 3 [6%]), and infection (n = 4 [9%]).
      Mean MSTS functional outcome score at followup was 70% (range, 33%-93%).
      CONCLUSIONS: At short-term followup, the LUMiC((R)) prosthesis demonstrated a low
      frequency of mechanical complications and failure when used to reconstruct the
      acetabulum in patients who underwent major pelvic tumor resections, and we
      believe this is a useful reconstruction for periacetabular resections for tumor
      or failed prior reconstructions. Still, infection and dislocation are relatively 
      common after these complex reconstructions. Dual-mobility articulation in our
      experience is associated with a lower risk of dislocation. Future, larger studies
      will need to further control for factors such as dual-mobility articulation and
      silver coating. We will continue to follow our patients over the longer term to
      ascertain the role of this implant in this setting. LEVEL OF EVIDENCE: Level IV, 
      therapeutic study.
FAU - Bus, Michael P A
AU  - Bus MP
AUID- ORCID: http://orcid.org/0000-0003-0023-6016
AD  - Department of Orthopaedic Surgery, Leiden University Medical Center, Albinusdreef
      2, 2300, RC Leiden, The Netherlands. [email protected]
FAU - Szafranski, Andrzej
AU  - Szafranski A
AD  - Institute of Mother & Child, Warsaw, Poland.
FAU - Sellevold, Simen
AU  - Sellevold S
AD  - Oslo University Hospital, Oslo, Norway.
FAU - Goryn, Tomasz
AU  - Goryn T
AD  - Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, 
      Poland.
FAU - Jutte, Paul C
AU  - Jutte PC
AD  - University Medical Center Groningen, Groningen, The Netherlands.
FAU - Bramer, Jos A M
AU  - Bramer JA
AD  - Academic Medical Center, Amsterdam, The Netherlands.
FAU - Fiocco, M
AU  - Fiocco M
AD  - Department of Medical Statistics and Bioinformatics, Leiden University Medical
      Center, Leiden, The Netherlands.
AD  - Mathematical Institute, Leiden University, Leiden, The Netherlands.
FAU - Streitburger, Arne
AU  - Streitburger A
AD  - Universitatsklinikum Munster, Munster, Germany.
FAU - Kotrych, Daniel
AU  - Kotrych D
AD  - Pomeranian Medical University, Szczecin, Poland.
FAU - van de Sande, Michiel A J
AU  - van de Sande MA
AD  - Department of Orthopaedic Surgery, Leiden University Medical Center, Albinusdreef
      2, 2300, RC Leiden, The Netherlands.
FAU - Dijkstra, P D Sander
AU  - Dijkstra PD
AD  - Department of Orthopaedic Surgery, Leiden University Medical Center, Albinusdreef
      2, 2300, RC Leiden, The Netherlands.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PL  - United States
TA  - Clin Orthop Relat Res
JT  - Clinical orthopaedics and related research
JID - 0075674
SB  - AIM
SB  - IM
CIN - Clin Orthop Relat Res. 2017 Mar;475(3):696-697. PMID: 27116207
MH  - Acetabulum/diagnostic imaging/pathology/physiopathology/*surgery
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Arthroplasty, Replacement, Hip/adverse effects/*instrumentation
MH  - Biomechanical Phenomena
MH  - Bone Neoplasms/diagnostic imaging/pathology/*surgery
MH  - Chi-Square Distribution
MH  - Child
MH  - Europe
MH  - Female
MH  - Hip Dislocation/etiology/prevention & control
MH  - Hip Joint/diagnostic imaging/pathology/physiopathology/*surgery
MH  - *Hip Prosthesis/adverse effects
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Male
MH  - Middle Aged
MH  - Odds Ratio
MH  - *Osteotomy/adverse effects
MH  - Pelvic Neoplasms/diagnostic imaging/pathology/*surgery
MH  - Proportional Hazards Models
MH  - Prosthesis Design
MH  - Prosthesis Failure
MH  - Prosthesis-Related Infections/microbiology/prevention & control
MH  - Recovery of Function
MH  - Registries
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Time Factors
MH  - Tomography, X-Ray Computed
MH  - Treatment Outcome
MH  - Young Adult
PMC - PMC5289170
EDAT- 2016/03/30 06:00
MHDA- 2017/03/21 06:00
CRDT- 2016/03/30 06:00
PHST- 2016/03/30 06:00 [pubmed]
PHST- 2017/03/21 06:00 [medline]
PHST- 2016/03/30 06:00 [entrez]
AID - 10.1007/s11999-016-4805-4 [doi]
AID - 10.1007/s11999-016-4805-4 [pii]
PST - ppublish
SO  - Clin Orthop Relat Res. 2017 Mar;475(3):686-695. doi: 10.1007/s11999-016-4805-4.