Distal femur and proximal tibia replacement with megaprosthesis in revision knee arthroplasty: a limb-saving procedure

Höll, Steffen; Schlomberg, Annabel; Gosheger, Georg; Dieckmann, Ralf; Streitbuerger, Arne; Schulz, Dino; Hardes, Jendrik

doi:10.1007/s00167-012-1945-2

Cited by 91 publications

(90 citation statements)

References 30 publications

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“…For comparison, previously reported infection history preimplantation has ranged from 16% to 20% for distal and 4% to 16% for diaphyseal endoprostheses [10,11,20]. Previously reported infection risk after endoprosthetic reconstruction of various lengths for revision arthroplasty in the nononcologic setting have varied from 13% to 35% for distal through total femoral replacements [1,2,6,[10][11][12]20]. Our high proportion of patients with a PJI history compared with previously reported cohorts likely contributed to the high proportion of patients who developed postoperative infection overall in this series; however, we feel the bigger cases through larger exposures in patients with multiple comorbidities and compromised soft tissues likely all contribute to the higher prevalence in the diaphyseal group.…”

Section: Discussionmentioning

confidence: 99%

“…Seven of 22 had the twostage exchange immediately before endoprosthetic implantation. For comparison, previously reported infection history preimplantation has ranged from 16% to 20% for distal and 4% to 16% for diaphyseal endoprostheses [10,11,20]. Previously reported infection risk after endoprosthetic reconstruction of various lengths for revision arthroplasty in the nononcologic setting have varied from 13% to 35% for distal through total femoral replacements [1,2,6,[10][11][12]20].…”

Section: Discussionmentioning

confidence: 99%

“…An endoprosthesis is an effective alternative to structural allograft reconstruction for revision TKA in the setting of severe femoral bone loss. The relative ease of insertion and early mobility it affords are attractive benefits, especially for older and frailer individuals [5,9,10].…”

Section: Introductionmentioning

confidence: 99%

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Length of Endoprosthetic Reconstruction in Revision Knee Arthroplasty Is Associated With Complications and Reoperations

Barry

Thielen

Sing

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Complex revision total knee arthroplasty (TKA) often calls for endoprosthetic reconstruction to address bone loss, poor bone quality, and soft tissue insufficiency. Larger amounts of segmental bone loss in the setting of joint replacement may be associated with greater areas of devascularized tissue, which could increase the risk of complications and worsen functional results. Questions/purposes Are longer endoprosthetic reconstructions associated with (1) higher risk of deep infection; (2) increased risk of reoperation and decreased implant survivorship; or (3) poorer ambulatory status? Methods This is a single-institution retrospective case series of nononcologic femoral endoprosthetic reconstructions for revision TKA from 1995 to 2013 (n = 32). Cases were categorized as distal (n = 17) or diaphyseal (n = 15) femoral reconstructions based on extension to or above the supracondylar metaphyseal-diaphyseal junction, respectively. Five patients from each group were lost to followup before 2 years (distal mean 4 years [range, 2-8 years]; diaphyseal mean = 6 years [range, 2-16 years]), and one of the 12 distal reconstructions and two of the 10 diaphyseal reconstructions had not been evaluated within the past 5 years. Clinical outcomes and ambulatory status (able to walk or not) were assessed through chart review by authors not involved in any cases. Prior incidence of periprosthetic joint infection was high in both groups (distal = seven of 12 versus diaphyseal = four of 10; p = 0.670). Results Patients with diaphyseal femoral replacements were more likely to develop postoperative deep infections than patients with distal femoral replacements (distal = three of 12 versus diaphyseal = nine of 10; p = 0.004). Implant survivorship (revision-free) for diaphyseal reconstructions was worse at 2 years (distal = 100%, 95% confidence interval [CI], 100%-100% versus diaphyseal = 40%, 95% CI, 19%-86%; p = 0.001) and 5 years (distal = 90%, 95% CI, 75%-100% versus diaphyseal = 30%, 95% CI, 12%-73%; p = 0.001). Infection-free, revision-free survival (retention AND no infection) was worse for diaphyseal femoral replacing reconstructions than for distal femoral replacements at 2 years (distal = 70%, 95% CI, 48%-100% versus diaphyseal = 20%, 95% CI, 6%-69%; p = 0.037) and 5 years (distal = 70%, 95% CI, 48%-100% versus diaphyseal = 10%, 95% CI, 2%-

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Length of Endoprosthetic Reconstruction in Revision Knee Arthroplasty Is Associated With Complications and Reoperations

Barry

Thielen

Sing

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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“…In the literature, the rate of deep infection has ranges from 3%-10% [1, 11,13,23,24]. Removal of the endoprosthesis, curettage, debridement, irrigation and filling the gaps with spacers for 3 months and reinsertion of the endoprosthesis again were performed in three patients; in two patients we had unsatisfactory final results: amputation following local recurrence in one patient and knee ankyloses in the other patient.…”

Section: Discussionmentioning

confidence: 99%

Limb Salvage Surgery for Bone Tumors around the Knee: The Oncological and Functional Outcome—King Hussein Medical Center Experience

Al-Zaben¹,

Alturk²,

Alkhawaldah³

et al. 2015

UCMS

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Abstract:It is a challenge to save the lower limb with a malignant or invasive benign bone tumor around the knee. Retrospectively, we analyzed 30 patients with bone tumors around the knee region. The distal femur involved in 24 patients and proximal tibia in six patients. The tumors included 25 primary malignancies, two metastatic lesions and three giant cell tumors. The reconstruction procedures included 28 endoprosthesis replacements and two autogenous fibular grafts. The average follow-up was 35 months. Twelve patients died and 18 remained disease free. The five year survival rate of 25 patients with primary malignant bone tumors was 60%. The average MSTS (Musculoskeletal Tumor Society) functional score was 60% (range 20%-100%) in all patients. So we conclude that the limb-salvage procedures which accompanied with neo-adjuvant chemotherapy and post-operative chemotherapy are relatively safe. The functional outcome study has inherent limitations which are the inability to randomize treatment and the subjective of the measures, but we conclude that remaining 18 patients were active at home with efficient gait in home and outdoor at a mean of 30 months and those with more functional lower limbs had better quality of life. The infection was the leading cause of surgical complications which needed multi-staged surgery and associated with lower functional outcome. In our opinion, endoprosthesis should be considered as the treatment of choice for bone tumors around the knee joint. Advances in limb salvage surgery are, and will long continue to be, a great challenge for orthopedic oncologists of the 21st century.

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“…While the study numbers are limited (further so by loss to followup), and the timeframe quite broad due to the fortunate rarity of these reconstructions, their results provide a sobering snapshot of ''where we are now.'' To prevent the reader from dismissing these findings as ''just one retrospective study,'' I would highlight the authors' point that infection rates as high as 35% and reoperation rates as high as 59% have been reported by others following similar procedures [1,5].…”

mentioning

confidence: 99%

CORR Insights®: Length of Endoprosthetic Reconstruction in Revision Knee Arthroplasty Is Associated With Complications and Reoperations

Potter

2017

Clinical Orthopaedics &Amp; Related Research

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Distal femur and proximal tibia replacement with megaprosthesis in revision knee arthroplasty: a limb-saving procedure

Abstract: Megaprosthesis implantation in revision knee arthroplasty is an exceptional indication. Despite the high complication rate, the patients can be spared amputation in most cases, and rapid mobilization with full weight-bearing is possible.

Cited by 91 publications

References 30 publications

Length of Endoprosthetic Reconstruction in Revision Knee Arthroplasty Is Associated With Complications and Reoperations

Length of Endoprosthetic Reconstruction in Revision Knee Arthroplasty Is Associated With Complications and Reoperations

Limb Salvage Surgery for Bone Tumors around the Knee: The Oncological and Functional Outcome—King Hussein Medical Center Experience

CORR Insights®: Length of Endoprosthetic Reconstruction in Revision Knee Arthroplasty Is Associated With Complications and Reoperations

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