M. Nica, R. Ene, Z. Panti, M. Popa, M. Pleniceanu, M.M. Cîrstoiu and C. Cîrstoiu
Introduction. The management of critical bone defects has experienced an unprecedented improvement in the last few decades. A good primary mechanical stability and versatility of the modular reconstruction systems allowed the conversion to universal setups and the expansion of indication. The progression and reliability of the reconstruction possibilities available nowadays are outlined using the experience of our department. Material and method. A retrospective review of critical bone defect cases and the reconstruction management using endoprosthetic systems is presented. Ten reconstruction surgeries performed in the last 18 months in our department were observed. The patients were 3 males and 7 females with a mean age of 45.3 (range 19 to 75). Modular systems were used for the reconstruction of bone defects subsequent to resections of benign or malignant musculoskeletal tumors (76%) and to non-neoplastic conditions (24%). Results. On the latest follow-up, all the patients were alive, with one case of tumoral recurrence. No aseptic loosening, soft tissue or structural failure were recorded following surgery, with one case under treatment for infection after it required an open procedure for a prosthetic hip dislocation. The early functional results were adequate in all cases, with good secondary stability and satisfactory quality of life. Conclusion. The evolution of endoprosthetic reconstruction surgery has improved the prognosis for many patients diagnosed with critical bone defects. Continuous advances in implant design, fixation, and soft tissue attachment combined with the improvement of surgical techniques will ensure a bright future for this type of procedures.
R.S. Cismașiu, R.M. Bîrluțiu, A. Tudor, D. Pop and C.I. Stoica
Oncological resection and articular reconstruction through modular tumor prosthesis is a challenge for the surgeon, but at the same time gives the patient the certainty of keeping the function and hope for healing. Due to technical evolution, the recovery of osteoarticular post-resection tumor is today much more versatile and permissive, providing the comfort of the orthopedic oncologist surgeon during reconstruction and at the same time the patient satisfaction. Purpose of the paper. Short-term and medium-term evaluation of surgical treatment outcome of bone oncological pathogenesis of the knee with modular tumor prosthesis. Material and method. Recording based on the unique tumor registry of the Clinic in a monocentric, retrospective continuously study between 2009 and 2017, of all orthopedic oncology patients with malignant/ borderline tumors with metaphyso-epiphyseal knee periarticular involvement, beneficiaries of the resection-reconstruction with prosthesis modular tumor - a total of 21 cases. Case analysis included details of histopathological types of tumors, followed by Enneking staging, which was performed, alongside classical demographics. The Malaware oncological resection technique was followed and the learning curve and results of the prostatic modular prosthetic reconstruction were registered, considering failure for any of the following reasons: revision, necessity exhaustion of the prosthesis - infection, relapse, or amputation. The functional evaluation was based on the revised Muscular-skeletal Tumor Society Score (rMSTS). Results and discussions. Only one case of failure was registered - a periprosthetic infection. The overall rate of apparently postoperative complications followed the literature data for this type of intervention - 40-50%. Compared to amputation, the lower limb salvage process in the knee malignant tumors has proven to be cost-effective and has contributed to improving the quality of life, becoming one of the sustainable options for onco-surgical management in good cases selected. The limits of the study are determined by the relatively short duration of follow-up, and the apparently large number of complications is nevertheless included in the international statistics related to such interventions.
Alexandru Papuc, Ioan Mihai Japie, Traian Ciobanu, Octavian Nutiu, Dragos Radulescu and Radu Radulescu
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Introduction. Besides the improvement of the survival rate in young patients with musculoskeletal cancer, we should always consider that infertility and premature menopause due to treatment might dramatically affect their quality of life. Material and methods. This article is a review of literature. Results. After puberty, the first option should be ovarian controlled hyperstimulation (COS) resulting in oocytes that are consequently fertilized using FIV or ICSI and the cryopreservation of the embryos. If the patient does not have a partner at that moment, the next method is the vitrification of the oocytes resulting from the COS. The disadvantages of using COS are the need to postpone the radio and chemotherapy for at least 2-3 weeks and high oestradiol levels, but there are very few hormone dependent musculoskeletal tumors that may be affected. Ovarian tissue cryopreservation (OTC), with ovarian tissue transplantation (OTT) is the only method used if the patient is before puberty, plus, this technique allows patients to spontaneously conceive, if they do not have any other fertility pathology, but this freezing/ thawing procedure may have success or not. There is currently no evidence to suggest that OTT causes reseeding of the original cancer, and the restoring of the ovarian endocrine function was reported in about 95% of the cases. Conclusions. The success of fertility preservation techniques is related to the cryopreservation methods used and the age of the patient. The reproductive cells with the best survival are the embryos, the next are oocytes, or ovarian tissue may be cryopreserved. For best outcomes, the fertility preservation must be pluridisciplinary discussed, involving the ART specialist gynecologist, the oncologist and the surgeon of the musculoskeletal tumor.
Mihai Gherman, Anca-Mădălina Sere, Mihai-Daniel Angheluță and Remus Coste
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