Artikel
Outcomes of noninvasive expandable endoprostheses for malignant bone tumors in skeletally immature patients: Can dummy-prosthesis be a good surgical alternative?
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Autoren
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Recep Öztürk
- Klinik für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Essen, Germany
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Arne Streitbürger
- Klinik für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Essen, Germany
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Jendrik Hardes
- Klinik für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Essen, Germany
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Wiebke Guder
- Klinik für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Essen, Germany
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Lars E. Podleska
- Klinik für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Essen, Germany
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Markus Nottrott
- Klinik für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Essen, Germany
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Nina Myline Engel
- Klinik für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Essen, Germany
| Veröffentlicht: | 21. Oktober 2024 |
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Gliederung
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Objectives: In the two-stage lengthening approach with expandable prostheses, a functional motor is not placed at index surgery, but instead a placeholder (dummy) with the same dimensions as the motor is placed. In this study, it was planned to investigate the effect of using dummy in index surgery on the management of these cases.
Methods: The data of a total of 30 patients, with an average age of 9.7 years, who underwent reconstruction with expandable prosthesis between 2010 and 2023, were analyzed retrospectively. While the prosthesis was applied with a motor in 9 patients (group I), a dummy-prosthesis was used in the first surgery in 21 patients. A motor was implanted in 8 of these cases at an average of 52 months (group II). In 6 of these surgeries, motor implantation was during revision surgery (3 for mechanical complicatin, 1 two stage revision of infection, and 2 for arthrofibrosis). Thirteen cases are still under follow-up with dummy (group III).
Results and conclusion: The mean follow-up periods of groups were 45, 104 and 27 months, respectively.A total of 7 and 5 cases in groups 1 and 2 had an average lengthening of 3 and 6 cm, respectively. Two cases in each group could not be extended due to engine failure. Surgery was performed due to 3 (33%) (all mechanical), 6 (%75) (3 mechanical, 3 infection) and 4 (31%) (all mechanical) complications in the groups, respectively. Limb inequality over than 2 cm was present in 3, 4, and 4 patients in the groups, at the last follow-up, respectively.
The addition of motors to some of the complicated dummy cases during revision and the much longer follow-up period of group 2 seem to have made the complication rate of this group relatively high. However, deep infections were only present in this group. While it is clear that expandable prostheses are one of the best options for eliminating limb inequality in patients with unclosed physes, dummy-prosthesis appears to be an important additional option that contributes to the management of these challenging cases. The use of dummy at index surgery seems to have similar extension success as the use of a direct motor, and it has the advantage of ensuring that an expensive motor can be used only when needed. However, additional surgery for motor addition may increase the risk of infection.
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