Background and purpose The methods of reconstruction for proximal femur bone
July 20, 2017
Background and purpose The methods of reconstruction for proximal femur bone tumors that are used most often include modular prosthetic replacement and allograft-prosthesis composite reconstruction. was reduced in all patients, and buy Mizolastine especially in patients with modular prosthetic replacement. Different hip extension patterns during late stance were found in the 2 2 groups. Surface EMG showed a typical prolonged muscle co-contraction pattern during gait, which was more evident in modular prosthetic patients. Interpretation Although both procedures provided good functional outcome in the long-term follow-up, gait analysis revealed mechanical changes during gait that were probably related to the muscle reinsertion procedure. Direct fixation of the muscles to the bone graft seemed to create a better muscular recovery. The two 2 hottest approaches for reconstruction after resection of the tumor in the proximal femur are modular prosthetic alternative (MP) and allograft-prosthetic amalgamated reconstruction (APC) (Unwin et al. 1996, Giurea et al. 1998, Bickels et al. 2000, Fox et al. 2002). The mostly utilized MP prostheses were created having a trochanter muscle tissue insertion device which allows immediate fixation from the gluteus medius towards the prosthesis (Kotz et al. 1986, Bickels et al. 2000). This kind or sort of fixation could be inadequate, with insufficient strength from the buy Mizolastine gluteal muscle groups and feasible joint instability and impaired function (Schreiber et al. 1991, Rechl et al. 1999). On the other hand, the abductor muscle groups could be reinserted in to the fascia latabut also with impaired function (Giurea et al. 1998, Gottsauner-Wolf et. 1999, Anderson et al. 2002). The iliopsoas muscle tissue isn’t re-attached generally, but is remaining absolve to heal without the fixation or can be rotated anteriorly to close and strengthen the hip capsular restoration. Apart from poor function, several authors have reported aseptic loosening and instability (Zwart et al. 1994, Sanjay and Moreau buy Mizolastine 1999, Mittermayer et al. 2001, Menedez et al. 2006, Chandrasekar et al. 2009). The allograft-prosthesis composite (APC) implant was recently designed to reduce these complications. This implant is composed of a revision-type prosthesis inserted inside a bone allograft to which the residual abductors and the iliopsoas muscle tendons are biologically reinserted, which should reduce the risk of postoperative dislocation and give better function (Gitelis et al. 1988, Zehr et al. 1996, Giurea et al. 1998, Anract et al. 2000, Langlais et al. 2003, Farid et al. 2006, Biau et al. 2008, Donati et al. 2008, 2011). In a comparative study on MP and APC, however, Zehr et al. (1996) found no differences in function and survival. In our own experience (Donati et al. 2001, 2002), function in APC patientswhen assessed by the MSTS scorecompared favorably with that in MP patients in whom a Trendelenburg gait was present in most cases. In almost all of these studies, however, the functional outcome was assessed by scoring systems that have recently been questioned for not providing objective and quantitative information about NGFR functional recovery (Rompen et al. 2002, Rosenbaum et al. 2008). Functional outcome has seldom been evaluated with laboratory-based computer-assisted gait analysis. In the present study, using gait analysis we objectively assessed walking ability in patients treated with the APC implant or with the MP system with long-term follow-up. Our hypothesis was that the APC implant would provide better control of the hip during gait both in the sagittal plane and buy Mizolastine the coronal plane, due to the biological reconstruction of muscles. Patients and methods 2 groups of patients were retrospectively recruited from subjects treated at the Rizzoli Institute with proximal femur bone tumor resection, either with modular prosthetic replacement (MP) or allograft-prosthesis composite (APC). The inclusion criteria were: (1) presence of gluteus medius tendon to be re-attached onto the trochanter of the implant; (2) absence of implant complications; (3) no local or faraway tumor.