Skip to main content
SpringerLink
Log in
Book cover

Management of Bone Metastases pp 191–211Cite as

Management of Fractures and Failures Around Tumor Implants

  • Chapter
  • First Online:

  • 787 Accesses

Abstract

As more patients with skeletal metastases live longer, many implants are at risk for mechanical failure and for tumor progression in the face of previous treatment. The causes for and treatment options available to failed cases have received some attention in the literature, but few papers suggested what surgery was the best. Failures around tumor implants can be mechanical and not mechanical. The first include dislocation, soft tissue defect, wound dehiscence, aseptic loosening, and fractures, whereas the second infections and disease progression. For all types of failure, different strategies of treatment are described.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Laitinen M, Parry M, Ratasvuori M, Wedin R, Albergo JI, Jeys L, et al. Survival and complications of skeletal reconstructions after surgical treatment of bony metastatic renal cell carcinoma. Eur J Surg Oncol. 2015;41(7):886–92.

    Article  CAS  PubMed  Google Scholar 

  2. Guzik G. Results of the treatment of bone metastases with modular prosthetic replacement—analysis of 67 patients. J Orthop Surg. 2016;11:20.

    Article  Google Scholar 

  3. Sørensen MS, Gregersen KG, Grum-Schwensen T, Hovgaard D, Petersen MM. Patient and implant survival following joint replacement because of metastatic bone disease. Acta Orthop. 2013;84(3):301–6.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Forsberg JA, Wedin R, Bauer H. Which implant is best after failed treatment for pathologic femur fractures? Clin Orthop. 2013;471(3):735–40.

    Article  PubMed  Google Scholar 

  5. Henrichs M-P, Krebs J, Gosheger G, Streitbuerger A, Nottrott M, Sauer T, et al. Modular tumor endoprostheses in surgical palliation of long-bone metastases: a reduction in tumor burden and a durable reconstruction. World J Surg Oncol. 2014;12:330.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Tanaka T, Imanishi J, Charoenlap C, Choong PFM. Intramedullary nailing has sufficient durability for metastatic femoral fractures. World J Surg Oncol. 2016;14:80.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Henderson ER, Groundland JS, Pala E, Dennis JA, Wooten R, Cheong D, et al. Failure mode classification for tumor endoprostheses: retrospective review of five institutions and a literature review. J Bone Joint Surg Am. 2011;93(5):418–29.

    Article  PubMed  Google Scholar 

  8. Wedin R, Hansen BH, Laitinen M, Trovik C, Zaikova O, Bergh P, et al. Complications and survival after surgical treatment of 214 metastatic lesions of the humerus. J Shoulder Elbow Surg. 2012;21(8):1049–55.

    Article  PubMed  Google Scholar 

  9. Capanna R, Scoccianti G, Frenos F, Vilardi A, Beltrami G, Campanacci DA. What was the survival of megaprostheses in lower limb reconstructions after tumor resections? Clin Orthop. 2015;473(3):820–30.

    Article  PubMed  Google Scholar 

  10. Pala E, Henderson ER, Calabrò T, Angelini A, Abati CN, Trovarelli G, et al. Survival of current production tumor endoprostheses: complications, functional results, and a comparative statistical analysis. J Surg Oncol. 2013;108(6):403–8.

    Article  CAS  PubMed  Google Scholar 

  11. Steensma M, Boland PJ, Morris CD, Athanasian E, Healey JH. Endoprosthetic treatment is more durable for pathologic proximal femur fractures. Clin Orthop. 2012;470(3):920–6.

    Article  PubMed  Google Scholar 

  12. Laitinen M, Nieminen J, Pakarinen T-K. Treatment of pathological humerus shaft fractures with intramedullary nails with or without cement fixation. Arch Orthop Trauma Surg. 2011;131(4):503–8.

    Article  PubMed  Google Scholar 

  13. Kostuj T, Streit R, Baums MH, Schaper K, Meurer A. Midterm outcome after mega-prosthesis implanted in patients with bony defects in cases of revision compared to patients with malignant tumors. J Arthroplast. 2015;30(9):1592–6.

    Article  Google Scholar 

  14. Thambapillary S, Dimitriou R, Makridis KG, Fragkakis EM, Bobak P, Giannoudis PV. Implant longevity, complications and functional outcome following proximal femoral arthroplasty for musculoskeletal tumors: a systematic review. J Arthroplast. 2013;28(8):1381–5.

    Article  Google Scholar 

  15. Alvi HM, Damron TA. Prophylactic stabilization for bone metastases, myeloma, or lymphoma: do we need to protect the entire bone? Clin Orthop. 2013;471(3):706–14.

    Article  PubMed  Google Scholar 

  16. Wedin R, Bauer HCF. Surgical treatment of skeletal metastatic lesions of the proximal femur: endoprosthesis or reconstruction nail? J Bone Joint Surg Br. 2005;87(12):1653–7.

    Article  CAS  PubMed  Google Scholar 

  17. Shehadeh A, Noveau J, Malawer M, Henshaw R. Late complications and survival of endoprosthetic reconstruction after resection of bone tumors. Clin Orthop. 2010;468(11):2885–95.

    Article  PubMed  Google Scholar 

  18. Hettwer WH, Horstmann PF, Hovgaard TB, Grum-Scwensen TA, Petersen MM. Low infection rate after tumor hip arthroplasty for metastatic bone disease in a cohort treated with extended antibiotic prophylaxis. Adv Orthop. 2015;2015:428986.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Jacofsky DJ, Haidukewych GJ, Zhang H, Sim FH. Complications and results of arthroplasty for salvage of failed treatment of malignant pathologic fractures of the hip. Clin Orthop. 2004;427:52–6.

    Article  Google Scholar 

  20. Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Barut N, Anract P, Babinet A, Biau D. Peri-prosthetic fractures around tumor endoprostheses: a retrospective analysis of eighteen cases. Int Orthop. 2015;39(9):1851–6.

    Article  PubMed  Google Scholar 

  22. Capanna R, Campanacci DA. The treatment of metastases in the appendicular skeleton. J Bone Joint Surg Br. 2001;83(4):471–81.

    Article  CAS  PubMed  Google Scholar 

  23. Fakler JK, Hase F, Böhme J, Josten C. Safety aspects in surgical treatment of pathological fractures of the proximal femur—modular endoprosthetic replacement vs. intramedullary nailing. Patient Saf Surg. 2013;7(1):37.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Menendez LR, Ahlmann ER, Kermani C, Gotha H. Endoprosthetic reconstruction for neoplasms of the proximal femur. Clin Orthop. 2006;450:46–51.

    Article  PubMed  Google Scholar 

  25. Houdek MT, Wagner ER, Wilke BK, Wyles CC, Taunton MJ, Sim FH. Long term outcomes of cemented endoprosthetic reconstruction for periarticular tumors of the distal femur. Knee. 2016;23(1):167–72.

    Article  PubMed  Google Scholar 

  26. Hobusch GM, Funovics PT, Hourscht C, Domayer SE, Puchner SE, Dominkus M, et al. LARS® band and tube for extensor mechanism reconstructions in proximal tibial modular endoprostheses after bone tumors. Knee. 2016;23(5):905–10.

    Article  PubMed  Google Scholar 

  27. Stavropoulos NA, Sawan H, Dandachli F, Turcotte RE. Use of ligament advanced reinforcement system tube in stabilization of proximal humeral endoprostheses. World J Orthop. 2016;7(4):265–71.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Houdek MT, Wagner ER, Wilke BK, Wyles CC, Taunton MJ, Sim FH. Late complications and long-term outcomes following aseptic revision of a hip arthroplasty performed for oncological resection. Hip Int. 2015;25(5):428–34.

    Article  PubMed  Google Scholar 

  29. Bickels J, Kollender Y, Wittig JC, Cohen N, Meller I, Malawer MM. Vacuum-assisted wound closure after resection of musculoskeletal tumors. Clin Orthop. 2005;441:346–50.

    Article  PubMed  Google Scholar 

  30. Healey JH, Morris CD, Athanasian EA, Boland PJ. Compress knee arthroplasty has 80% 10-year survivorship and novel forms of bone failure. Clin Orthop. 2013;471(3):774–83.

    Article  PubMed  Google Scholar 

  31. Gebhart M, Shumelinsky F. Management of periprosthetic fractures in patients treated with a megaprosthesis for malignant bone tumours around the knee. Acta Orthop Belg. 2012;78(4):558–63.

    PubMed  Google Scholar 

  32. Wright TW, Cofield RH. Humeral fractures after shoulder arthroplasty. J Bone Joint Surg Am. 1995;77(9):1340–6.

    Article  CAS  PubMed  Google Scholar 

  33. Piccioli A, Rossi B, Sacchetti FM, Spinelli MS, Di Martino A. Fractures in bone tumour prosthesis. Int Orthop. 2015;39(10):1981–7.

    Article  PubMed  Google Scholar 

  34. Worland RL, Kim DY, Arredondo J. Periprosthetic humeral fractures: management and classification. J Shoulder Elb Surg. 1999;8(6):590–4.

    Article  CAS  Google Scholar 

  35. Duncan CP, Haddad FS. The Unified Classification System (UCS): improving our understanding of periprosthetic fractures. Bone Joint J. 2014;96-B(6):713–6.

    Article  CAS  PubMed  Google Scholar 

  36. Bickels J, Kollender Y, Wittig JC, Meller I, Malawer MM. Function after resection of humeral metastases: analysis of 59 consecutive patients. Clin Orthop. 2005;437:201–8.

    Article  Google Scholar 

  37. Hardes J, Gebert C, Schwappach A, Ahrens H, Streitburger A, Winkelmann W, et al. Characteristics and outcome of infections associated with tumor endoprostheses. Arch Orthop Trauma Surg. 2006;126(5):289–96.

    Article  CAS  PubMed  Google Scholar 

  38. Hardes J, von Eiff C, Streitbuerger A, Balke M, Budny T, Henrichs MP, et al. Reduction of periprosthetic infection with silver-coated megaprostheses in patients with bone sarcoma. J Surg Oncol. 2010;101(5):389–95.

    PubMed  Google Scholar 

  39. Racano A, Pazionis T, Farrokhyar F, Deheshi B, Ghert M. High infection rate outcomes in long-bone tumor surgery with endoprosthetic reconstruction in adults: a systematic review. Clin Orthop. 2013;471(6):2017–27.

    Article  PubMed  Google Scholar 

  40. Lee SH, Kim HS, Park YB, Rhie TY, Lee HK. Prosthetic reconstruction for tumours of the distal tibia and fibula. J Bone Joint Surg Br. 1999;81(5):803–7.

    Article  CAS  PubMed  Google Scholar 

Download references

Disclosure

Each author certified that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Author information

Authors and Affiliations

  1. Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy

    Roberto Casadei, Gabriele Drago & Davide Donati

Authors
  1. Roberto Casadei
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gabriele Drago
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Davide Donati
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Roberto Casadei .

Editor information

Editors and Affiliations

  1. Department of Orthopaedics and Trauma Surgery, University Campus Bio-Medico of Rome, Rome, Italy

    Vincenzo Denaro

  2. Department of Orthopaedics and Trauma Surgery, University Campus Bio-Medico of Rome, Rome, Italy

    Alberto Di Martino

  3. General Direction of Health Program, National Ministry of Health of Italy, Rome, Italy

    Andrea Piccioli

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Casadei, R., Drago, G., Donati, D. (2019). Management of Fractures and Failures Around Tumor Implants. In: Denaro, V., Di Martino, A., Piccioli, A. (eds) Management of Bone Metastases. Springer, Cham. https://doi.org/10.1007/978-3-319-73485-9_19

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-73485-9_19

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-73484-2

  • Online ISBN: 978-3-319-73485-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation