Vyrva O. Modular custom made endoprosthesis in the treatment of malignant bone tumors of the limbs

The thesis is dedicated to improving the effectiveness of surgical treatment of patients with malignant bone tumors of the limbs through the substantiation, development and practical application of the methods of replacement of postresection bone-joints defects with modular custom made endoprosthesis. The thesis analyzes the results of existing methods of replacement of postresection bone-joints defects in the system of comprehensive treatment of malignant bone tumors of the limbs, identifies the correlation between the biochemical data, as well as the state of immunoreactivity in patients with malignant bone tumors. Theoretical and experimental studies allowed to explore the methotrexate elution kinetics from granules of hydroxyapatite ceramics, to investigate the morphological particulars of the osteoreparation under the implantation of ceramic samples saturated with cytostatics, to investigate the morphological particulars of bone-to-ceramics connection while using ceramic-coated implant samples. Conducted clinical studies allowed to develop an algorithm for diagnostics of malignant tumors of the limbs and a technology of surgical intervention to remove malignant bone tumors and modular custom made tumor endoprosthesis replacement. The author developed personal unified modular systems for tumor endoprosthesis replacement of bone-joints defects of the limbs of different sizes and localization, and conducted their clinical approbation together with the biomechanical examination. The thesis analyses treatment results of 166 patients with malignant tumors of the limbs, as well as complications after the use of the modular custom made tumor endoprosthesis for replacing postresection bone-joints defects. The main results of the research have been practically applied in specialized medical institutions for surgical treatment of patients with malignant bone tumors. Obtained functional results in patients after tumor endoprosthesis replacement meet international data in accordance with MSTS and TESS scales, and testify in favor of high efficiency of such a surgical treatment method in the complex therapy system for patients with malignant tumors of the limbs.