Distal Femur Allograft Prosthetic Composite Reconstruction for Short Proximal Femur Segments following Tumor Resection

Abstract

Short metaphyseal segments remaining after distal femoral tumor resection pose a unique challenge. Limb sparing options include a short stemmed modular prosthesis, total endoprosthetic replacement, cross-pin fixation to a custom implant, and allograft prosthetic composite reconstruction (APC). A series of patients with APC reconstruction were evaluated to determine functional and radiologic outcome and complication rates. Twelve patients were retrospectively identified who had a distal femoral APC reconstruction between 1994 and 2007 to salvage an extremity with a segment of remaining bone that was less than 20 centimeters in length. Seventeen APC reconstructions were performed in twelve patients. Eight were primary procedures and nine were revision procedures. Average f/u was 89 months. Twelve APC reconstructions (71%) united and five (29%) were persistent nonunions. At most recent followup 10 patients (83%) had a healed APC which allowed WBAT. One pt (8%) had an amputation and one pt (8%) died prior to union. Average time to union was 19 months. Four pts (33%) or five APC reconstructions (29%) required further surgery to obtain a united reconstruction. Although Distal Femoral APC reconstruction has a high complication rate, a stable reconstruction was obtained in 83% of patients.

Hip-preserving reconstruction using a customized cemented femoral endoprosthesis with a curved stem in patients with short proximal femur segments: Mid-term follow-up outcomes

“…In addition, proximal femoral resection can also result in the opening of an additional compartment, and the hip joint may be affected in cases of local infection or recurrence, necessitating hemipelvectomy in certain cases to achieve the margins necessary to avoid further local recurrence (22) Hip joint preservation is critical to the improvement of lower limb function, and bone stock preservation is critical to permit future revision. Reported hip-preserving reconstructive surgical approaches to date have included customized short medullary stems (23), stems with extra-cortical plates (19), allograft prosthetic composite (APC) (1,24), stems with cross-fixation pins (16,25) or the Compress® implant (26, 27). Short-stemmed endoprostheses have the potential to exhibit higher aseptic loosening and implant failure rates (28), with extracortical plates thus being employed in an effort to reduce these risks via supplemental fixation.…”

Bone regeneration during use of allo- and xenograftsin combination with bioactive blood serum factors

“…За даними різних авторів, частота незрощень після переломів довгих кісток кінцівок становить від 5-10 % [5] до 12,5-26 % [6,7]. Складними також є випадки заміщення великих дефектів кісток після видалення пухлин [8,9], високоенергетичних травм хребта [10]. Один із перспективних підходів -це застосування збагаченого тромбоцитами фібрину (англ.…”

Experimental and histological study of reparative osteogenesis in conditions of different methods of fixation during allograft alocompositive arthroplasty of long bones

“…Таким чином, вивчення різних аспектів алокомпозитного ендопротезування є актуальним і цікавим питанням сьогодення. Потребують поглибленого вивчення процеси репарації кістки у випадках автопластики зони контакту ендопротеза з кісткою, васкуляризації кісткового алотрансплантата алокомпозитного ендопротеза, остеоінтеграції керамічного покриття ніжки ендопротеза з васкуляризованим алотрансплантатом [8][9][10][11][12].…”