INITIAL EXPERIENCE WITH MUTARS KNEE PROSTHESES IN CHILDREN
UŞAQLARDA MUTARS DİZ PROTEZİNİN TƏTBİQİNDƏ
İLK TƏCRÜBƏMİZ
НАЧАЛЬНЫЙ ОПЫТ ИСПОЛЬЗОВАНИЯ ПРОТЕЗОВ КОЛЕННОГО КОЛЕНА MUTARS У ДЕТЕЙ
LUBEN STOKOV1, GEORGI P. GEORGIEV2, VLADIMIR STAVREV3
1Clinic of Orthopedics and Traumatology, UMHAT “St. Anna”, Sofia, Bulgaria
2Department of Orthopaedics and Traumatology, University Hospital Queen Giovanna-ISUL, Medical University of Sofia, Bulgaria
3Department of Orthopaedics and Traumatology, Medical University of Plovdiv, Bulgaria
We introduced a reconstructive modular prosthesis for the first time in our country in 2010. Until March 2023, we have operated 10 children – 8 girls aged 9 to 17 years and 2 boys aged 4 and 8 years.
Eight children had an osteosarcoma of the femur, one patient had an Ewing sarcoma of the distal tibia, and another patient had an aggressive distal femur osteoclastoma with three surgeries before the prosthesis. The follow-up ranged from 6 months to 156 months (13 years). Three of the patients died between the 4th and 5th years postoperatively due to lung metastases.
Histologically, eight cases were diagnosed as classic osteosarcoma, one as Ewing sarcoma and one as osteoclastoma.
The imaging studies revealed engagement of the bone and surrounding soft tissues to various extents, sparing the main neurovascular bundle.
Preoperatively, patients were treated with chemotherapy according to the COSS-96 protocol, which resulted in delineation and arrest of tumor growth.
Preoperative planning included the volume of the resection with a 4 cm margin and the dimensions of the medullary canal in the area of implant fixation.
In 5 patients, extended femoral components were used. In another 5 of them, a growing prosthesis was used, subsequently in 3 of the femur and in another 2 of the tibia. In a 9-year-old patient, we performed a total femur replacement growing prosthesis, and in another 4-year-old patient, we performed a total tibial prosthesis with a distal femur replacement growing prosthesis. There were no neurovascular complications during follow-up.
Leg length discrepancy postoperatively ranged from 1-3 cm (90%).
Secondary stiffness and contractures occur because of leg lengthening (15-60%).
Coming incongruence between acetabulum and bipolar head because of lengthening (20%).
Aseptic loosening in follow-up in growing prosthesis (20%).
Damage to distant magnetic devices in growing prostheses (40%).
Infecting the tissues after repeating mechanical lengthening of the growing prosthesis (20%).