Endoprosthetic replacement of the distal femur for bone tumours

Abstract

We investigated whether improvements in design have altered the outcome for patients undergoing endoprosthetic replacement of the distal femur after resection of a tumour. Survival of the implant and 'servicing' procedures have been documented using a prospective database, review of the design of the implant and case records. In total, 335 patients underwent a distal femoral replacement, 162 having a fixed-hinge design and 173 a rotating-hinge. The median age of the patients was 24 years (interquartile range 17 to 48). A total of 192 patients remained alive with a mean follow-up of 12 years (5 to 30). The risk of revision for any reason was 17% at five years, 33% at ten years and 58% at 20 years. Aseptic loosening was the main reason for revision of the fixed-hinge knees while infection and fracture of the stem were the most common for the rotating-hinge implant. The risk of revision for aseptic loosening was 35% at ten years with the fixed-hinge knee, which has, however, been replaced by the rotating-hinge knee with a hydroxyapatite collar. The overall risk of revision for any reason fell by 52% when the rotating-hinge implant was used. Improvements in the design of distal femoral endoprostheses have significantly decreased the need for revision operations, but infection remains a serious problem. We believe that a cemented, rotating-hinge prosthesis with a hydroxyapatite collar offers the best chance of long-term survival of the prosthesis.

Aseptic Failure: How Does the Compress® Implant Compare to Cemented Stems?

“…Data from the Royal Orthopaedic Hospital published over a longer period of time with a greater number of patients demonstrate this point. The authors found an 83% implant survival at 5 years, and the risk of revision fell by 52% when rotating-hinge knee implants with hydroxyapatite collars were used in exchange for fixed-hinge knee implants with a smooth collar [19]. In that series, there were no patients with aseptic loosening in adult patients with cemented stems and hydroxyapatite collars at a mean followup of 12 years.…”

“…Were the study to be started today, it would be possible to more carefully match CIS primary oncologic nonexpandable implants with the same CPS indications, for which a more robust patient population now exists. It is also important to note the reliability of Stanmore CIS implants has been well-documented, and furthermore, technical design advancement in these cemented limb salvage prostheses have been associated with improved implant longevity [19]. Data from the Royal Orthopaedic Hospital published over a longer period of time with a greater number of patients demonstrate this point.…”

Extracorporeally irradiated autografts for the treatment of bone tumours: tips and tricks

“…Prosthetic reconstruction allows rapid restoration of mobility and weightbearing, but complications have been described in 25-92% of cases [2,3]. A 57% cumulative five-year survival for knee prostheses has been reported [4].…”

Biological reconstruction of bone defects: The role of the free fibula flap

“…This type of reconstruction allows a functional reconstruction by preserving joint movement. There are, however, disadvantages, including infection, prosthesis loosening, the need to change prostheses in a growing child, a limitation to their function and lifestyle, and, perhaps the most significant disadvantage, limited durability, especially when performed in paediatric populations and in young adults [45,46]. To achieve an ideal reconstruction, the resected bone and joint should be replaced with an identical vascularised bone.…”