Abstract
Background
Orthopedic oncology has evolved over the past few decades to favor limb salvage over amputations. The noninvasive expandable prosthesis can be lengthened with an externally applied magnetic field eliminating the pain, stiffness, as well as the risk of infection. We present the largest series in Indian experience with this implant over the last 8 years while analyzing its benefit to the surgeons and the patients, but are we able to justify the cost effectiveness?
Materials and Methods
Eighteen implants were used in 16 patients with nonmetastatic primary bone sarcoma from May 2006 to June 2015. All implants were manufactured by Stanmore implants worldwide based in London, UK. Lengthening was done in the outpatient department during the followup visits using an external electromagnetic coil. The function was assessed using the musculoskeletal tumor society (MSTS) score.
Results
The patients had a mean age of 10.25 years at the time of surgery. The mean followup was 49.56 months. Twelve patients are alive at a followup after surgery. The prostheses were lengthened by a mean of 31.64 mm and average lengthening per session was 4.18 mm. The mean MSTS score was 28.83. Two revisions for jammed mechanism and two patients had a successful two-stage revision for delayed infection.
Conclusion
The noninvasive expandable prosthesis is an ideal implant for children undergoing limb salvage surgery for bone sarcoma who are expected to have more than 3 cm of limb length discrepancy at maturity. The initial high cost compared to a minimally invasive expandable implant can be recovered as there is no additional cost of lengthening. The small amounts of lengthening at more frequent intervals is more physiological as compared with the minimally invasive type where more lengthening is done to minimize the number of procedures. While the functional and oncological outcomes are comparable, this implant allows limb lengths to be maintained without pain, functional compromise or risk of infection.
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References
Lewis MM. The use of an expandable and adjustable prosthesis in the treatment of childhood malignant bone tumors of the extremity. Cancer 1986;57:499–502.
Link MP, Goorin AM, Miser AW, Green AA, Pratt CB, Belasco JB, et al. The effect of adjuvant chemotherapy on relapse-free survival in patients with osteosarcoma of the extremity. N Engl J Med 1986;314:1600–6.
Lewis MM, Bloom N, Esquieres EM, Kenan S, Ryniker DM. The expandable prosthesis. An alternative to amputation for children with malignant bone tumors. AORN J 1987;46:457–70.
Rougraff BT, Simon MA, Kneisl JS, Greenberg DB, Mankin HJ. Limb salvage compared with amputation for osteosarcoma of the distal end of the femur. A long-term oncological, functional, and quality-of-life study. J Bone Joint Surg Am 1994;76:649–56.
Schindler OS, Cannon SR, Briggs TW, Blunn GW, Grimer RJ, Walker PS. Use of extendable total femoral replacements in children with malignant bone tumors. Clin Orthop Relat Res 1998;357:157–70.
Krieg AH, Lenze U, Speth BM, Hasler CC. Intramedullary leg lengthening with a motorized nail. Acta Orthop 2011;82:344–50.
Eckardt JJ, Kabo JM, Kelley CM, Ward WG Sr, Asavamongkolkul A, Wirganowicz PZ, et al. Expandable endoprosthesis reconstruction in skeletally immature patients with tumors. Clin Orthop Relat Res 2000;373:51–61.
Eckardt JJ, Safran MR, Eilber FR, Rosen G, Kabo JM. Expandable endoprosthetic reconstruction of the skeletally immature after malignant bone tumor resection. Clin Orthop Relat Res 1993;297:188–202.
Gupta A, Meswania J, Pollock R, Cannon SR, Briggs TW, Taylor S, et al. Non-invasive distal femoral expandable endoprosthesis for limb-salvage surgery in paediatric tumours. J Bone Joint Surg Br 2006;88:649–54.
Pramesh CS, Deshpande MS, Pardiwala DN, Agarwal MG, Puri A. Core needle biopsy for bone tumours. Eur J Surg Oncol 2001;27:668–71.
Enneking WF. A system of staging musculoskeletal neoplasms. Clin Orthop Relat Res 1986;204:9–24.
Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res 1993;286:241–6.
Implants Information. Available from: http://www.stanmoreimplants.com. [Last accessed on 2016 Jan].
Simon MA, Aschliman MA, Thomas N, Mankin HJ. Limb-salvage treatment versus amputation for osteosarcoma of the distal end of the femur 1986. J Bone Joint Surg Am 2005;87:2822.
Wilkins RM, Soubeiran A. The Phenix expandable prosthesis: Early American experience. Clin Orthop Relat Res 2001;382:51–8.
Gitelis S, Neel MD, Wilkins RM, Rao BN, Kelly CM, Yao TK. The use of a closed expandable prosthesis for pediatric sarcomas. Chir Organi Mov 2003;88:327–33.
Neel MD, Wilkins RM, Rao BN, Kelly CM. Early multicenter experience with a noninvasive expandable prosthesis. Clin Orthop Relat Res 2003;415:72–81.
Baumgart R, Betz A, Schweiberer L. A fully implantable motorized intramedullary nail for limb lengthening and bone transport. Clin Orthop Relat Res 1997;415:135–43.
Geesink RG, de Groot K, Klein CP. Bonding of bone to apatite-coated implants. J Bone Joint Surg Br 1988;70:17–22.
FP Implant. FDA approves minimally invasive extendible implant system from UK developer. J Clin Eng 2011;36:150.
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Gundavda, M.K., Agarwal, M.G. Growing Without Pain: The Noninvasive Expandable Prosthesis is Boon for Children with Bone Cancer, as well as Their Surgeons!. JOIO 53, 174–182 (2019). https://doi.org/10.4103/ortho.IJOrtho_53_17
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DOI: https://doi.org/10.4103/ortho.IJOrtho_53_17