Orthopedic Surgical Oncology For Bone Tumors: A Case Study Atlas

Description

This atlas presents a collection of richly illustrated teaching cases. It covers the fundamentals of orthopedic oncology complemented with relevant aspects that are demonstrated using individual cases. In a specialty that deals with a relatively smaller number of cases compared to tumors of other systems, this atlas prepares readers for clinical practice by combining a problem-based learning (PBL) approach, which lies on the continuum between structured and guided learning, with theory and practical insights. The book is divided into sections, arranged according to anatomical regions and the reconstruction type. Each section focuses on a specific anatomical region, and each case presentation includes the basic clinical history, basic principles, preoperative, perioperative and radiographic images, a pitfall list, treatment strategy, technical pearls, outcomes and complications. For each region the authors discuss both the biological and non-biological reconstruction techniques. The book is designed to actively involve the reader, making it an invaluable tool for all orthopedic surgeons confronted with oncologic surgery. The book is intended for trainees in orthopedics, orthopedic oncology fellows as well as practicing consultants. Foreword Preface Contents Part I: Philosophy of Limb Salvage Surgery 1: When and Why Biological/Implant Reconstruction? 1.1 Principles of Limb Salvage Surgery 1.2 When and Why Biological Reconstruction? 1.3 When and Why Implant (Non-biological) Reconstruction? 1.4 The Gray Zone 1.5 Conclusion References Part II: Mobile Spine 2: Biological Reconstruction Using Frozen Autograft in Total En Bloc Spondylectomy for Spinal Tumors 2.1 Introduction 2.2 Brief Clinical History 2.3 Preoperative Clinical Photos and Radiographs 2.4 Preoperative Problem List 2.5 Treatment Strategy 2.6 Basic Principles 2.7 Intraoperative 2.8 Technical Pearls 2.9 Outcome Clinical Photos and Radiographs 2.10 Avoiding and Managing Problems References 3: Implant Reconstruction of the Mobile Spine 3.1 Brief Clinical History 3.2 Preoperative Clinical Photos and Imaging 3.3 Preoperative Problem List 3.4 Treatment Strategy 3.5 Basic Principles 3.6 Clinical Photos and Imaging During Treatment 3.7 Technical Pearls 3.8 Outcome Clinical Photos and Imaging 3.9 Avoiding and Managing Complications 3.10 Cross-References References and Additional Reading Part III: Sacrum 4: Biological Sacral Reconstruction 4.1 Basic Clinical History 4.2 Preoperative Photos and X-Rays 4.3 Problem List 4.4 Treatment Strategy 4.5 Basic Principles 4.6 Photos and X-Rays During Treatment 4.7 Technical Pearls 4.8 Outcome Photos and X-Rays 4.9 Avoiding and Managing Complications 4.10 Cross References: List of Other Similar Cases in the Atlas References 5: Total Sacrectomy Without Spinopelvic Reconstruction 5.1 Introduction 5.2 Brief Clinical History 5.3 Preoperative Clinical Photos and Radiographs 5.4 Preoperative Problem List 5.5 Treatment Strategy and Considerations 5.6 Basic Principles 5.7 Images During Treatment 5.8 Technical Pearls 5.9 Outcomes, Clinical Photos, and Radiographs 5.10 Avoiding and Managing Problems 5.10.1 Intraoperative Massive Bleeding 5.10.2 Recurrence 5.10.3 Nerve Injury 5.10.4 Rectal Injury 5.10.5 Wound Dehiscence and Infection 5.10.6 Pain after Total Sacrectomy 5.11 Conclusion References 6: Implant Reconstruction of the Sacrum: Modular Sacrum Prosthesis 6.1 Introduction 6.2 Brief Clinical History 6.3 Preoperative Clinical Photos and Radiographs 6.4 Preoperative Problem List 6.5 Treatment Strategy 6.6 Basic Principles 6.7 Intra-operative Images 6.8 Technical Pearls 6.9 Outcome Clinical Photos and Radiographs 6.10 Avoiding and Managing Problems References Part IV: Pelvis 7: Biological Reconstruction of the Pelvis: I: Liquid-Nitrogen Treated Autograft and Onlaid Free Vascular Fibula 7.1 Introduction 7.2 Brief Clinical History 7.3 Preoperative Clinical Photos and Radiographs 7.4 Preoperative Problem List 7.5 Treatment Strategy 7.6 Basic Principles 7.7 Intraoperative Images 7.8 Technical Pearls 7.9 Outcome Clinical Photos and Radiographs 7.10 Avoiding and Managing Problems References 8: Biological Reconstruction of the Pelvis: II: Femoral Head Plus Total Hip Replacement 8.1 Introduction 8.2 Brief Clinical History 8.3 Preoperative Clinical Photos and Radiographs 8.4 Preoperative Problem List 8.5 Treatment Strategy 8.6 Basic Principles 8.7 Intraoperative Images 8.8 Technical Pearls 8.9 Outcome Clinical Photos and Radiographs 8.10 Avoiding and Managing Problems References 9: Implant Reconstruction of the Pelvis: I: Modular Hemipelvic Prosthesis 9.1 Introduction 9.2 Brief Clinical History 9.3 Preoperative Clinical Photos and Radiographs 9.4 Preoperative Problem List 9.5 Treatment Strategy 9.6 Basic Principles 9.7 Intraoperative Images 9.8 Technical Pearls 9.9 Outcome Clinical Photos and Radiographs 9.10 Avoiding and Managing Problems References 10: Implant Reconstruction of the Pelvis: II: Modular Pedestal Cup Prosthesis 10.1 Brief Clinical History 10.2 Preoperative Imaging 10.3 Problem List 10.4 Treatment Strategy 10.5 Basic Principles 10.6 Photos of Preoperative Planning and Intraoperative Photographs 10.7 Technical Pearls 10.8 Outcome Photos and Imaging 10.9 Avoiding and Managing Complications References 11: Implant Reconstruction of the Pelvis: III High Acetabular Placement and Prosthetic Femoral Extension 11.1 Introduction 11.2 Brief Clinical History 11.3 Preoperative Clinical Photos and Radiographs 11.4 Preoperative Problem List 11.5 Treatment Strategy 11.6 Basic Principles 11.7 Intraoperative Images 11.8 Technical Pearls (Fig. 11.4) 11.9 Outcome Clinical Photos and Radiographs 11.10 Avoiding and Managing Problems References 12: Implant Reconstruction of the Pelvis: IV: 3D-Printed Custom-Made Prosthesis 12.1 Introduction 12.2 Basic Clinical History 12.3 Preoperative Radiographs 12.4 Preoperative Problem List 12.5 Treatment Strategy 12.6 Basic Principles 12.7 Photos and Imaging During Treatment 12.8 Technical Pearls 12.9 Outcome Photos and Imaging 12.10 Avoiding and Managing Complications References Part V: Proximal Femur 13: Biological Reconstruction of the Proximal Femur with Extracorporeally Irradiated Autograft 13.1 Introduction 13.2 Brief Clinical History 13.3 Preoperative Problem List 13.4 Treatment Strategy 13.5 Basic Principles 13.6 Intraoperative Images 13.7 Technical Pearls 13.8 Outcome Clinical Images and Radiographs 13.9 Avoiding and Managing Problems References 14: Implant Reconstruction of the Proximal Femur: Modular Prosthesis 14.1 Brief Clinical History 14.2 Preoperative Problem List 14.3 Treatment Strategy 14.4 Preoperative Clinical Photos and Radiographs 14.5 Basic Principles of Surgery 14.6 Images During Treatment 14.7 Oncologic and Functional Outcomes 14.8 Outcome Clinical Images and Radiographs 14.9 Technical Pearls 14.10 Avoiding and Managing Problems 15: Prosthetic Reconstruction for Soft Tissue Sarcomas with Bone Involvement 15.1 Introduction 15.2 Case 1 15.2.1 Brief Clinical History 15.2.2 Preoperative Radiographs 15.2.3 Preoperative Problem List 15.2.4 Treatment Strategy 15.2.5 Basic Principles 15.2.6 Intraoperative Images 15.2.7 Technical Pearls 15.2.8 Outcome Radiographs 15.2.9 Avoiding and Managing Problems 15.3 Case 2 15.3.1 Additional Learning Points 15.4 Case 3 15.4.1 Additional Learning Points 15.5 Case 4 15.5.1 Additional Learning Points References Part VI: Femoral Diaphysis 16: Biological Reconstruction of the Femoral Diaphysis: Van Nes Rotationplasty 16.1 Introduction 16.2 Brief Clinical History 16.3 Preoperative Radiographs 16.4 Preoperative Problem List 16.5 Treatment Strategy 16.6 Basic Principles 16.7 Images During Treatment (Images are from Different Patients to Give the Best Pictorial Representation of Technique) 16.8 Technical Pearls 16.9 Outcome Clinical Photos and Radiographs 16.10 Avoiding and Managing Problems References 17: Implant Reconstruction of the Femoral Diaphysis: I: Intercalary Femur Prosthesis 17.1 Introduction 17.2 Basic Clinical History 17.3 Preoperative Clinical Images and Radiographs 17.4 Problem List 17.5 Treatment Strategy 17.6 Basic Principles 17.7 Outcome Images and Imaging 17.8 Technical Pearls 17.9 Avoiding and Managing Complications References 18: Implant Reconstruction of the Femoral Diaphysis: II—Short-Segment Dynamic Compression Stem 18.1 Introduction 18.2 Brief Clinical History 18.3 Preoperative Clinical Images and Radiographs 18.4 Preoperative Problem List 18.5 Treatment Strategy 18.6 Basic Principles 18.7 Intraoperative Images 18.8 Technical Pearls 18.9 Outcome Clinical Images and Radiographs 18.10 Avoiding and Managing Problems References Part VII: Distal Femur 19: Biological Reconstruction of the Distal Femur—I: Massive Allograft and Inlaid Free Vascular Fibula 19.1 Introduction 19.2 Brief Clinical History 19.3 Preoperative Images and X-Rays 19.4 Problem List 19.5 Treatment Strategy 19.6 Basic Principles 19.7 Photos and Images During Treatment 19.8 Technical Pearls 19.9 Outcome Images and Imaging 19.10 Avoiding and Managing Complications 19.11 Cross References: List of Other Similar Cases in the Atlas Bibliography 20: Biological Reconstruction of the Distal Femur: II: Resurfacing Allograft-Prosthesis Composite 20.1 Introduction 20.2 Brief Clinical History 20.3 Preoperative Clinical Image and Radiograph 20.4 Preoperative Problem List 20.5 Treatment Strategy 20.6 Basic Principles 20.7 Images During Treatment 20.8 Technical Pearl 20.9 Outcome Clinical Images and Radiographs 20.10 Avoiding and Managing Problems References 21: Biological Reconstruction of the Distal Femur: III Liquid Nitrogen Treated Autograft and Inlaid Free Vascular Fibula (the “Frozen Hotdog”) 21.1 Introduction 21.2 Brief Clinical History 21.3 Preoperative Clinical Images and Radiographs 21.4 Preoperative Problem List 21.5 Treatment Strategies 21.6 Basic Principles 21.7 Intraoperative Images 21.8 Technical Pearls 21.9 Outcome Clinical Images and Radiographs 21.10 Avoiding and Managing Problems References 22: Implant Reconstruction of the Distal Femur: I—Modular Prosthesis 22.1 Brief Clinical History 22.2 Preoperative Clinical Photos and Radiographs 22.3 Preoperative Problem List 22.4 Treatment Strategy 22.5 Basic Principles 22.6 Intraoperative Images 22.7 Technical Pearls 22.8 Outcome Clinical Photos and Radiographs 22.9 Avoiding and Managing Problems 22.10 Cross-References Bibliography 23: Implant Reconstruction of the Distal Femur: II—Joint-Preserving Resection and Reconstruction with Image-Guided Computer Navigation 23.1 Introduction 23.2 Basic Clinical History 23.3 Preoperative Clinical Photos and Imaging Investigations 23.4 Preoperative Problem Lists 23.5 Treatment Strategy 23.6 Basic Principles 23.6.1 Preoperative Planning 23.6.2 Intraoperative Surgical Exposure 23.6.3 Intraoperative Navigated Procedures 23.6.4 Placement of the Implant 23.6.5 Wound Closure 23.6.6 Postoperative Care 23.7 Preoperative Navigation Planning and Intraoperative Images 23.7.1 Preoperative Navigation Planning 23.7.2 Intraoperative Surgical Exposure 23.7.3 Intraoperative Navigated Procedures 23.7.4 Placement of the Implant 23.8 Technical Pearls 23.9 Outcome Clinical Photos and Radiographs 23.10 Avoiding and Managing Problems References 24: Implant Reconstruction of the Distal Femur: III—Expandable Prosthesis 24.1 Introduction 24.2 Brief Clinical History 24.3 Preoperative Clinical Photos and Radiographs 24.4 Preoperative Problem List 24.5 Treatment Strategy 24.6 Basic Principles 24.7 Intraoperative 24.8 Technical Pearls 24.9 Outcome Clinical Photos and Radiographs 24.10 Avoiding and Managing Problems References 25: Implant Reconstruction of the Distal Femur—IV: Prosthesis Revision 25.1 Brief Clinical History 25.2 Preoperative Clinical Photos and Radiographs 25.3 Preoperative Problem List 25.4 Treatment Strategy 25.5 Basic Principles 25.6 Images During Treatment 25.7 Technical Pearls 25.8 Outcome Clinical Photos and Radiographs 25.9 Avoiding and Managing Problems References Suggested Reading 26: Percutaneous Osseointegration Prosthesis 26.1 Introduction 26.2 Brief Clinical History 26.3 Preoperative Images and Radiographs 26.4 Preoperative Problem List 26.5 Treatment Strategy 26.6 Basic Principles 26.7 Images During Treatment 26.8 Technical Pearls 26.9 Outcome Images and Radiographs 26.10 Avoiding and Managing Problems References Part VIII: Proximal Tibia 27: Biological Reconstruction of the Proximal Shaft of Tibia—I: Pedicle Frozen Autograft 27.1 Introduction 27.2 Brief Clinical History 27.3 Preoperative Clinical Photos and Radiographs 27.4 Preoperative Problem List 27.5 Treatment Strategy 27.6 Basic Principles 27.7 Intraoperative Images 27.8 Technical Pearls 27.9 Outcome Clinical Photos and Radiographs 27.10 Avoiding and Managing Problems References 28: Biological Reconstruction of the Proximal Tibia—II: Distraction-Epiphysiolysis Before Resectioning of the Tumor 28.1 Basic Clinical History 28.2 Preoperative Images 28.3 Preoperative Problem List 28.4 Treatment Strategy 28.5 Basic Principles 28.6 Photos and Imaging During Treatment 28.7 Technical Pearls 28.8 Outcome Photos and Imaging 28.9 Avoiding and Managing Complications 28.10 Cross References: List of Other Similar Cases in the Atlas References 29: Implant Reconstruction of the Proximal Tibia: Modular Prosthesis and Rotational Gastrocnemius Flap 29.1 Brief Clinical History 29.2 Preoperative Photos and Radiographs 29.3 Preoperative Problem List 29.4 Treatment Strategy 29.5 Basic Principles 29.6 Photos and Imaging During Treatment 29.7 Technical Pearls 29.8 Outcome Photos and Imaging 29.9 Avoiding and Managing Complications 29.10 Cross References: List of Other Similar Cases in the Atlas References Part IX: Tibial Diaphysis and Ankle 30: Biological Reconstruction of the Tibial Diaphysis and Ankle—I: Ilizarov Technique 30.1 Introduction 30.2 Brief Clinical History 30.3 Preoperative Radiographs and Clinical Photos 30.4 Preoperative Problem List 30.5 Treatment Strategy 30.6 Basic Principles 30.7 Images During Treatment 30.8 Technical Pearls 30.9 Outcome Clinical Photos and Radiographs 30.10 Avoiding and Managing Problems References 31: Biological Reconstruction of the Tibial Diaphysis and Ankle—II: Fibular Centralization Technique 31.1 Introduction 31.2 Brief Clinical History 31.3 Preoperative Radiographs 31.4 Preoperative Problem List 31.5 Treatment Strategy 31.6 Basic Principles 31.7 Intraoperative Images (Intraoperative Images Are of a Different Patient to Give the Best Pictorial Representation of Technique) 31.8 Technical Pearls 31.9 Outcome Radiographs 31.10 Avoiding and Managing Problems References 32: Biological Reconstruction of the Tibial Diaphysis and Ankle—III: Arthrodesis with Massive Allograft 32.1 Brief Clinical History 32.2 Preoperative Photos and X-Rays 32.3 Problem List 32.4 Treatment Strategy 32.5 Basic Principles and Surgical Technique and Technical Pearls 32.6 To Avoid Complications 32.7 Photos and Imaging during Treatments 32.8 Outcome Photos and Imaging 32.9 Cross References: List of Other Similar Cases in the Atlas Bibliography 33: Implant Reconstruction of the Tibial Diaphysis and Ankle: 3D-Printed Custom-Made Prosthesis 33.1 Basic Clinical History 33.2 Preoperative Photos and X-Rays 33.3 Problem List 33.4 Treatment Strategy 33.5 Basic Principles 33.6 Photos and Imaging during Treatment 33.7 Technical Pearls 33.8 Outcome Photos and Imaging 33.9 Avoiding and Managing Complications Bibliography Part X: Foot 34: Biological Reconstruction of the Foot: Free Vascular Iliac Flap 34.1 Introduction 34.2 Brief Clinical History 34.3 Preoperative Clinical Photos and Radiographs 34.4 Preoperative Problem List 34.5 Treatment Strategy 34.6 Basic Principles 34.7 Intraoperative Images 34.8 Technical Pearls 34.9 Outcome Clinical Photos and Radiographs 34.10 Avoiding and Managing Problems References 35: Implant Reconstruction of the Foot 3D-Printed Custom-Made Prosthesis 35.1 Basic Clinical Ηistory 35.2 Preoperative Photos and X-Rays 35.3 Problem List 35.4 Treatment Strategy 35.5 Basic Principles 35.6 Photos and Imaging During Treatment 35.7 Technical Pearls 35.8 Outcome Photos and Imaging 35.9 Avoiding and Managing Complications Bibliography Part XI: Shoulder Girdle 36: Biological Reconstruction of the Shoulder Girdle: Scapular Massive Allograft 36.1 Introduction 36.2 Brief Clinical History and Preoperative Imaging 36.3 Treatment Strategy 36.3.1 First Step (Resection) 36.3.2 Second Step (Reconstruction) 36.4 Basic Principles and Surgical Technique 36.5 Technical Pearls 36.6 Clinical and Radiographical Outcome (12 Years Follow-Up) 36.7 Avoiding and Managing Complications References 37: Implant Reconstruction of the Shoulder Girdle: Scapular Prosthesis 37.1 Introduction 37.2 Brief Clinical History 37.3 Preoperative Clinical Photos and Radiographs 37.4 Preoperative Problem List 37.5 Treatment Strategy 37.6 Basic Principles 37.7 Images During Treatment 37.8 Technical Pearls 37.9 Outcome Clinical Photos and Radiographs 37.10 Avoiding and Managing Problems References Part XII: Proximal Humerus 38: Proximal Humerus, Biological Reconstruction 38.1 Basic Clinical History 38.2 Initial and Preoperative (After Neoadjuvant Chemotherapy) Radiological Studies 38.3 Preoperative Problem List 38.4 Treatment Strategy 38.5 Basic Principles 38.6 Photos and Imaging During Treatment 38.7 Technical Pearls 38.8 Outcome Photos and Imaging 38.9 Avoiding and Managing Complications Bibliography 39: Claviculo-Pro-Humero Reconstruction Following Proximal Humeral Resection 39.1 Brief History 39.2 Staging Investigations 39.2.1 Imaging 39.2.2 Biopsy 39.3 Preoperative Considerations 39.3.1 Anatomical Consideration 39.3.2 Advantages of CPH Reconstruction 39.3.3 Disadvantages of CPH Reconstruction 39.3.4 Indications 39.3.5 Contra-indications 39.3.6 Requirements 39.4 Preoperative Preparation 39.4.1 Anaesthesia 39.4.2 Intraoperative Positioning 39.4.3 Incision 39.5 Surgery: Tips and Traps 39.5.1 Soft Tissue Dissection 39.5.2 Osteotomy 39.5.3 Dissection of the Medial Clavicle 39.6 Postoperative Care 39.7 Discussion References 40: Biological Reconstruction of the Proximal Humerus—III: Massive Allograft and Inlaid Free Vascular Fibula Epiphyseal Transfer 40.1 Brief Clinical History 40.2 Preoperative Clinical Photos and Imaging 40.3 Preoperative Problem List 40.4 Treatment Strategies 40.5 Basic Principles 40.6 Clinical Photos and Imaging During Treatment 40.7 Technical Pearls 40.8 Outcome Clinical Photos and Imaging 40.9 Avoiding and Managing Complications References 41: Implant Reconstruction of the Proximal Humerus 41.1 Modular Endoprosthetic Reconstruction 41.1.1 Introduction 41.1.2 Brief Clinical History 41.1.3 Preoperative Imaging 41.1.4 Problem List 41.1.5 Treatment Strategy 41.1.6 Basic Principles 41.1.7 Photos of Preoperative Planning and Intraoperative Photographs 41.1.8 Technical Pearls 41.1.9 Outcome Photos and Imaging 41.1.10 Avoiding and Managing Complications 41.2 Reconstruction with a Temporary Spacer 41.2.1 Introduction 41.2.2 Brief Clinical History 41.2.3 Preoperative Imaging 41.2.4 Problem List 41.2.5 Treatment Strategy 41.2.6 Basic Principles 41.2.7 Photos and Imaging During Treatment 41.2.8 Technical Pearls 41.2.9 Outcome Photos and Imaging 41.2.10 Avoiding and Managing Complications References 42: Implant Reconstruction of the Proximal Humerus—II: Reverse Prosthesis 42.1 Basic Clinical History 42.2 Preoperative Photos and X-rays 42.3 Problem List 42.4 Treatment Strategy 42.5 Basic Principles 42.6 Photos and Imaging During Treatment 42.7 Technical Pearls 42.8 Outcome Photos and Imaging 42.9 Avoiding and Managing Complications Bibliography Part XIII: Humeral Diaphysis 43: Biological Reconstruction of the Humeral Diaphysis: Irradiated Autograft 43.1 Brief Clinical History 43.2 Preoperative Clinical Photos and Radiographs 43.3 Preoperative Problem List 43.4 Treatment Strategy 43.5 Basic Principles 43.6 Images During Treatment 43.7 Technical Pearls 43.8 Outcome Clinical Photos and Radiographs 43.9 Avoiding and Managing Problems References 44: Implant Reconstruction of the Humeral Diaphysis: Total Humerus Prosthesis 44.1 Brief Clinical History 44.2 Preoperative Radiographs and MRI Findings 44.3 Preoperative Problem List 44.4 Treatment Strategy 44.5 Principles of Surgery 44.6 Intraoperative Photographs 44.7 Technical Pearls 44.8 Postoperative Outcomes and Radiographs: (Fig. 44.19) 44.9 Avoiding and Managing Problems References Part XIV: Distal Humerus and Elbow 45: Implant Reconstruction of the Distal Humerus and Elbow: Modular Prosthesis 45.1 Brief Clinical History 45.2 Preoperative Photos and Radiographs 45.3 Preoperative Problem List 45.4 Treatment Strategy 45.5 Basic Principles 45.6 Photos and Imaging During Treatment 45.7 Technical Pearls 45.8 Outcome Photos and Imaging 45.9 Avoiding and Managing Complications 45.10 Cross References: List of Other Similar Cases in the Atlas References Part XV: Forearm, Wrist and Hand 46: Biological Reconstruction of the Forearm, Wrist, and Hand—I: Free Vascular Fibula 46.1 Introduction 46.2 Brief Clinical History 46.3 Preoperative Clinical Photos and Radiographs 46.4 Preoperative Problem List 46.5 Treatment Strategy 46.6 Basic Principles 46.7 Intraoperative Images 46.8 Technical Pearls 46.9 Outcome Clinical Photos and Radiographs 46.10 Avoiding and Managing Problems References 47: Biological Reconstruction of the Forearm, Wrist, and Hand—II: Transposition of the Distal Ulna 47.1 Introduction 47.2 Brief Clinical History 47.3 Preoperative Clinical Photos and Radiographs 47.4 Preoperative Problem List 47.5 Treatment Strategy 47.6 Basic Principles 47.7 Intraoperative Images (Intraoperative Images Are of a Different Patient to Give the Best Pictorial Representation of Technique) 47.8 Technical Pearls 47.9 Avoiding and Managing Problems References 48: Implant Reconstruction of the Forearm, Wrist and Hand: Distal Radius Endoprosthesis 48.1 Brief Clinical History 48.2 Preoperative Radiographs 48.3 Preoperative Problem List 48.4 Implant Design 48.5 Treatment Strategy 48.6 Principles of Surgery 48.7 Technical Pearls 48.8 Avoiding and Managing Problems References Part XVI: Complications of Orthopedic Oncologic Reconstructions 49: Complications of Orthopedic Oncologic Reconstructions Using Biological Reconstruction 49.1 Introduction 49.2 Case 1: Age-Independent and Age-Dependent Complications 49.2.1 Brief Clinical History 49.2.2 Preoperative Clinical Photos and Radiographs 49.2.3 Preoperative Problem List 49.2.4 Treatment Strategy 49.2.5 Basic Principles 49.2.6 Images During Treatment 49.2.7 Technical Pearls 49.2.8 Outcome Clinical Photos and Radiographs 49.2.9 Avoiding and Managing Problems 49.3 Case 2: Age-Independent Complication 49.3.1 Brief Clinical History 49.3.2 Preoperative Clinical Photos and Radiographs 49.3.3 Preoperative Problem List 49.3.4 Treatment Strategy 49.3.5 Basic Principles 49.3.6 Images During Treatment 49.3.7 Technical Pearls 49.3.8 Outcome Clinical Photos and Radiographs 49.3.9 Avoiding and Managing Problems 49.4 Case 3: Age-Dependent Complication 49.4.1 Brief Clinical History 49.4.2 Preoperative Clinical Photos and Radiographs 49.4.3 Preoperative Problem List 49.4.4 Treatment Strategy [11] 49.4.5 Basic Principles [11] 49.4.6 Images During Treatment 49.4.7 Technical Pearls [11] 49.4.8 Outcome Clinical Photos and Radiographs 49.4.9 Avoiding and Managing Problems [11] 49.5 Case 4: Age-Dependent Complication 49.5.1 Brief Clinical History 49.5.2 Preoperative Clinical Photos and Radiographs 49.5.3 Preoperative Problem List 49.5.4 Treatment Strategy 49.5.5 Basic Principles [13] 49.5.6 Images During Treatment 49.5.7 Technical Pearls [13] 49.5.8 Outcome Clinical Photos and Radiographs 49.5.9 Avoiding and Managing Problems [14] References Suggested Reading 50: Complications of Orthopedic Oncologic Reconstructions Using Implants 50.1 Introduction 50.2 Case 1: Age-Dependent Complication 50.2.1 Brief Clinical History 50.2.2 Preoperative Clinical Photos and Radiographs 50.2.3 Preoperative Problem List 50.2.4 Treatment Strategy 50.2.5 Basic Principles 50.2.6 Images During Treatment 50.2.7 Technical Pearls 50.2.8 Outcome Clinical Photos and Radiographs 50.2.9 Avoiding and Managing Problems 50.3 Case 2: Age-Dependent complication 50.3.1 Brief Clinical History 50.3.2 Preoperative Clinical Photos and Radiographs 50.3.3 Preoperative Problem List 50.3.4 Treatment Strategy 50.3.5 Basic Principles 50.3.6 Images During Treatment 50.3.7 Technical Pearls 50.3.8 Outcome Clinical Photos and Radiographs 50.3.9 Avoiding and Managing Problems 50.4 Case 3: Age-Dependent Complication 50.4.1 Brief Clinical History 50.4.2 Preoperative Clinical Photos and Radiographs 50.4.3 Preoperative Problem List 50.4.4 Treatment Strategy 50.4.5 Basic Principles 50.4.6 Images During Treatment 50.4.7 Technical Pearls 50.4.8 Outcome Clinical Photos and Radiographs 50.4.9 Avoiding and Managing Problems 50.5 Case 4: Age Independent Complication 50.5.1 Brief Clinical History 50.5.2 Preoperative Clinical Photos and Radiographs 50.5.3 Preoperative Problem List 50.5.4 Treatment Strategy [15] 50.5.5 Basic Principles [15–17] 50.5.6 Images During Treatment 50.5.7 Technical Pearls [15–17] 50.5.8 Outcome Clinical Photos and Radiographs 50.5.9 Avoiding and Managing Problems 50.6 Case 5: Age-independent complication 50.6.1 Brief Clinical History 50.6.2 Preoperative Clinical Photos and Radiographs 50.6.3 Preoperative Problem List 50.6.4 Treatment Strategy 50.6.5 Basic Principles 50.6.6 Images During Treatment 50.6.7 Technical Pearls 50.6.8 Outcome Clinical Photos and Radiographs 50.6.9 Avoiding and Managing Problems References