The long-term results of endoprosthetic replacement of the proximal tibia for bone tumours

Abstract

We have investigated whether improvements in design have altered the outcome for patients undergoing endoprosthetic replacement of the proximal tibia following resection of a tumour. Survival of the implant and 'servicing' procedures have been documented using a prospective database. A total of 194 patients underwent a proximal tibial replacement, with 95 having a fixed-hinge design and 99 a rotating-hinge with a hydroxyapatite collar; their median age was 21.5 years (10 to 74). At a mean follow-up of 14.7 years (5 to 29), 115 patients remain alive. The risk of revision for any reason in the fixed-hinge group was 32% at five years, 61% at ten years and 75% at 15 and 20 years, and in the rotating-hinge group 12% at five years, 25% at ten years and 30% at 15 years. Aseptic loosening was the most common reason for revision in the fixed-hinge knees, fracture of the implant in the early design of rotating hinges and infection in the current version. The risk of revision for aseptic loosening in the fixed-hinge knees was 46% at ten years. This was reduced to 3% in the rotating-hinge knee with a hydroxyapatite collar. The cemented, rotating hinge design currently offers the best chance of long-term survival of the prosthesis.

Reduction of periprosthetic infection with silver‐coated megaprostheses in patients with bone sarcoma

“…Importantly, two-stage revision surgery and even amputation were not necessary in any of the patients in the silver group, whereas these procedures were almost always performed in the titanium group. The literature also includes many studies describing a high percentage of two-stage revision surgery or even amputation in 19-46% of cases [5][6][7]27]. As in the present study, Jeys et al [6] and Myers et al [7] also found that the risk for secondary amputation due to infection was highest in proximal tibia replacements.…”

“…Despite advances in endoprosthetic design that have led to lower complication rates, particularly with regard to mechanical failure and aseptic loosening [1], periprosthetic infection of megaprostheses continues to be a common and serious complication in orthopedic oncology [5][6][7]. Currently, it is not possible to avoid periprosthetic infection completely, despite the use of systemic antibiotic treatment, operating rooms with laminar airflow, and routine screening for methicillin-resistant Staphylococcus aureus (MRSA).…”

“…Currently, it is not possible to avoid periprosthetic infection completely, despite the use of systemic antibiotic treatment, operating rooms with laminar airflow, and routine screening for methicillin-resistant Staphylococcus aureus (MRSA). In the literature, overall infection rates of between 8.7% and 14% have been reported, with lower rates in the upper extremity and higher rates in the lower extremity [2,7,[16][17][18][19]. Patients with proximal tibia replacements in particular are at high risk for periprosthetic infection.…”

“…Patients with proximal tibia replacements in particular are at high risk for periprosthetic infection. Myers et al [7] reported an infection rate of 31% before the introduction of the gastrocnemius flap procedure and 14% despite the routine use of the flap. In the present study, the infection rate with titanium prostheses of the proximal tibia was even somewhat higher, at 17%.…”

“…In most cases, it is not possible to eradicate the biofilm-producing bacteria from the prosthetic surface, and removing the medical device is the only way to resolve the infection [4]. When there are concomitant poor softtissue conditions, secondary amputation is sometimes inevitable [5][6][7]. Preventing periprosthetic infection is therefore of the utmost importance.…”