Orthopaedic Procedures in the Rehabilitation of Cancer Patients

  • R. Kotz
  • A. Azzarelli

Abstract

In the past 10 years significant progress has been made in the management of malignant bone tumours, with improved functional results and patient survival. This fact is due to more experienced and defined conservative surgery, sophisticated endoprostheses and aggressive neoadjuvant multidrug chemotherapies. This chapter reports the current concepts and approaches widely accepted in major cancer orthopaedic institutes towards the diagnosis, treatment and rehabilitation of patients with malignant bone lesions and in particular those seen at the Orthopaedic University Clinic of Vienna and recorded in the Vienna Bone Tumor Registry (Kotz et al. 1984), which over the past 25 years has collected more than 3700 cases1 as well as those seen at the Istituto Nazionale Tumori of Milan. In a specialised institute an interdisciplinary team should evaluate each patient, taking into account histological diagnosis, location and extent of the disease and the expected and achieved effects of therapeutic procedures and functional results. Diagnosis, symptoms, physical examination and single X-ray may provide a first indication towards appropriate diagnosis. If a malignant bone tumour is suspected the roentgenographic diagnosis must be verified with further investigation, such as bone scan, CT scan, angiography and nuclear magnetic resonance (NMR).

Keywords

Fatigue Europe Shrinkage Oncol Sarcoma 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Aust J, Absolon B (1962) A successful lumbosacral amputation hemicorporectomy. Surgery 52: 756–579PubMedGoogle Scholar
  2. Borggreve J (1930) Kniegelenksersatz durch das in der Beinlängsachse urn 180° gedrehte Fußgelenk. Arch Orthop Unfall-Chir 28: 175–178CrossRefGoogle Scholar
  3. Burwell HN (1965) Resection of the shoulder with humeral suspension for sarcoma involving the scapula. J Bone Joint Surg [B] 47: 300–303Google Scholar
  4. Campanacci M, Capanna R, Cervellati C, Calderoni P (1983) Modular rotatory endoprosthesis for segmental resection of the proximal humerus: experience with 33 cases. Thieme-Stratton, New York, p 64Google Scholar
  5. Chao EYS, Sim FH (1983) Tumor prostheses design: a system approach. Thieme-Stratton, New York, p 157Google Scholar
  6. Dölle V, Rinecker H (1975) Die Behandlung maligner Frakturen des Femurs durch die totale Hüft–Femur–Kniegelenks–Alloplastik. Arch Orthop Unfall–Chir 83: 295–303CrossRefGoogle Scholar
  7. Dor P (1962) La resection de la ceinture scapulaire. Acta Chir Belg 61: 897–902Google Scholar
  8. Enneking WF, Spanier MA, Goodmann MA (1980) Current concept review. Trie surgical staging of musculoskeletal sarcoma. J Bone Joint Surg 62: 1027–1030PubMedGoogle Scholar
  9. Enneking WF (1983 a) Functional evaluation of reconstruction after tumor resection. In: Proceedings of the second international workshop on the design and application of tumor prostheses for bone and joint reconstruction. September 5-8, Vienna, pp 5–10Google Scholar
  10. Enneking WF (1983 b) Musculoskeletal tumor surgery. Churchill-Livingstone, New York, p 81Google Scholar
  11. Francis KC, Worcester JN (1962) Radical resection for tumors of the shoulder with preservation of a functional extremity. J Bone Joint Surg [Am] 44: 1423–1430Google Scholar
  12. Fuchs G (1966) Resektion des proximalen Oberarmes und Ersatz durch eine Vitallium-Endoprothese. Chir Prax 10: 69–75Google Scholar
  13. Gasparini M, Azzarelli A (1987) Chemotherapy: protocols and results at the Istituto Nazionale Tumori of Milan. In: Consensus meeting on Osteosarcoma - state of the art in Europe. Istituto Ortopedico, Rizzoli Editore, Bologna, pp 19–22Google Scholar
  14. Gennari L, Bignami P, Azzarelli A, Nava M (1981) Emipelvec–tomie e disarticolazioni interscapolotoraciche. In: Veronesi U, Perussia A, Gennari L, Emanuelli H, (eds) I tumori delle ossa e dei tessuti molli. CEA, Milano, pp 375–381Google Scholar
  15. Genovesi A (1962) Resezione ed innesto osseo autoplastico per neoplasie primitive del;’estremo prossimale delfomero. Clin Orthop 14: 233–253Google Scholar
  16. Grimby G, Stener B (1973) Physical performance and cardiorespiratory function after hemicorporectomy. Scand J Rehabil Med 5: 124–129PubMedGoogle Scholar
  17. Jürgens H (1981) Ewing-Sarkom bei Kindern und Jugendlichen: Planung einer kooperativen Therapiestudie der Gesellschaft für Pädiatrische Onkologie (CESS 1981). Klin Pädiatr 193: 253–256CrossRefGoogle Scholar
  18. Juvara E (1929) Reconstruction de la tige osseuse femore-tibiale, interrompue pour la resection d’une des extremites osseuses, qui constitute l’articulation du genu, par une greffe provenant du deboublement de f extremity osseuse apposee. Bull Soc Chir [Paris] 55: 541Google Scholar
  19. Kotz R (1983 a) A modular femur and tibia reconstruction system. In: Proceedings of the second international workshop on the design and application of tumor prostheses for bone and joint reconstruction. September 5–8, Vienna, pp 223–226Google Scholar
  20. Kotz R (1983 b) Possibilities and limitations of limb–preserving therapy for bone tumors today. J Cancer Res Clin Oncol 106 [Suppl]: 68–76PubMedCrossRefGoogle Scholar
  21. Kotz R, Salzer M (1975) Resection therapy of malignant tumors of the shoulder girdle. Öst Z Onkol 2: 97–109Google Scholar
  22. Kotz R, Salzer M (1982) Rotationsplasty for childhood osteosarcoma of the distal part of the femur. J Bone Joint Surg [Am] 64: 959–969Google Scholar
  23. Kotz R, Sunder-Plaßmann M (1977) Ventrale Stabilisierung bei Metastasen der Hals– und oberen Brustwirbelsäule. Orthop Prax 12: 891Google Scholar
  24. Kotz R, Leber H, Ramach W, Arbes H, Wolf A (1977) Erfahrungen mit der Durchführung der hochdosierten Methotrexatbehandlung beim Osteosarkom. Wien Klin Wochenschr 89: 474–479PubMedGoogle Scholar
  25. Kotz R, Salzer-Kuntschik M, Lechner G, Immenkamp M, Kogelnik HD, Salzer M (1984) Orthopädie in Praxis und Klinik. Band III: Allgemeine Orthopädie, Teil 2: Tumore und tumorähnliche Erkrankungen. Thieme, StuttgartGoogle Scholar
  26. Kotz R, Ritschl P, Pongracz N, Zimmermann R (1986) Hemi–pelvektomie: Indikation, Operationstechnik und Ergebnisse. Acta Chir Austriaca 18: 108–109Google Scholar
  27. Larson DL, Liang MD (1983) The quadrizeps musculocutaneous flap: a reliable, sensate flap for the hemipelvectomy defect. Plast Reconstr Surg 72 (3): 347–354PubMedCrossRefGoogle Scholar
  28. Lewis MM (1986) The use of an expandable and adjustable prosthesis in the treatment of childhood malignant bone tumors of the extremity. Cancer 57: 499–502PubMedCrossRefGoogle Scholar
  29. Linberg BE (1928) Interscapulo-thoracic resection for malignant tumors of the shoulder joint region. J Bone Joint Surg 26: 344–349Google Scholar
  30. MacFarlane DA (1971) Radical surgery for malignant lesions of the shoulder with upper limb preservation. Bull Soc Int Chir 30: 23–30PubMedGoogle Scholar
  31. Mankin HJ, Doppelt SH, Sullivan TR (1982) Osteoarticular and intercalary allograft transplantation in the management of malignant tumors of bone. Cancer 50: 613–630PubMedCrossRefGoogle Scholar
  32. Marcove RC, Khafagy MM (1974) Total femur and knee replacement using a metalic prosthesis. Clin Bull 4: 69–71PubMedGoogle Scholar
  33. Meary R (1970) Wide resections in bone-tumors (except pelvis and knee). In: Chapchal G. (ed) Operative treatment of bone tumors. Thieme, Stuttgart, pp 89–91Google Scholar
  34. Miller ThR (1962) Hemipelvectomy in the treatment of advanced cancer. AJR 87: 531Google Scholar
  35. Miller ThR, Mackenzie AR, Randall HT (1966) Translumbar amputation for advanced cancer: indications and physiologic alterations in four cases. Ann Surg 164: 514–521PubMedCrossRefGoogle Scholar
  36. Nadjafi A (1970) The results of limb-saving plastic procedures for malignant bone sarcomas of the skelton. In: Chapchal G. (ed) Operative treatment of bone tumors. Thieme, Stuttgart, p 98Google Scholar
  37. Nieder E, Engelbrecht E, Steinbrink K, Keller A (1983) Modular system of the total femoral prosthesis – endo – model. In: Proceedings of the second international workshop on the design and application of tumor prostheses for bone and joint reconstruction. September 5–8, Vienna, pp 231–235Google Scholar
  38. Nilsonne U (1965) Radical amputation for malignant tumours of the extremities. Acta Chir Scand 129: 150PubMedGoogle Scholar
  39. Pack GT (1956) Major exarticulations for malignant neoplasms of the extremities: interscapulothoracic amputation, hipjoint disarticulation and interilio-abdominal amputation. A report of endresults in 228 cases. J Bone Joint Surg [Am] 38: 249Google Scholar
  40. Pack GT, Baldwin JC (1961) The Tichof-Linberg resection of the shoulder–girdle, indications for its substitution for interscapulothoracic amputation, recent data on endresults of the forequarter amputation. Clin Orthop 19: 148Google Scholar
  41. Pack GT, Miller ThR (1964) Exarticulation of the innominate bone and corresponding lower extremity (hemipelvectomy) for primary and metastatic cancer. J Bone Joint Surg [Am] 46: 91Google Scholar
  42. Packard AG (1973) Prosthetic replacement of the proximal half of the humerus. Clin Orthop 93: 250–252PubMedCrossRefGoogle Scholar
  43. Parrish FF (1966) Treatment of bone tumors by total excision and replacement with massive autologuous and homologous grafts. J Bone Joint Surg [Am] 48: 968–990Google Scholar
  44. Parrish FF (1973) Allograft replacement of all or part of the end of long bone following excision of a tumor. Report of twenty one cases. J Bone Joint Surg [Am] 55: 1–22Google Scholar
  45. Ramach W, Sigmund R, Sekera J, Salzer-Kuntschik M, Kotz R, Knahr K, Salzer M (1987) Functional results of customized prosthetic devices for the knee region after resection of bone and joints. In: Enneking WF. (ed) Limb Salvage in Musculoskeletal Oncology. Churchill Livingstone, New York, pp 215–220Google Scholar
  46. Rosen G, Murphy ML, Huvos AG, Gutierrez M, Marcove RA (1976) Chemotherapy en bloc resection and prosthetic bone replacement in the treatment of osteogenic sarcoma. Cancer 37: 1–11PubMedCrossRefGoogle Scholar
  47. Salzer M (1965) Die Hemipelvektomie. Wien Klin Wochenschr 77: 330PubMedGoogle Scholar
  48. Salzer M, Knahr K (1976) Resection treatment of malignant bone tumors. Recent Results Cancer Res 54: 239PubMedGoogle Scholar
  49. Salzer M, Salzer G, Denck H, Brenner H (1973) Operative Behandlung ÉsolitäterÉ Metastasen der Brust– und Lenden–wirbelkorper. Arch Orthop Unfall-Chir 75: 249–254CrossRefGoogle Scholar
  50. Salzer M, Knahr K, Locke H, Stark M, Metajovsky Z, Plenk H, Punzet G, Zweymuller K (1979) A bioceramic endoprosthesis for the replacement of the proximal humerus. Arch Orthop Trauma Surg 93: 169–184PubMedCrossRefGoogle Scholar
  51. Salzer H, Knahr K, Kotz R, Kristen H (1981) Treatment of osteosarcoma of the distal femur by rotationplasty. Arch Orthop Trauma Surg 99: 131PubMedCrossRefGoogle Scholar
  52. Sauerbruch F (1922) Die Exstirpation des Femur mit Umkipp–Plastik des Unterschenkels. Dtsch Z Chir 169: 1CrossRefGoogle Scholar
  53. Smith WS, Simon MA, Arbor A (1975) Segmental resection for chondrosarcoma. J Bone Joint Surg [Am] 57: 1097–1103Google Scholar
  54. Steiner AK, Miiller W, Remagen W, Rüedi Th (1973) Extremitatenerhaltende Resektion bei Tumoren der langen Rohren-knochen. Helv Chir Acta 40: 177–183PubMedGoogle Scholar
  55. Troell A (1931) Sarkom in den langen Röhrenknochen mit besonderer Berücksichtigung ihrer Behandlung und der Bedeutung des Traumas fur die Geschwulstätiologie. Langenbecks Arch Chir 163: 199–299Google Scholar
  56. Ungethüm M, Knahr K, Salzer M, Blomer W (1983) Zementfrei zu implantierende Spezialendoprothesen nach dem Baukastenprinzip für den proximalen Femur– und Hume–rusersatz. Med Orthop Technik 4: 104Google Scholar
  57. Van Nes CP (1950) Rotationplasty in the treatment of congenital defects of the femur. J Bone Joint Surg [Br] 32: 12Google Scholar
  58. Volkow M (1970) Allotransplantation of joints. J Bone Joint Surg Br 52: 49–53Google Scholar
  59. Wilson PD, Lance EM (1965) Surgical reconstruction of the skeleton following segmental resection for bone tumors. J Bone Joint Surg [Am] 47: 1629–1656Google Scholar
  60. Winkelmann W (1983) Die Umdrehplastik bei malignen proximalen Femurtumoren. Z Orthop 121: 547–549PubMedCrossRefGoogle Scholar
  61. Winkler K, Beron G, Kotz R, Salzer-Kuntschik M, Beck J, Beck W, Brandeis W, Ebell W, Erttmann R, Göbel U, Havers W, Henze G, Hinderfeld L, Höcker P, Jobke A, Järgens H, Kabisch H, Preusser P, Prindull G, Ramach W, Ritter J, Sekera J, Treuner J, Wiist G, Landbeck G (1984) Neoadjuvant chemotherapy of osteogenic sarcoma: results of a cooperative German/Austrian study (COSS–80). J Clin Oncol 2 (6): 617–624PubMedGoogle Scholar
  62. Winkler K, Beron G, Kotz R, Salzer-Kuntschik M, Beck J, Beck W, Brandeis W, Ebell W, Erttman R, Göbel U, Havers W, Henze G, Hinderfeld L, Höcker P, Jobke A, Jurgens H, Kabisch H, Preusser P, Prindull G, Ramach W, Ritter J, Sekera J, Treuner J, Wüst G, Landbeck G (1986) Einfluß des lokalchirurgischen Vorgehens auf die Inzidenz von Metastasen nach neoadjuvanter Chemotherapie des Osteosarkoms. Z Orthop 124: 22–29PubMedCrossRefGoogle Scholar
  63. Yancey AG, Ryan HF, Blasingame JT (1964) An experience with hemicorporectomy. J Natl Med Assoc 56: 323–325PubMedGoogle Scholar
  64. Zenker H (1967) Zum Problem des Knochenersatzes durch Endoprothese bei einem bösartigen Tumor am koxalen Femurende. Z Orthop 103: 539–541PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1989

Authors and Affiliations

  • R. Kotz
  • A. Azzarelli

There are no affiliations available

Personalised recommendations