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Expandable prostheses continue to evolve but their role remains ill-defined. Numerous small series have compared patient function, quality of life, and reconstruction longevity after expandable endoprosthesis and amputation or rotationplasty with external prosthesis; no one option has presented as a clear winner [, , , , ]. Lacking from these analyses has been any mention of the expense of these implants. Our findings showed that expandable prosthesis use requires continued financial investment on the part of the healthcare cost provider and the magnitude of that investment is correlated to the patient’s age, sex, tumor location, and complication incidence. Prosthesis selection or, more appropriately, lengthening mechanism selection also appears to have a considerable effect on the net reimbursements associated with these implants. Additional study is needed, but given similar or perhaps higher complication rates for the surgical lengthening devices, the smallness of the lengthening required to exceed the equivalence point allowing these implants a financial edge calls into question whether these devices should be used. The prosthesis is not at fault, but rather it is the substantial expense of taking a patient to the operating room. Unfortunately percutaneous lengthening procedures are performed more easily with fluoroscopy and to attempt surgical lengthening in the office setting precludes many techniques that decrease surgical site infection . Our practice is to use nonsurgical lengthening endoprostheses when pediatric limb preservation is required.
The Stanmore Knee Arthrodesis Prosthesis - …
As the number of primary and revision arthroplasties performed each year increases, the complexity of the reconstructive efforts also increases. A case of a patient with a total knee arthroplasty complicated with infection, deficient extensor mechanism, bone loss and limb shortening of 5.5 cm is reported. We describe an alternative surgical technique of reconstruction of the knee and lengthening of the limb using the Stanmore Non-Invasive Growing-Distal Femoral Prosthesis. The prosthesis had a magnetic disc attached to a gearbox. The generation of an external electromagnetic field caused the magnetic disc to rotate and lengthen the prosthesis. This reconstructive technique has not been described in the literature. (C) 2006 Elsevier B.V. All rights reserved.
N2 - BACKGROUND: Expandable prostheses offer the advantages of limb-salvage and limb-length equality at skeletal maturity. However, what is the cost for achieving that goal, and in how many children this is achieved? MATERIALS AND METHODS: We present 32 children (16 boys and 16 girls; mean age, 9 y) with bone sarcomas of the femur treated with limb salvage using expandable prostheses. The Kotz Growing prosthesis and the noninvasive Repiphysis and Stanmore expandable prostheses were used. The mean follow-up was 49 months. Survival analysis of the children and primary implants and functional evaluation were performed. RESULTS: Survival of the children was 94% and 84% at 48 and 72 months. Survival of the primary prostheses was 78% and 66% at 48 and 72 months; survival was significantly higher only for the Kotz when compared with the Repiphysis prostheses (P=0.026). The rate of implant-related complications was 51.3%; 9 prostheses (23%) were revised because of aseptic loosening, infection, and breakage. A mean total lengthening of 28 mm (4 to 165 mm) was achieved by 84 procedures (2.6 procedures/patient). Three of the 9 children who reached skeletal maturity had limb-length equality and 6 discrepancy of 15 to 30 mm. The mean Musculoskeletal Tumor Society score was excellent (79%) without a significant difference between the type of prostheses (P=0.934). CONCLUSIONS: The Kotz Growing prosthesis, although it requires an open lengthening procedure, has shown higher survival when compared with the noninvasive Repiphysis prosthesis. However, the total lengthening remains small, and the complications rates are high even with the noninvasive prostheses.