Cemented &lt;em&gt;versus&lt;/em&gt; cementless megaprosthesis in proximal femur metastatic disease: A systematic review

Oliva, Maria Serena; Vitiello, Raffaele; Cauteruccio, Michele; Pesare, Elisa; Rovere, Giuseppe; Meschini, Cesare; Liuzza, Francesco; Maccauro, Giulio; Ziranu, Antonio

doi:10.4081/or.2020.8689

Cited by 19 publications

(20 citation statements)

References 16 publications

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“…Furthermore, excision of large segments of the joint requires extensive joint reconstruction. Allogenic bone graft or cement for this reconstruction leads to reduced joint function and a similar risk of infection to other internal plants [ 17 , 18 ]. Therefore, despite its limited indications, hemicortical resection followed by inactivation and replantation is recognized and applied by many scholars [ 6 – 8 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

3D printing guide plate for accurate hemicortical bone tumor resection in metaphysis of distal femoral: a technical note

Yang

Liu

et al. 2021

J Orthop Surg Res

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Background Surgical resection and reconstruction for low-grade bone sarcoma in the metaphysis of the distal femur remain challenging. We hypothesized that 3D printing osteotomy guide plate could assist to accurately resect the tumor lesion and save the joint function. Methods From January 2017 to August 2019, five patients diagnosed with low-grade bone sarcoma in the metaphysis of the distal femur were treated with hemicortical resection using 3D printing guide plate. Autologous bone graft was inactivated in a high-temperature water bath and re-implanted in situ fixed with plate and screw. Patients were followed up from 17 to 33 months. The Musculoskeletal Tumor Society Score was used to evaluate the joint function. X-ray was used to evaluate the bone union. Results One patient was paracorticular osteosarcoma, and four cases had highly differentiated chondrosarcoma. All cases were involved in the metaphysis of the distal femur. Patients were followed up from 13 to 33 months, with an average of 23.6 months. There was neither post-operation infection, internal fixation loosening, nor fracture occurrence in any of the patients. The Musculoskeletal Tumor Society Score averaged at 28.1, while the International Society of Limb Salvage imaging score examination averaged 89.8%. Conclusions Here, we demonstrate that the 3D printing osteotomy guide plate-assisted hemicortical bone resection is a beneficial strategy to effectively resect the primary low-grade malignant bone tumors in the metaphysis of the distal femur and retained satisfied joint function.

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Section: Discussionmentioning

confidence: 99%

3D printing guide plate for accurate hemicortical bone tumor resection in metaphysis of distal femoral: a technical note

Yang

Liu

et al. 2021

J Orthop Surg Res

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“…Due to heterogenic patient populations, different implant types and retrospective study designs, it is still unclear if cemented or press-fit diaphyseal stems show better results regarding implant survival in megaprostheses [ 1 , 3 , 7 , 21 , 30 ]. Investigations performed by Pala et al [ 31 ], Gebert et al [ 32 ] and Oliva et al [ 33 ] suggested favourable results in cementless prostheses, whereas Gerdemeyer et al [ 30 ] and Toepfer et al [ 21 ] found fewer cases of aspetic loosening in cemented megaprostheses of the distal femur in their case series.…”

Section: Discussionmentioning

confidence: 99%

Different outcomes after proximal femoral replacement in oncologic and failed revision arthroplasty patients - a retrospective cohort study

Toepfer

Straßer

Ladurner

et al. 2021

BMC Musculoskelet Disord

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Background Proximal femoral replacement (PFR) is a technically demanding procedure commonly performed to restore extensive, oncological or non-oncological bone defects in a severely debilitated patient collective. Depending on different indications, a varying outcome has been reported. The aim of the study was to assess the functional outcomes and complication rates of PFR with the modular Munich-Luebeck (MML) femoral megaprosthesis (ESKA/Orthodynamics, Luebeck, Germany), and to highlight outcome differences in patients treated for failed revision total hip arthroplasty (THA) or malignant bone disease. Methods A retrospective review of patients treated with PFR for failed THA or malignant tumor disease between 2000 and 2012 was performed. Patient satisfaction, functional outcome (VAS, SF-12, MSTS, WOMAC, TESS), complications and failure types (Henderson’s failure classification) were assessed. A Kaplan-Meier analysis determined implant survival. Results Fifty-eight patients (age: 69.9 years, BMI: 26.7 kg/m2, mean follow-up: 66 months) were included. The mean SF-12 (physical / mental) was 37.9 / 48.4. MSTS averaged 68% at final follow-up, while mean WOMAC and TESS scored 37.8 and 59.5. TESS and WOMAC scores demonstrated significantly worse outcomes in the revision group (RG) compared to the tumor group (TG). Overall complication rate was 43.1%, and dislocation was the most common complication (27.6%). Implant survival rates were 83% (RG) and 85% (TG; p = n.s.) at 5 years, while 10-year survival was 57% (RG) and 85% (TG, p < 0.05). Conclusions PFR is a salvage procedure for restoration of mechanical integrity and limb preservation after extensive bone loss. Complications rates are considerably high. Functional outcomes and 10-year implant survival rate were worse in the RG compared to the TG. Strict indications and disease-specific patient education are essential in preoperative planning and prognosis.

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“…In case of severe proximal femoral bone loss multiple treatment options have been described in the literature, including structural allograft-prosthesis composite, impaction allografting, long revision stems, resection arthroplasty, and proximal femoral replacement (PFR) [ 3 , 4 , 8 ]. Proximal femoral replacement, also known as “megaprosthesis”, is a well-established limb salvage procedure for reconstruction of bone defects after the oncological resections of malignant bone neoplasms [ 9 ] and the encouraging outcomes have broadened the indications to the treatment of severe bone loss in non-oncologic conditions [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…Multiple studies have described the outcomes of PFR in oncologic patients [ 9 , 10 ], however, only few have described PFR usage in non-oncologic severe femoral bone loss associated with periprosthetic fracture, septic and aseptic revisions, or failed osteosynthesis. We therefore performed a systematic review of the literature in order to examine survivorship and complication rates of PFRs.…”

Section: Introductionmentioning

confidence: 99%

Survivorship and clinical outcomes of proximal femoral replacement in non-neoplastic primary and revision total hip arthroplasty: a systematic review

Mancino

Matteo

Mocini

et al. 2021

BMC Musculoskelet Disord

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Background Several studies have evaluated the survivorship and clinical outcomes of proximal femoral replacement (PFR) in complex primary and revision total hip arthroplasty with severe proximal femoral bone loss; however, there remains no consensus on the overall performance of this implant. We therefore performed a systematic review of the literature in order to examine survivorship and complication rates of PFR usage. Methods A systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. A comprehensive search of PubMed, MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews was conducted for English articles using various combinations of keywords. Results In all, 18 articles met the inclusion criteria. A total of 578 PFR were implanted. The all-cause reoperation-free survivorship was 76.6%. The overall complication rate was 27.2%. Dislocation was the most common complication observed and the most frequent reason for reoperation with an incidence of 12.8 and 7.6%, respectively. Infection after PFR had an incidence of 7.6% and a reoperation rate of 6.4%. The reoperation rate for aseptic loosening of the implant was 5.9%. Overall, patients had improved outcomes as documented by postoperative hip scores. Conclusion PFR usage have a relatively high complication rate, however, it remains an efficacious treatment option in elderly patients with osteoporotic bone affected by severe proximal femoral bone loss. Modular designs have shown reduced dislocations rate and higher survivorship free from dislocation. However, PFR should only be used as salvage procedure when no other reconstruction options are available.

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Cemented <em>versus</em> cementless megaprosthesis in proximal femur metastatic disease: A systematic review

Cited by 19 publications

References 16 publications

3D printing guide plate for accurate hemicortical bone tumor resection in metaphysis of distal femoral: a technical note

3D printing guide plate for accurate hemicortical bone tumor resection in metaphysis of distal femoral: a technical note

Different outcomes after proximal femoral replacement in oncologic and failed revision arthroplasty patients - a retrospective cohort study

Survivorship and clinical outcomes of proximal femoral replacement in non-neoplastic primary and revision total hip arthroplasty: a systematic review

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