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Hip-preserving reconstruction using a customized cemented femoral endoprosthesis with a curved stem in patients with short proximal femur segments: Mid-term follow-up outcomes

BACKGROUND: Short metaphyseal segments that remain following extensive distal femoral tumor resection can be challenging to manage, as the residual short segments may not be sufficient to accept an intramedullary cemented stem of standard length. The present study was developed to detail preliminary...

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Autores principales: You, Qi, Lu, Minxun, Min, Li, Zhang, Yuqi, Luo, Yi, Zhou, Yong, Tu, Chongqi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9632978/
https://www.ncbi.nlm.nih.gov/pubmed/36338613
http://dx.doi.org/10.3389/fsurg.2022.991168
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author You, Qi
Lu, Minxun
Min, Li
Zhang, Yuqi
Luo, Yi
Zhou, Yong
Tu, Chongqi
author_facet You, Qi
Lu, Minxun
Min, Li
Zhang, Yuqi
Luo, Yi
Zhou, Yong
Tu, Chongqi
author_sort You, Qi
collection PubMed
description BACKGROUND: Short metaphyseal segments that remain following extensive distal femoral tumor resection can be challenging to manage, as the residual short segments may not be sufficient to accept an intramedullary cemented stem of standard length. The present study was developed to detail preliminary findings and experiences associated with an intra-neck curved stem (INCS) reconstructive approach, with a particular focus on mechanical stability. METHOD: From March 2013 to August 2016, 11 total patients underwent reconstructive procedures using a customized cemented femoral endoprosthesis (CCFE) with an INCS. Measurements of femoral neck-shaft angle values were made before and after this procedure. Radiological outcomes associated with this treatment strategy over an average 63-month follow-up period were additionally assessed. Functionality was assessed based upon Musculoskeletal Tumor Society (MSTS) scores, while a visual analog scale (VAS) was used to rate pre- and postoperative pain, and any complications were noted. RESULTS: Relative to the preoperative design, no significant differences in femoral neck–shaft angle were observed after this reconstructive procedure (p = 0.410). Postoperatively, the tip of the stem was primarily positioned within the middle third of the femoral head in both lateral and posterior-anterior radiographic, supporting the accuracy of INCS positioning. The average MSTS score for these patients was 25 (range: 21–28), and VAS scores were significantly reduced after surgery (p < 0.0001). One patient exhibited local disease recurrence and ultimately succumbed to lung metastases, while two patients exhibited aseptic loosening. None of the treated patients exhibited complications such as infections, periprosthetic fractures, or prosthetic fractures as of most recent follow-up. CONCLUSION: CCFE with an INCS represents a viable approach to massive femoral diaphyseal defect with short proximal femur repair, as patients can achieve good functional outcomes and early weight-bearing with proper individualized rehabilitative interventions, all while exhibiting low rates of procedure-related complications.
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spelling pubmed-96329782022-11-04 Hip-preserving reconstruction using a customized cemented femoral endoprosthesis with a curved stem in patients with short proximal femur segments: Mid-term follow-up outcomes You, Qi Lu, Minxun Min, Li Zhang, Yuqi Luo, Yi Zhou, Yong Tu, Chongqi Front Surg Surgery BACKGROUND: Short metaphyseal segments that remain following extensive distal femoral tumor resection can be challenging to manage, as the residual short segments may not be sufficient to accept an intramedullary cemented stem of standard length. The present study was developed to detail preliminary findings and experiences associated with an intra-neck curved stem (INCS) reconstructive approach, with a particular focus on mechanical stability. METHOD: From March 2013 to August 2016, 11 total patients underwent reconstructive procedures using a customized cemented femoral endoprosthesis (CCFE) with an INCS. Measurements of femoral neck-shaft angle values were made before and after this procedure. Radiological outcomes associated with this treatment strategy over an average 63-month follow-up period were additionally assessed. Functionality was assessed based upon Musculoskeletal Tumor Society (MSTS) scores, while a visual analog scale (VAS) was used to rate pre- and postoperative pain, and any complications were noted. RESULTS: Relative to the preoperative design, no significant differences in femoral neck–shaft angle were observed after this reconstructive procedure (p = 0.410). Postoperatively, the tip of the stem was primarily positioned within the middle third of the femoral head in both lateral and posterior-anterior radiographic, supporting the accuracy of INCS positioning. The average MSTS score for these patients was 25 (range: 21–28), and VAS scores were significantly reduced after surgery (p < 0.0001). One patient exhibited local disease recurrence and ultimately succumbed to lung metastases, while two patients exhibited aseptic loosening. None of the treated patients exhibited complications such as infections, periprosthetic fractures, or prosthetic fractures as of most recent follow-up. CONCLUSION: CCFE with an INCS represents a viable approach to massive femoral diaphyseal defect with short proximal femur repair, as patients can achieve good functional outcomes and early weight-bearing with proper individualized rehabilitative interventions, all while exhibiting low rates of procedure-related complications. Frontiers Media S.A. 2022-09-22 /pmc/articles/PMC9632978/ /pubmed/36338613 http://dx.doi.org/10.3389/fsurg.2022.991168 Text en © 2022 You, Lu, Min, Zhang, Luo, Zhou and Tu. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Surgery
You, Qi
Lu, Minxun
Min, Li
Zhang, Yuqi
Luo, Yi
Zhou, Yong
Tu, Chongqi
Hip-preserving reconstruction using a customized cemented femoral endoprosthesis with a curved stem in patients with short proximal femur segments: Mid-term follow-up outcomes
title Hip-preserving reconstruction using a customized cemented femoral endoprosthesis with a curved stem in patients with short proximal femur segments: Mid-term follow-up outcomes
title_full Hip-preserving reconstruction using a customized cemented femoral endoprosthesis with a curved stem in patients with short proximal femur segments: Mid-term follow-up outcomes
title_fullStr Hip-preserving reconstruction using a customized cemented femoral endoprosthesis with a curved stem in patients with short proximal femur segments: Mid-term follow-up outcomes
title_full_unstemmed Hip-preserving reconstruction using a customized cemented femoral endoprosthesis with a curved stem in patients with short proximal femur segments: Mid-term follow-up outcomes
title_short Hip-preserving reconstruction using a customized cemented femoral endoprosthesis with a curved stem in patients with short proximal femur segments: Mid-term follow-up outcomes
title_sort hip-preserving reconstruction using a customized cemented femoral endoprosthesis with a curved stem in patients with short proximal femur segments: mid-term follow-up outcomes
topic Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9632978/
https://www.ncbi.nlm.nih.gov/pubmed/36338613
http://dx.doi.org/10.3389/fsurg.2022.991168
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