Megaprostheses in the treatment of periprosthetic fractures of the knee joint: indication, technique, results and review of literature

Windhager, Reinhard; Schreiner, Markus; Staats, Kevin; Apprich, Sebastian

doi:10.1007/s00264-015-2991-4

Cited by 60 publications

(38 citation statements)

References 25 publications

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“…Aseptic loosening was seen in 7.7% and 9.9% of proximal and distal femur megaprosthesis, respectively. Aseptic loosening of megaprosthesis in the treatment of nonneoplastic diseases has been previously detected with rates ranging from 0% to 9.5% [25,29], and these reports are consistent with aseptic loosening after tumor prosthesis [4]. Periprosthetic fracture was seen in 3.2% and 11.1% of cases of proximal and distal femur megaprosthesis, respectively.…”

Section: Discussionsupporting

confidence: 76%

“…Megaprosthesis of the proximal or distal femur is a viable option for limb reconstruction in non-neoplastic conditions like failed hip or knee arthroplasty, periprosthetic fractures, osteoporotic fracture with severe comminution, or resistant non-union in elderly patients [2,29]. Megaprosthesis in such cases should be considered as a limb salvage option in carefully selected patients when other surgical options are not feasible [14].…”

Section: Discussionmentioning

confidence: 99%

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Non-neoplastic indications and outcomes of the proximal and distal femur megaprosthesis: a critical review

Vaishya

Thapa

Vaish

2020

Knee Surg & Relat Res

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Purpose: Megaprosthesis or endoprosthetic replacement of the proximal and distal femur is a well-established modality for treatment of tumors. The indications for megaprosthesis have been expanded to the treatment of some non-neoplastic conditions of the knee and hip, with the severe bone loss associated with failed arthroplasty, communited fractures in the elderly with poor bone quality, and resistant non-union. Th aim of this study is to find out whether megaprosthesis of the knee and hip is successful in the treatment of non-neoplastic condtions. The study comprises a review of the indications, complications, and outcomes of megaprosthesis of the proximal and distal femur in non-neoplastic conditions of the knee and hip joints. Methods: We extensively reviewed the literature on non-neoplastic indications for megaprosthesis of the proximal and distal femur after performing a detailed search of the Pubmed database using the medical subject heading (MeSH) terms 'proximal femur replacement' or 'distal femur replacement' and 'hip or knee megaprosthesis.' The data obtained after the structured search were entered into a Microsoft Excel spreadsheet. The frequency distribution of the demographic data, indications, complications, and outcome was calculated. Result: We included ten studies (seven proximal femur replacement and three distal femur replacement) of 245 proximal femur and 54 distal femur mega prostheses for treatment of non-neoplastic conditions. Bone loss in failed arthroplasty, either due to periprosthetic fracture or deep infection, was the most common indication for megaprosthesis. Dislocation was the most common complication after proximal femur megaprosthesis, and infection was the leading cause of complications after distal femur megaprosthesis. Conclusion: Megaprosthesis for treatment of non-neoplastic conditions around the distal and proximal femur is a viable option for limb salvage, with an acceptable long-term outcome. Although the complications and survival rates of megaprosthesis in non-neoplastic conditions are inferior to a primary arthroplasty of the hip and knee but are comparable or better than the mega prosthetic replacement in the neoplastic conditions. Proximal femoral megaprosthesis has higher dislocation rates and requirement for revision compared to distal femoral megaprosthesis. However, the proximal femoral megaprosthesis has lower rates of infection, periprosthetic fractures, and soft tissue complications, as compared to distal femoral megaprosthetic replacement. Both associated with aseptic loosening but not statistically significant.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Non-neoplastic indications and outcomes of the proximal and distal femur megaprosthesis: a critical review

Vaishya

Thapa

Vaish

2020

Knee Surg & Relat Res

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“…Of interest, aseptic loosening of megaprostheses in the treatment of nonneoplastic diseases has been previously detected with rates ranging from 0% to 9.5% [2, 3, 8–10, 13]. …”

Section: Discussionmentioning

confidence: 99%

Modular Endoprostheses for Nonneoplastic Conditions: Midterm Complications and Survival

Gori

Scoccianti

Frenos

et al. 2016

BioMed Research International

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The use of modular endoprostheses is a viable option to manage both tumor resection and severe bone loss due to nonneoplastic conditions such as fracture sequelae, failed osteoarticular grafts, arthroplasty revisions, and periprosthetic fractures. We sought to investigate both midterm complications and failures occurred in 87 patients who underwent a megaprosthetic reconstruction in a nonneoplastic setting. After a mean follow-up of 58 (1–167) months, overall failure-free survival was 91.5% at 1 year, 80% at 2 years, 71.6% at 5 years, and 69.1% at 5 and 10 years. There was no significant difference in the survival rate according to the diagnosis at the index procedure (p = 0.921), nor to the reconstruction site (p = 0.402). The use of megaprostheses in a postneoplastic setting did not affect survival rate in comparison with endoprosthetic reconstruction of pure nonneoplastic conditions (p = 0.851). Perimegaprosthetic infection was the leading complication, occurring in 10 (11.5%) patients and implying a megaprosthetic revision in all but one case. Physicians should consider these results when discussing with patients desired outcomes of endoprosthetic reconstructions of a nonneoplastic disease.

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“… [1] or with the new Unified Classification System [2] and occur with a frequency of up to 3% after total knee arthroplasty. They are the reason for revision surgery in about 3% of cases [3] , [4] , [5] , [6] , [7] , [8] .…”

Section: Introductionmentioning

confidence: 99%

“…Revision surgery is necessary when the knee endoprosthesis becomes loose or when osteosynthesis is not possible because of the size of the bone defect. In the latter case, treatment has often involved megaprostheses with a metallic replacement of the distal femur or allograft replacement of the distal femur [4] , [8] . The disadvantage of these techniques are associated with the low level of biological reconstruction and the high risk of infection that results from the large metallic or dead bone surfaces [8] , [9] , [10] , [11] .…”

Section: Introductionmentioning

confidence: 99%

Treatment of periprosthetic fractures of the knee using trabecular metal cones for stabilization

Fink

Mittelstädt

2019

Arthroplasty Today

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This report describes an operative technique for the treatment of periprosthetic fractures of the knee with instability of the metaphysis and the metadiaphyseal junction that stabilizes the metaphyseal fragment by a distraction technique using trabecular metal cones. Fifteen patients were examined clinically and radiologically for a follow-up period of 36.7 ± 8.7 months. The Knee Society Score improved to 73.2 ± 20.2 by 24 months after surgery; the function score improved to 68.3 ± 20.2 by 24 months after surgery. The mean flexion amounted to 94.4 ± 9.7 degrees by 24 months after surgery. The only complication was one case of thrombosis. This technique involving trabecular metal cones to stabilize metaphyseal fractures seems to represent a further option for fixation of periprosthetic fractures that are otherwise treated with megaprostheses.

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Megaprostheses in the treatment of periprosthetic fractures of the knee joint: indication, technique, results and review of literature

Cited by 60 publications

References 25 publications

Non-neoplastic indications and outcomes of the proximal and distal femur megaprosthesis: a critical review

Non-neoplastic indications and outcomes of the proximal and distal femur megaprosthesis: a critical review

Modular Endoprostheses for Nonneoplastic Conditions: Midterm Complications and Survival

Treatment of periprosthetic fractures of the knee using trabecular metal cones for stabilization

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