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Oncologic Hardware and Complications
Andrew M. Zbojniewicz, MD; A. Carlson Merrow, Jr., MD, FAAP
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Definitions

            • Limb salvage surgery: Tumor resection & reconstruction techniques optimized to preserve adequate function of involved limb without compromising overall survival
            • Oncologic hardware relates to 2 main types of reconstruction
              • Endoprosthetic reconstruction: Conventional vs. growing
                • Growing endoprosthesis used in pediatric patients when > 30 mm of growth remains
                  • Synonyms: Expandable endoprosthesis, extendible endoprosthesis
                  • May consist of minimally invasive or noninvasive lengthening mechanism
                  • Noninvasive growing endoprostheses not MR compatible due to motor & magnet controlling mechanism (activated by external rotating electromagnetic field)
              • Biological reconstruction: Use of native or donor tissue
            • Complications
              • Endoprosthetic: Infection, mechanical failure, local recurrence
                • Mechanical failure includes
                  • Aseptic loosening
                  • Implant fracture
                  • Periprosthetic fracture
                  • Instability (e.g., subluxation at shoulder or hip)
                  • Rotational loosening
                  • Acute unplanned shortening or lengthening
                  • Outgrowing available extension
                  • Stiffness
                  • Pain
              • Biological: Nonunion, fracture, infection, or local recurrence

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Ultrasonographic Findings

                    • Nuclear Medicine Findings

                      CLINICAL ISSUES

                      • Presentation

                        • Natural History & Prognosis

                          • Treatment

                            DIAGNOSTIC CHECKLIST

                            • Consider

                              • Image Interpretation Pearls

                                Selected References

                                1. Boudabbous S et al: Model-Based Iterative Reconstruction (MBIR) for the Reduction of Metal Artifacts on CT. AJR Am J Roentgenol. 205(2):380-5, 2015
                                2. Tan TJ et al: Imaging of limb salvage surgery and pelvic reconstruction following resection of malignant bone tumours. Eur J Radiol. 84(9):1782-90, 2015
                                3. Coupal TM et al: Peering through the glare: using dual-energy CT to overcome the problem of metal artefacts in bone radiology. Skeletal Radiol. 43(5):567-75, 2014
                                4. Zbojniewicz AM et al: Posttreatment imaging of pediatric musculoskeletal tumors. Radiographics. 34(3):724-40, 2014
                                5. Abed R et al: Surgical modalities in the treatment of bone sarcoma in children. Cancer Treat Rev. 36(4):342-7, 2010
                                6. Koch KM et al: Magnetic resonance imaging near metal implants. J Magn Reson Imaging. 32(4):773-87, 2010
                                7. Nystrom LM et al: Expanding endoprosthesis for pediatric musculoskeletal malignancy: current concepts and results. Iowa Orthop J. 30:141-9, 2010
                                8. Love C et al: Nuclear medicine and the infected joint replacement. Semin Nucl Med. 39(1):66-78, 2009
                                9. Friedrich JB et al: Free vascularized fibular graft salvage of complications of long-bone allograft after tumor reconstruction. J Bone Joint Surg Am. 90(1):93-100, 2008
                                10. Jeys LM et al: Endoprosthetic reconstruction for the treatment of musculoskeletal tumors of the appendicular skeleton and pelvis. J Bone Joint Surg Am. 90(6):1265-71, 2008
                                11. Jeys LM et al: Periprosthetic infection in patients treated for an orthopaedic oncological condition. J Bone Joint Surg Am. 87(4):842-9, 2005
                                12. Brenner W et al: PET imaging of osteosarcoma. J Nucl Med. 44(6):930-42, 2003
                                13. Taljanovic MS et al: Joint arthroplasties and prostheses. Radiographics. 23(5):1295-314, 2003
                                14. Manaster BJ: From the RSNA refresher courses. Total hip arthroplasty: radiographic evaluation. Radiographics. 16(3):645-60, 1996
                                Related Anatomy
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                                Related Differential Diagnoses
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                                References
                                Tables

                                Tables

                                KEY FACTS

                                • Terminology

                                  • Imaging

                                    • Clinical Issues

                                      • Diagnostic Checklist

                                        TERMINOLOGY

                                        • Definitions

                                          • Limb salvage surgery: Tumor resection & reconstruction techniques optimized to preserve adequate function of involved limb without compromising overall survival
                                          • Oncologic hardware relates to 2 main types of reconstruction
                                            • Endoprosthetic reconstruction: Conventional vs. growing
                                              • Growing endoprosthesis used in pediatric patients when > 30 mm of growth remains
                                                • Synonyms: Expandable endoprosthesis, extendible endoprosthesis
                                                • May consist of minimally invasive or noninvasive lengthening mechanism
                                                • Noninvasive growing endoprostheses not MR compatible due to motor & magnet controlling mechanism (activated by external rotating electromagnetic field)
                                            • Biological reconstruction: Use of native or donor tissue
                                          • Complications
                                            • Endoprosthetic: Infection, mechanical failure, local recurrence
                                              • Mechanical failure includes
                                                • Aseptic loosening
                                                • Implant fracture
                                                • Periprosthetic fracture
                                                • Instability (e.g., subluxation at shoulder or hip)
                                                • Rotational loosening
                                                • Acute unplanned shortening or lengthening
                                                • Outgrowing available extension
                                                • Stiffness
                                                • Pain
                                            • Biological: Nonunion, fracture, infection, or local recurrence

                                        IMAGING

                                        • General Features

                                          • Radiographic Findings

                                            • CT Findings

                                              • MR Findings

                                                • Ultrasonographic Findings

                                                  • Nuclear Medicine Findings

                                                    CLINICAL ISSUES

                                                    • Presentation

                                                      • Natural History & Prognosis

                                                        • Treatment

                                                          DIAGNOSTIC CHECKLIST

                                                          • Consider

                                                            • Image Interpretation Pearls

                                                              Selected References

                                                              1. Boudabbous S et al: Model-Based Iterative Reconstruction (MBIR) for the Reduction of Metal Artifacts on CT. AJR Am J Roentgenol. 205(2):380-5, 2015
                                                              2. Tan TJ et al: Imaging of limb salvage surgery and pelvic reconstruction following resection of malignant bone tumours. Eur J Radiol. 84(9):1782-90, 2015
                                                              3. Coupal TM et al: Peering through the glare: using dual-energy CT to overcome the problem of metal artefacts in bone radiology. Skeletal Radiol. 43(5):567-75, 2014
                                                              4. Zbojniewicz AM et al: Posttreatment imaging of pediatric musculoskeletal tumors. Radiographics. 34(3):724-40, 2014
                                                              5. Abed R et al: Surgical modalities in the treatment of bone sarcoma in children. Cancer Treat Rev. 36(4):342-7, 2010
                                                              6. Koch KM et al: Magnetic resonance imaging near metal implants. J Magn Reson Imaging. 32(4):773-87, 2010
                                                              7. Nystrom LM et al: Expanding endoprosthesis for pediatric musculoskeletal malignancy: current concepts and results. Iowa Orthop J. 30:141-9, 2010
                                                              8. Love C et al: Nuclear medicine and the infected joint replacement. Semin Nucl Med. 39(1):66-78, 2009
                                                              9. Friedrich JB et al: Free vascularized fibular graft salvage of complications of long-bone allograft after tumor reconstruction. J Bone Joint Surg Am. 90(1):93-100, 2008
                                                              10. Jeys LM et al: Endoprosthetic reconstruction for the treatment of musculoskeletal tumors of the appendicular skeleton and pelvis. J Bone Joint Surg Am. 90(6):1265-71, 2008
                                                              11. Jeys LM et al: Periprosthetic infection in patients treated for an orthopaedic oncological condition. J Bone Joint Surg Am. 87(4):842-9, 2005
                                                              12. Brenner W et al: PET imaging of osteosarcoma. J Nucl Med. 44(6):930-42, 2003
                                                              13. Taljanovic MS et al: Joint arthroplasties and prostheses. Radiographics. 23(5):1295-314, 2003
                                                              14. Manaster BJ: From the RSNA refresher courses. Total hip arthroplasty: radiographic evaluation. Radiographics. 16(3):645-60, 1996