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The use of a non-invasive extendable prosthesis at the time of revision arthroplasty.

Abstract Aims The use of a noninvasive growing endoprosthesis in the management of primary bone tumours in children is well established. However, the efficacy of such a prosthesis in those requiring a revision procedure has yet to be established. The aim of this series was to present our results using extendable prostheses for the revision of previous endoprostheses. Patients and Methods All patients who had a noninvasive growing endoprosthesis inserted at the time of a revision procedure were identified from our database. A total of 21 patients (seven female patients, 14 male) with a mean age of 20.4 years (10 to 41) at the time of revision were included. The indications for revision were mechanical failure, trauma or infection with a residual leg-length discrepancy. The mean follow-up was 70 months (17 to 128). The mean shortening prior to revision was 44 mm (10 to 100). Lengthening was performed in all but one patient with a mean lengthening of 51 mm (5 to 140). Results The mean residual leg length discrepancy at final follow-up of 15 mm (1 to 35). Two patients developed a deep periprosthetic infection, of whom one required amputation to eradicate the infection; the other required two-stage revision. Implant survival according to Henderson criteria was 86% at two years and 72% at five years. When considering revision for any cause (including revision of the growing prosthesis to a non-growing prosthesis), revision-free implant survival was 75% at two years, but reduced to 55% at five years. Conclusion Our experience indicates that revision surgery using a noninvasive growing endoprosthesis is a successful option for improving leg length discrepancy and should be considered in patients with significant leg-length discrepancy requiring a revision procedure. Cite this article: Bone Joint J 2018;100-B:370-7.
PMID
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Authors

Mayor MeshTerms

Leg

Prostheses and Implants

Keywords

Endoprosthesis

Expandible

Extendable

Growing

Leg length

Lengthening

Noninvasive

Revision

Sarcoma

Journal Title the bone & joint journal
Publication Year Start




PMID- 29589498
OWN - NLM
STAT- MEDLINE
DCOM- 20180402
LR  - 20180402
IS  - 2049-4408 (Electronic)
IS  - 2049-4394 (Linking)
VI  - 100-B
IP  - 3
DP  - 2018 Mar 1
TI  - The use of a non-invasive extendable prosthesis at the time of revision
      arthroplasty.
PG  - 370-377
LID - 10.1302/0301-620X.100B3.BJJ-2017-0651.R1 [doi]
AB  - Aims The use of a noninvasive growing endoprosthesis in the management of primary
      bone tumours in children is well established. However, the efficacy of such a
      prosthesis in those requiring a revision procedure has yet to be established. The
      aim of this series was to present our results using extendable prostheses for the
      revision of previous endoprostheses. Patients and Methods All patients who had a 
      noninvasive growing endoprosthesis inserted at the time of a revision procedure
      were identified from our database. A total of 21 patients (seven female patients,
      14 male) with a mean age of 20.4 years (10 to 41) at the time of revision were
      included. The indications for revision were mechanical failure, trauma or
      infection with a residual leg-length discrepancy. The mean follow-up was 70
      months (17 to 128). The mean shortening prior to revision was 44 mm (10 to 100). 
      Lengthening was performed in all but one patient with a mean lengthening of 51 mm
      (5 to 140). Results The mean residual leg length discrepancy at final follow-up
      of 15 mm (1 to 35). Two patients developed a deep periprosthetic infection, of
      whom one required amputation to eradicate the infection; the other required
      two-stage revision. Implant survival according to Henderson criteria was 86% at
      two years and 72% at five years. When considering revision for any cause
      (including revision of the growing prosthesis to a non-growing prosthesis),
      revision-free implant survival was 75% at two years, but reduced to 55% at five
      years. Conclusion Our experience indicates that revision surgery using a
      noninvasive growing endoprosthesis is a successful option for improving leg
      length discrepancy and should be considered in patients with significant
      leg-length discrepancy requiring a revision procedure. Cite this article: Bone
      Joint J 2018;100-B:370-7.
FAU - Gilg, M M
AU  - Gilg MM
AD  - Department of Orthopedic Surgery and Trauma, Medical University of Graz,
      Auenbruggerplatz 5, 8036 Graz, Austria.
FAU - Gaston, C L
AU  - Gaston CL
AD  - Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK and The
      Department of Orthopedics, Philippine General Hospital, Manila Taft Avenue,
      Manila, 1000, Philippines.
FAU - Jeys, L
AU  - Jeys L
AD  - Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, United
      Kingdom.
FAU - Abudu, A
AU  - Abudu A
AD  - Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, United
      Kingdom.
FAU - Tillman, R M
AU  - Tillman RM
AD  - Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, United
      Kingdom.
FAU - Stevenson, J D
AU  - Stevenson JD
AD  - Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, United
      Kingdom.
FAU - Grimer, R J
AU  - Grimer RJ
AD  - Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, United
      Kingdom.
FAU - Parry, M C
AU  - Parry MC
AD  - Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP, United
      Kingdom.
LA  - eng
PT  - Journal Article
PL  - England
TA  - Bone Joint J
JT  - The bone & joint journal
JID - 101599229
SB  - AIM
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Amputation
MH  - Bone Neoplasms/*surgery
MH  - Child
MH  - Female
MH  - Humans
MH  - *Leg
MH  - Leg Length Inequality
MH  - Male
MH  - Postoperative Complications
MH  - Prospective Studies
MH  - *Prostheses and Implants
MH  - Prosthesis Design
MH  - Prosthesis Implantation/*methods
MH  - Reoperation
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Endoprosthesis
OT  - Expandible
OT  - Extendable
OT  - Growing
OT  - Leg length
OT  - Lengthening
OT  - Noninvasive
OT  - Revision
OT  - Sarcoma
EDAT- 2018/03/29 06:00
MHDA- 2018/04/03 06:00
CRDT- 2018/03/29 06:00
PHST- 2018/03/29 06:00 [entrez]
PHST- 2018/03/29 06:00 [pubmed]
PHST- 2018/04/03 06:00 [medline]
AID - 10.1302/0301-620X.100B3.BJJ-2017-0651.R1 [doi]
PST - ppublish
SO  - Bone Joint J. 2018 Mar 1;100-B(3):370-377. doi:
      10.1302/0301-620X.100B3.BJJ-2017-0651.R1.