YANMing , WANGBaocang , LIYong , WANGHui , LUQiang , ZHOUYueshuang
  • Department of Osteopathy, the Second Hospital of Tangshan(North China University of Science and Technology Affiliated Orthopedic Hospital), Tangshan Hebei, 063000, P. R. China;
WANGBaocang, Email: tshwangbaocang@163.com
Osteosarcoma; Extensible semi-joint prosthesis; Complication; Limb salvage surgery; Children
10.7507/1002-1892.20150260
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Objective To investigate the causes of the complications and prevention strategy by analyzing occurrence of prosthesis-related complications after extensible semi-joint prosthesis replacement for lower limbs osteosarcoma in children. Methods Eleven children with lower limbs osteosarcoma underwent resection of tumor and replacement of the extensible semi-joint prosthesis between May 2006 and October 2012. There were 6 boys and 5 girls, with an average age of 9.3 years (range, 7-12 years). The lesions located at the distal femur in 6 cases, at the proximal femur in 2 cases, and at the proximal tibia in 3 cases. The disease duration was 2-8 months (mean, 3.6 months). According to the Enneking stage, 3 cases were rated as stage ⅡA and 8 cases as stage ⅡB. The pulmonary CT and ECT results showed no pulmonary metastasis or multi spots before operation. All patients received preoperative chemotherapy treatment for 4 times. Results Primary healing of incision was obtained in 10 cases. Infection occurred in 1 case at 1 week after operation, and was cured after symptomatic treatment. Nine patients received postoperative chemotherapy for 12 times, 2 patients for 2 times and 4 times respectively. One case died of multiple metastasis; in 3 cases of pulmonary metastasis, 2 cases died and 1 case survived after resection of metastatic lesion. Eight survival cases received a follow-up of 25-89 months (mean, 42.5 months). Loosening and dislocation of the proximal femoral prosthesis occurred in 1 case, loosening and subsidence of the distal femoral prosthesis in 1 case, subluxation in 1 case, and retraction in 1 case. The incidence of prosthesis-related complications was 50%. Lengthening operation was performed on 3 cases for 1 time, and on 1 case for 2 times. And 4 cases did not undergo lengthening operation. According to Enneking function evaluation standard after malignant tumor limb-salvage surgery, the results were excellent in 1 case, good in 3, fair in 3, and poor in 1 at last follow-up with an excellent and good rate of 50%. Conclusion The prosthesis-related complications include loosening and subsidence, dislocation, knee instability, and retraction after extensible semi-joint prosthesis replacement for lower limbs osteosarcoma. The prosthesis-related complications can be reduced by the improvement of prosthesis design and manufacture, and the use of intraoperative bone cement, artificial mesh, and postoperative restrictive brace.

Citation： YANMing, WANGBaocang, LIYong, WANGHui, LUQiang, ZHOUYueshuang. ANALYSIS OF PROSTHESIS-RELATED COMPLICATIONS AFTER EXTENSIBLE SEMI-JOINT PROSTHESIS REPLACEMENT FOR LOWER LIMBS OSTEOSARCOMA IN CHILDREN. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(10): 1194-1198. doi: 10.7507/1002-1892.20150260 Copy

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