@article{5d96b81483bf447d9a25c6e7e18eb583,
title = "Survival and failure modes of the Compress{\textregistered} spindle and expandable distal femur endoprosthesis among pediatric patients: A multi-institutional study",
abstract = "Background: Expandable endoprostheses can be used to equalize limb length for pediatric patients requiring reconstruction following large bony oncologic resections. Outcomes of the Compress{\textregistered} Compliant Pre-Stress (CPS) spindle paired with an Orthopedic Salvage System expandable distal femur endoprosthesis have not been reported. Methods: We conducted a multi-institutional retrospective study of pediatric patients with distal femoral bone sarcomas reconstructed with the above endoprostheses. Statistical analysis utilized Kaplan–Meier survival technique and competing risk analysis. Results: Thirty-six patients were included from five institutions. Spindle survivorship was 86.3% (95% confidence interval [CI], 67.7–93.5) at 10 years. Two patients had a failure of osseointegration (5.7%), both within 12 months. Twenty-two (59%) patients had 70 lengthening procedures, with mean expansions of 3.2 cm (range: 1–9) over 3.4 surgeries. The expandable mechanism failed in eight patients with a cumulative incidence of 16.1% (95% CI, 5.6–31.5) at 5 years. Twenty-nine patients sustained International Society of Limb Salvage failures requiring 63 unplanned surgeries. Periprosthetic joint infection occurred in six patients (16.7%). Limb preservation rate was 91% at 10 years. Conclusions: There is a high rate of osseointegration of the Compress{\textregistered} spindle among pediatric patients when coupled with an expandable implant. However, there is a high rate of expansion mechanism failure and prosthetic joint infections requiring revision surgery. Level of evidence: Level IV, therapeutic study.",
keywords = "expandable endoprosthesis, limb-salvage surgery, pediatric sarcoma",
author = "{other members of Study Group FORCE} and Tanaka, {Kara S.} and Andaya, {Veronica R.} and Thorpe, {Steven W.} and Gundle, {Kenneth R.} and Hayden, {James B.} and Duong, {Yee Cheen} and Avedian, {Raffi S.} and Mohler, {David G.} and Morse, {Lee J.} and Zimel, {Melissa N.} and O'Donnell, {Richard J.} and Andrew Fang and Randall, {Robert Lor} and Tran, {Tina H.} and Christin New and Wustrack, {Rosanna L.}",
note = "Funding Information: We thank Li Zhang, PhD, from the Division of Hematology and Medical Oncology, for her work on the statistical analysis, Anne Griffin, PhD, from the UCSF Cancer Registry, for her help with patient data, and Stephen and Diane Heiman for supporting medical student research through the Department of Orthopaedic Surgery, University of California, San Francisco. Thank you to Chancey Sweeney and Gaby Zumaran from the University of California, Davis, Department of Orthopaedic Surgery, and to Rebecca Wetzel from Oregon Health and Science University, Department of Orthopaedics and Rehabilitation for their administrative support. This study was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through UCSF‐CTSI Grant Number UL1‐TR001872. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. Support for the study was provided in part by the Taube Family Foundation. Funding Information: We thank Li Zhang, PhD, from the Division of Hematology and Medical Oncology, for her work on the statistical analysis, Anne Griffin, PhD, from the UCSF Cancer Registry, for her help with patient data, and Stephen and Diane Heiman for supporting medical student research through the Department of Orthopaedic Surgery, University of California, San Francisco. Thank you to Chancey Sweeney and Gaby Zumaran from the University of California, Davis, Department of Orthopaedic Surgery, and to Rebecca Wetzel from Oregon Health and Science University, Department of Orthopaedics and Rehabilitation for their administrative support. This study was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through UCSF-CTSI Grant Number UL1-TR001872. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. Support for the study was provided in part by the Taube Family Foundation. Publisher Copyright: {\textcopyright} 2022 The Authors. Journal of Surgical Oncology published by Wiley Periodicals LLC.",
year = "2023",
month = jan,
doi = "10.1002/jso.27094",
language = "English (US)",
volume = "127",
pages = "148--158",
journal = "Journal of surgical oncology",
issn = "0022-4790",
publisher = "Wiley-Liss Inc.",
number = "1",
}