Mechanisms of failure and survival of total femoral endoprosthetic replacements

Abstract

Aims The aim of this study was to evaluate the prosthesis characteristics and associated conditions that may modify the survival of total femoral endoprosthetic replacements (TFEPR). Patients and Methods In all, 81 patients treated with TFEPR from 1976 to 2017 were retrospectively evaluated and failures were categorized according to the Henderson classification. There were 38 female patients (47%) and 43 male patients (53%) with a mean age at diagnosis of 43 years (12 to 86). The mean follow-up time was 10.3 years (0 to 31.7). A survival analysis was performed followed by univariate and multivariate Cox regression to identify independent implant survival factors. Results The revision-free survival of the implant was 71% at five years and 63.3% at ten years. Three prostheses reached 15 years without revision. The mean Musculoskeletal Tumor Society score in the group was 26 (23 to 28). The mechanisms of failure were infection in 18%, structural failures in 6%, tumour progression in 5%, aseptic loosening in 2%, and soft-tissue failures in 1%. Prostheses used for primary reconstruction after oncological resections had lower infection rates than revision implants (8% vs 25%; p = 0.001). The rates of infection in silver-coated and non-silver-coated prosthesis were similar (17.4% vs 19.%; p = 0.869). The incidence of hip dislocation was 10%. Rotating hinge prosthesis had a lower failure rate than fixed hinge prosthesis (5.3% vs 11%). After Cox regression, the independent factors associated with failures were the history of previous operations (hazard ratio (HR) 3.7; p = 0.041), and the associated arthroplasty of the proximal tibia (HR 3.8; p = 0.034). At last follow-up, 11 patients (13%) required amputation. Conclusion TFEPR offers a reliable reconstruction option for massive bone loss of the femur, with a good survival when the prosthesis is used as a primary implant. The use of a rotating hinge at the knee and dual mobility bearing at the hip may be adequate to reduce the risk of mechanical and soft-tissue failures. Infection remains the main concern and there is insufficient evidence to support the routine use of silver-coated endoprosthesis. Cite this article: Bone Joint J 2019;101-B:522–528.

Novel Cemented Technique for Trochanteric Fixation and Reconstruction of the Abductor Mechanism in Proximal and Total Femoral Arthroplasty: An Observational Study

“…(age >60 years, female gender, malignant primary bone tumor, and benign condition, but not metastatic disease or soft-tissue tumors) [ 12 ]. Dislocation and infection, in alignment with previous studies, were found to be the primary complications of proximal and total femoral megaprostheses [ 5 , 10 ]. Although no patient used a hip abduction brace postoperatively, revision total hip arthroplasty literature suggests that precautionary mobility restrictions/bracing offer little benefit in protecting the abductor mechanism reconstruction in these megaprostheses [ 15 ].…”

“…Overall, the 18.1% dislocation rate was slightly higher than that noted in previous studies [ 4 , 5 , 10 ]. Both our patients with dislocations possessed at least 2 of the risk factors for proximal femoral instability as determined by Henderson et al.…”

Recent Advances in Research on Antibacterial Metals and Alloys as Implant Materials

“…Many observational studies found that silver coatings of arthroplasty components seemed to reduce the risk of the development and relapse of PJI in high-risk tumor patients (Fiore et al, 2021). However, no high-level evidence to support the use of silver coatings in orthopedics exists (Medellin et al, 2019). The generation and release of Ag ions is the most critical determinant of antibacterial ability, regardless of the form (i.e., metallic, ionic, or nanoparticle) (Chernousova and Epple, 2013).…”

Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining

“…These implants have also been used after PJI in patients with extensive bone loss [180]. However, the overall evidence in favor of using silver-coated implants is still insufficient [181]. In addition, one small study reported clinical follow-up (mean 5.6 years) for iodine-coated titanium THAs and TKAs in the treatment of postoperative infections in immunocompromised patients [182].…”