Non-invasive distal femoral expandable endoprosthesis for limb-salvage surgery in paediatric tumours.

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Abstract

[Indexed for MEDLINE] 3. Bone Joint J. 2014 Nov;96-B(11):1436-40. doi: 10.1302/0301-620X.96B11.34747. Classification of failure of limb salvage after reconstructive surgery for bone tumours : a modified system Including biological and expandable reconstructions. Henderson ER(1), O'Connor MI(2), Ruggieri P(3), Windhager R(4), Funovics PT(4), Gibbons CL(5), Guo W(6), Hornicek FJ(7), Temple HT(8), Letson GD(9). Author information: (1)Norris Cotton Cancer Center, Musculoskeletal Oncology Program, One Medical Center Drive, Lebanon, PA, 03756, USA. (2)Mayo Clinic, Department of Orthopaedic Surgery, Jacksonville, Florida, USA. (3)Instituto Ortopedico Rizzoli, Orthopaedic Oncology Division, Bologna, Italy. (4)University of Vienna, Department of Orthopaedic Surgery, Vienna, Austria. (5)Oxford University, Orthopaedic Oncology, Oxford University Hospitals, Oxford, UK. (6)People's Hospital, Musculoskeletal Tumor Center, Peking University, Beijing, China. (7)Massachusetts General Hospital, Center for Connective Tissue Oncology, Boston, Massachusetts, USA. (8)University of Miami, Department of Orthopaedic Surgery, Miami, Florida, USA. (9)Moffitt Cancer Center, Sarcoma Program, Tampa, Florida, USA. Previous classification systems of failure of limb salvage focused primarily on endoprosthetic failures and lacked sufficient depth for the effective study of the causes of failure. In order to address these inadequacies, the International Society of Limb Salvage (ISOLS) formed a committee to recommend revisions of the previous systems. The purpose of this study was to report on their recommendations. The modifications were prepared using an earlier, evidence-based model with subclassification based on the existing medical literature. Subclassification for all five primary types of failure of limb salvage following endoprosthetic reconstruction were formulated and a complementary system was derived for the failure of biological reconstruction. An additional classification of failure in paediatric patients was also described. Limb salvage surgery presents a complex array of potential mechanisms of failure, and a complete and precise classification of types of failure is required. Earlier classification systems lacked specificity, and the evidence-based system outlined here is designed to correct these weaknesses and to provide a means of reporting failures of limb salvage in order to allow the interpretation of outcome following reconstructive surgery. ©2014 The British Editorial Society of Bone & Joint Surgery. DOI: 10.1302/0301-620X.96B11.34747