Non-invasive massive growing prostheses reduce infection in paediatric cancer patients
Purpose: In this study, we asked the question of whether non-invasive (NI) extendible bone tumour implants are as reliable and reduce infection when compared with patients who received a minimally invasive (MI) extendible implant. Methods: Forty-two NI extendible bone tumour implants were investigat...
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Series: | Journal of Orthopaedic Surgery |
Online Access: | https://doi.org/10.1177/2309499019833403 |
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doaj-201206fa9c39436fbc8a07c121d86a152020-11-25T04:01:00ZengSAGE PublishingJournal of Orthopaedic Surgery2309-49902019-03-012710.1177/2309499019833403Non-invasive massive growing prostheses reduce infection in paediatric cancer patientsMelanie Jean Coathup0Samee Ahmad1Julian F Maempel2Timothy WR Briggs3William J Aston4John A Skinner5Gordon W Blunn6 Institute of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, The Royal National Orthopaedic Hospital, Middlesex, UK Institute of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, The Royal National Orthopaedic Hospital, Middlesex, UK Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK Royal National Orthopaedic Hospital, Middlesex, UK Royal National Orthopaedic Hospital, Middlesex, UK Royal National Orthopaedic Hospital, Middlesex, UK Institute of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, The Royal National Orthopaedic Hospital, Middlesex, UKPurpose: In this study, we asked the question of whether non-invasive (NI) extendible bone tumour implants are as reliable and reduce infection when compared with patients who received a minimally invasive (MI) extendible implant. Methods: Forty-two NI extendible bone tumour implants were investigated at a mean follow-up of 22 months (range, 1–87 months) and 63 MI implants at a mean follow-up of 49 months (range, 1–156 months). Results: Kaplan–Meier analysis showed that the probability of MI implant survival was 58.8% compared with 78.6% in NI patients. No significant difference between these two patient groups was found. Infection was the main reason for failure in the MI implant group where nine (35%) implants were revised. However, only one (11%) NI implant was revised for infection ( p = 0.042). None of the NI implants failed due to aseptic loosening; however, six (23%) MI implants were revised for aseptic loosening of the intramedullary stem. Four (15%) of the failed MI implants were revised due to full extension and five (56%) of failed NI implants were replaced as the implant had been fully extended where the patient still required growth. Conclusion: Where possible, an NI massive prosthesis should be used in this patient group. Our results suggest that MI prostheses should be infrequently used due to the high incidence of infection. Lengthening of NI prostheses is painless, can be carried out in the clinic and is more cost-effective. However, further work is required to increase the amount of growth potential available in these implants.https://doi.org/10.1177/2309499019833403 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Melanie Jean Coathup Samee Ahmad Julian F Maempel Timothy WR Briggs William J Aston John A Skinner Gordon W Blunn |
spellingShingle |
Melanie Jean Coathup Samee Ahmad Julian F Maempel Timothy WR Briggs William J Aston John A Skinner Gordon W Blunn Non-invasive massive growing prostheses reduce infection in paediatric cancer patients Journal of Orthopaedic Surgery |
author_facet |
Melanie Jean Coathup Samee Ahmad Julian F Maempel Timothy WR Briggs William J Aston John A Skinner Gordon W Blunn |
author_sort |
Melanie Jean Coathup |
title |
Non-invasive massive growing prostheses reduce infection in paediatric cancer patients |
title_short |
Non-invasive massive growing prostheses reduce infection in paediatric cancer patients |
title_full |
Non-invasive massive growing prostheses reduce infection in paediatric cancer patients |
title_fullStr |
Non-invasive massive growing prostheses reduce infection in paediatric cancer patients |
title_full_unstemmed |
Non-invasive massive growing prostheses reduce infection in paediatric cancer patients |
title_sort |
non-invasive massive growing prostheses reduce infection in paediatric cancer patients |
publisher |
SAGE Publishing |
series |
Journal of Orthopaedic Surgery |
issn |
2309-4990 |
publishDate |
2019-03-01 |
description |
Purpose: In this study, we asked the question of whether non-invasive (NI) extendible bone tumour implants are as reliable and reduce infection when compared with patients who received a minimally invasive (MI) extendible implant. Methods: Forty-two NI extendible bone tumour implants were investigated at a mean follow-up of 22 months (range, 1–87 months) and 63 MI implants at a mean follow-up of 49 months (range, 1–156 months). Results: Kaplan–Meier analysis showed that the probability of MI implant survival was 58.8% compared with 78.6% in NI patients. No significant difference between these two patient groups was found. Infection was the main reason for failure in the MI implant group where nine (35%) implants were revised. However, only one (11%) NI implant was revised for infection ( p = 0.042). None of the NI implants failed due to aseptic loosening; however, six (23%) MI implants were revised for aseptic loosening of the intramedullary stem. Four (15%) of the failed MI implants were revised due to full extension and five (56%) of failed NI implants were replaced as the implant had been fully extended where the patient still required growth. Conclusion: Where possible, an NI massive prosthesis should be used in this patient group. Our results suggest that MI prostheses should be infrequently used due to the high incidence of infection. Lengthening of NI prostheses is painless, can be carried out in the clinic and is more cost-effective. However, further work is required to increase the amount of growth potential available in these implants. |
url |
https://doi.org/10.1177/2309499019833403 |
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