Radiographic assessment of distal femur cemented stems in tumor endoprostheses

Turcotte, Robert; Stavropoulos, Nikolaos A.; Toreson, Jeff; Al-Sultan, Mustafa Muath Hamed

doi:10.1007/s00590-017-1965-1

Cited by 11 publications

(5 citation statements)

References 52 publications

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“…While the use of a 2−4 mm overream technique when utilizing cemented endoprostheses has been widely described, [15][16][17] other studies have supported a prioritization of a larger diameter implant and smaller cement mantle. 13,18,19 The French paradox technique was first described in 1987 for the Charnley-Kerboull femoral stem. 20 This technique includes removal of all cancellous bone and utilization of the maximum stem diameter possible to fill the medullary canal.…”

Section: Discussionmentioning

confidence: 99%

Larger stem to bone diameter ratio predicts lower cemented endoprosthesis failure

Kadkoy,

Ippolito,

Schneider

et al. 2024

Journal of Surgical Oncology

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Background and ObjectivesWith continued advances in treatment options, patients with endoprosthetic reconstruction are living longer and consequently relying upon their devices for a longer duration. Major causes of endoprosthesis failure include aseptic loosening and mechanical failure. In the setting of tumor resection, loss of bone stock and use of radiation therapy increase the risk for these complications. As such, considerations of remaining native bone and stem length and diameter may be increasingly important. We asked the following questions: (1) What was the overall rate of endoprosthesis failure at a minimum of 5‐year follow‐up? (2) Does resection length increase implant failure rates? (3) Does implant size and its ratio to cortical width of bone alter implant failure rates?MethodsWe retrospectively analyzed patient outcomes at a single institution between the years of 1999−2022 who underwent cemented endoprosthetic reconstruction at the hip or knee and identified 150 patients. Of these 150, 55 had a follow‐up of greater than 5 years and were used for analysis. Radiographs of these patients at time of surgery were assessed and measured for resection length, bone diameter, stem diameter, and remaining bone length. Resection percentage, and stem to bone diameter ratios were then calculated and their relationship to endoprosthesis failure were analyzed.ResultsPatients in this cohort had a mean age of 55.8, and mean follow‐up of 59.96 months. There were 78 distal femoral replacements (52%), 16 proximal femoral replacements (10.7%), and 56 proximal tibial replacements (37.3%). There were five patients who experienced aseptic loosening and six patients who experienced mechanical failure. Patients with implant failure had a smaller mean stem to bone diameter (36% vs. 44%; p = 0.002). A stem to bone diameter of 40% appeared to be a breaking point between success and failure in this series, with 90% of patients with implant failure having a stem: bone ratio less than 40%. Stem to bone ratio less than 40% increased risk for failure versus stems that were at least 40% the diameter of bone (6/19 [31.6%] vs. 0/36 [0%]; odds ratio 0.68; p < 0.001). Resection length did not appear to have an impact on the rates of aseptic loosening and mechanical failure in this series.ConclusionsData from this series suggests a benefit to using stems with a larger diameter when implanting cemented endoprostheses at the hip or knee. Stems which were less than 40% the diameter of bone were substantially more likely to undergo implant failure.

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Section: Discussionmentioning

confidence: 99%

Larger stem to bone diameter ratio predicts lower cemented endoprosthesis failure

Kadkoy,

Ippolito,

Schneider

et al. 2024

Journal of Surgical Oncology

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“…A cemented fixation technique, termed the French paradox (9), in which line-to-line re-aming of the medullary cavity was performed and a large-diameter stem was inserted into the medullary cavity, resulting in a thinner cement mantle, led to a lower incidence of aseptic loosening even in longterm follow-up, in both femoral reconstruction (10)(11)(12), as well as in regular hip arthroplasty (25)(26)(27)(28)(29)(30)(31). In the present study, reconstruction using the KMLS with thin-mantle cemented stem fixation, was performed in all the patients, with long-term patient benefit.…”

Section: Discussionmentioning

confidence: 99%

“…A cemented stem-fixation technique, termed the French paradox (9), in which the cemented bone mantle is thinner than with conventional techniques, caused fewer cases of aseptic loosening (10)(11)(12). Therefore, at the Ryukyu University Hospital, limb-salvage surgery was performed using the KMLS with a cemented fixated thin-mantle titanium stem for all patients with malignant bone tumors and the results are reviewed in the present study.…”

mentioning

confidence: 99%

Long-lasting Limb Salvage After Malignant Femoral-Bone Tumor Resection Reconstructed With a Thin-mantle Titanium Stem Fixated With Cement

AOKI,

TOME,

OSHIRO

et al. 2023

Anticancer Res

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Background/Aim: The purpose of the present study was to review and report clinical outcomes of the Kyocera Modular Limb Salvage System (KMLS) using a thin-mantle titanium stem fixated with cement, for reconstruction after resection of malignant femoral-bone tumors. Patients and Methods: Twenty consecutive patients who had undergone reconstruction using the KMLS with cemented thin-mantle titanium stem fixation between July 2010 and December 2019 at Ryukyu University Hospital were included. We retrospectively collected the following data: age, sex, follow-up period, tumor location, histological diagnosis, stem size, overall implant survival, radiolucency, postoperative complications, overall survival, and oncological survival. Results: The median followup period was 63 months (range=10.7-261 months). The bone tumors were in the proximal part of the femur in 9 patients and in the distal part of the femur in 11 patients. The 5-year overall implant survival rate was 90.9% among surviving patients. A revision surgery was required for only one patient (5%), due to infection. Radiolucency, due to an instability of the implant, was observed in 7 out of 20 patients: 6 patients with distal femoral reconstruction, and 1 patient with proximal femoral reconstruction. However, none of the patients complained of any symptoms or required revision surgeries at the last follow-up.The 5-year overall patient-survival rate was 67.6%. Conclusion: The KMLS with cemented thin-mantle titanium stem fixation for femoral bone reconstruction after resection for bone malignancy resulted in long-term patient benefit.

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“…Relatively few objective indicators exist for the imaging evaluation of the risk factors for prosthetic loosening. Piakong et al 12 and Turcotte et al 16 attempted to find imaging evidence of prosthetic loosening by studying the changes in the bone cement; however, measurements and studies on the prosthesis itself do not exist.…”

Section: Introductionmentioning

confidence: 99%

“…Piakong et al 12 . and Turcotte et al 16 . attempted to find imaging evidence of prosthetic loosening by studying the changes in the bone cement; however, measurements and studies on the prosthesis itself do not exist.…”

Section: Introductionmentioning

confidence: 99%

Radiographic Assessment of Aseptic Loosening of Tumor‐Type Knee Prosthesis in Distal Femur

Zheng

2022

Orthopaedic Surgery

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Objective To measure the full‐length anteroposterior and lateral radiographs of lower limbs after the resection of a tumor in the distal femur and tumor‐type knee prosthesis replacement and to analyze the factors leading to aseptic loosening of the prosthesis. Methods A total of 26 cases of tumor‐type knee prosthesis replacement or revision due to the distal femoral tumor at our hospital from January 2007 to December 2019 were retrospectively analyzed. The patients were divided into the loosening and unloosening groups depending on whether aseptic loosening occurred after surgery. Full‐length anteroposterior and lateral radiographs of lower limbs were used to measure bone resection length, length of prosthesis, distance of proximal apex of the medullary stem of the femoral prosthesis from the maximum arc of the anterior femoral arch, diameter of the medullary stem, etc. Data were analyzed, and the risk factors for aseptic loosening of the prosthesis were explored. Results The ratio of the prosthetic length to the femoral length (63.72 ± 5.21) and the ratio of the femoral medullary stem diameter to the femoral diameter (26.03 ± 8.45) were smaller in the loosening group than in the unloosening group. The difference was statistically significant (p < 0.05). The distance between the apex of the medullary stem and the maximum arc of the anterior femoral arch was significantly shorter in the loosening group (3.47 ± 2.96) than in the unloosening group, and the difference was statistically significant (p < 0.05). The measurement of the lower limb alignment showed significant differences between the loosening and unloosening groups in terms of HKAA, mLDFA, and distance between the lower limb alignment and the center of the knee joint (p < 0.05). The logistic regression analysis showed that less than 30% ratio between the medullary stem diameter and the femoral diameter, less than 3 cm distance between the apex of the medullary stem and the maximum curvature of the anterior arch of the femur, distance between the lower limb alignment and the center of the knee joint, and presence of varus knee and valgus knee after the surgery were the risk factors for aseptic loosening of the prosthesis. Conclusions The diameter of the femoral medullary stem of the prosthesis, the apex position of the prosthetic stem, and the lower limb alignment are the risk factors for aseptic loosening of the prosthesis.

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Radiographic assessment of distal femur cemented stems in tumor endoprostheses

Abstract: Despite our study limitations, no radiographic evidence of loosening was found. Cementing distal femur prosthesis with a tight canal fit and with a thin and inconsistent cement mantle appears to be a viable option at short and medium term.

Cited by 11 publications

References 52 publications

Larger stem to bone diameter ratio predicts lower cemented endoprosthesis failure

Larger stem to bone diameter ratio predicts lower cemented endoprosthesis failure

Long-lasting Limb Salvage After Malignant Femoral-Bone Tumor Resection Reconstructed With a Thin-mantle Titanium Stem Fixated With Cement

Radiographic Assessment of Aseptic Loosening of Tumor‐Type Knee Prosthesis in Distal Femur

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