Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Hackl, L.
30 years of growing endoprostheses in children with malignant bone tumours
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2016. pp. 76
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Gilg Magdalena Maria
- Leithner Andreas
- Altmetrics:
- Abstract:
- Thirty years ago, children with primary malignant bone sarcomas of the extremities were treated with amputation in nearly all cases. Due to the predilection age in the second decade of life, a special challenge in limb-salvage surgery is the continuing growth potential. Therefore, the first extendible growing prosthesis was implanted in 1976. To reduce the high risk of infection due to the recurrent minimally invasive lengthening procedures and the need of general anaesthesia, non-invasive growing prostheses were developed. The aim of this diploma thesis was first to analyse the complication rates and morbidity of patients who received an expandable prosthesis at the Department of Orthopeadics and Orthopaedic Surgery of the Medical University of Graz, Graz, Austria and second to perform a systematic literature review about growing prostheses. Data from the Department of Orthopeadic Surgery Graz was analysed by conducting a retrospective database review. Twelve patients fulfilled the inclusion criteria. Due to the low number of cases a literature review was done additionally to supplement and compare our results regarding lengthening procedures and complications. In our patients’ collective (mean age 9.7 years (range 5.0- 14.0)) eight patients were treated by minimally invasive expandable prostheses and four patients by non-invasive prostheses. The mean follow-up was 88.0 months (range 6.0- 232.0). The mean number of minimally invasive lengthening procedures per patient was 3.3 (range 0.0 to 10.0). Mean total lengthening was 36.2 mm (range 0.0 to 131.9). Complications were classified according to modified Henderson et al. In our patients’ collective the most common complication was deep infection. In our dataset neither amputation nor local recurrence occurred, However, three patients died of disease due to pulmonary metastases at initial diagnosis. In literature review, 23 studies with 489 participants were included (mean age 10.1 years (range 2.0- 16.0)) with a mean follow-up of 56.0 months (range 2.0 to 282). The most common complication according to modified Henderson et al. was deep infection. Amputation was necessary in 24 cases (5.0%), local recurrence was present in 24 patients (50%) and 95 patients died of disease (19.7%). Mean number of lengthening procedures per patient was 5.1 (2.1- 40.0) with a mean total lengthening of 40.3 mm (1.5- 82.0). Growing prostheses are a good alternative to amputation or rotationplasty regarding a good MSCS score. However, high rates of infection in minimally invasive growing prostheses and the high rate of prosthetic failures in non-invasive growing prostheses show a necessity of further development to meet the demands of a growing child.