Periprosthetic femoral fractures around tumor endoprostheses treated with limited revision surgery combined with allograft

Abstract

Rationale: Old periprosthetic femoral fractures (OPFFs) around a tumor prosthesis of the knee present formidable problems for orthopedic oncologists; large bone defects and inappropriate biomechanics of the revision implant design can impair successful reconstruction. Limited literature is available on the reconstruction of OPFFs using revision combined with massive allograft following resection of a bone tumor around the knee joint. In this study, we present the first reported case in the English literature of a limited revision followed by several segmental allografts for the reconstruction of the knee joint. Patient concerns: This case involved a 45-year-old female who was treated for a malignant fibrous histiocytoma (MFH) of the knee joint with surgical excision of the lesion and replacement of the defect using endoprosthetic reconstruction when she was 25 years old. Her surgical history was remarkable for a left tumoral knee prosthesis implanted 20 years ago. Nine years before revision, the patient had fall damage; however, she was able to walk independently and with moderate pain. In the 9-year period, prosthesis malfunction caused progressive left lower extremity shortening and a persistent swelling pain in the left thigh. Diagnoses: According to her clinical history, imaging results and physical examination, we confirmed the diagnosis of OPFFs potentially due to aseptic loosening and trauma injury. Interventions: In this study, we present the first case of OPFFs around a tumor endoprosthesis that was successfully treated using limited revision combined with a massive allograft. Outcomes: At 80 months after revision surgery, the patient had made a sufficient recovery from her symptoms. The bone union was complete without tumor recurrence or implant failure. Lessons: We propose that if prosthesis fracture is detected, revision surgery should be attempted as early as possible, and for patients with OPFFs, the use of limited revision combined with massive allografts may be useful for safely and adequately reconstructing OPFFs around the knee joint. However, patients should be followed-up closely after surgical treatment because of the high risk of revision.

Revision surgery for periprosthetic fracture of distal femur after endoprosthetic replacement of knee joint following resection of osteosarcoma

“…For patients who underwent total knee reconstruction after malignant tumor resection, the mean interval between first implantation and revision caused by PPF was significantly shorter than in those patients with non-tumoral disease ( 18 , 19 , 23 ). Andreou et al.…”

“…To our knowledge, very rare reports or recommendations have demonstrated treatment strategies for PPF with patients who experienced osteosarcoma around the knee joint ( 18 – 20 ). In this study, we aimed to produce different types of PPF and describe 13 cases with successful treatment of PPF with limb-salvaging strategies.…”

CORR Insights®: What Factors Are Associated With Stem Breakage in Distal Femoral Endoprosthetic Replacements Undertaken for Primary Bone Tumors?

“…Aseptic loosening owing to loosening at the bone-implant interface can lead to implant instability and eventually stem fracture [6,9]. Periprosthetic fractures around tumor prostheses caused by trauma or osteoporotic bone can also result in intramedullary stem breakage [13]. Implant malalignment or implant undersizing can also lead to implant fracture [3].…”