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Gonzalez MR, Inchaustegui ML, Layme J, Ruiz-Arellanos K, Larios F, Pretell-Mazzini J. Postoperative Outcomes of Total Femur Replacement in Oncologic and Nononcologic Patients: A Systematic Review of the Literature. J Arthroplasty 2024; 39:1624-1631.e2. [PMID: 38061400 DOI: 10.1016/j.arth.2023.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Total femur replacement (TFR) is used for primary reconstruction after extensive tumor resection or as a revision surgery due to prosthetic failure. Studies on TFR rates of failure and functional outcomes are scarce. The purpose of our study was to compare the modes of failure, amputation rates, and functional outcomes after TFR between oncologic and nononcologic patients. METHODS We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were for this manuscript. Our study was registered on PROSPERO (413582). Quality assessment of all studies was performed using Strengthening the Reporting of Observational Studies in Epidemiology checklist. Endoprosthesis failure was assessed using the Henderson classification and functional outcomes using the Musculoskeletal Tumor Society score. Weighted means and standard deviations were calculated. RESULTS Overall failure rate was similar between groups. Henderson type 4 failures were more common within the nononcologic group, while the others were more frequently found in the oncologic group. Overall amputation rate was higher in the oncologic group mainly due to type 5 failure. Amputations occurred mainly after type 4 and type 5 failures. Functional outcome was better within the oncologic group (70.5 versus 61.7, respectively; P < .001). CONCLUSIONS Total femoral replacement in the oncologic and nononcologic group is associated with a high rate of failure (31% and 32.5%, respectively). Overall amputation rate was higher in the oncologic group mainly due to type 5 failure. Functional outcome was better within the oncologic group. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Marcos R Gonzalez
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Maria L Inchaustegui
- Department of Orthopaedics and Traumatology, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Josue Layme
- Department of Orthopaedics and Traumatology, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Kim Ruiz-Arellanos
- Department of Orthopaedics and Traumatology, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Felipe Larios
- Department of Orthopaedics and Traumatology, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Juan Pretell-Mazzini
- Division of Orthopedic Oncology, Miami Cancer Institute, Baptist Health System South Florida, Plantation, Florida
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Damron TA. CORR Insights®: What Are the Complication Rates and Factors Associated With Total Femur Replacement After Tumor Resection? Findings From the Japanese Musculoskeletal Oncology Group. Clin Orthop Relat Res 2024; 482:713-715. [PMID: 37938137 PMCID: PMC10936994 DOI: 10.1097/corr.0000000000002915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/09/2023] [Indexed: 11/09/2023]
Affiliation(s)
- Timothy A Damron
- Vice-Chairman and David G. Murray Endowed Professor, Department of Orthopedic Surgery, Upstate Bone and Joint Center, East Syracuse, NY, USA
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Mori T, Kobayashi E, Sato Y, Takenaka S, Endo M, Nakamura T, Morii T, Yoshida Y, Ueda T, Kawano H, Kawai A. What Are the Complication Rates and Factors Associated With Total Femur Replacement After Tumor Resection? Findings From the Japanese Musculoskeletal Oncology Group. Clin Orthop Relat Res 2024; 482:702-712. [PMID: 37796200 PMCID: PMC10937000 DOI: 10.1097/corr.0000000000002874] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 08/28/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Patients undergoing massive tumor resection and total femur replacement (TFR) face a substantial risk of hip dislocation and infection, often resulting in multiple implant revisions or hip disarticulation. These complications can impact their independence and prognosis. Additionally, their shorter life expectancy is influenced by challenges in achieving local radical resection and controlling metastases. Identifying suitable candidates for TFR is vital, necessitating investigations into dislocation, infection, implant failure rates, local recurrence, overall survival, and associated factors. QUESTIONS/PURPOSES (1) What is the postsurgical complication (hip dislocation and infection) rate and factors associated with postsurgical complications in patients who underwent TFR after tumor resection? (2) What is the local recurrence rate, implant failure rate, overall survival rate, and factors associated with local recurrence and implant failure? METHODS We retrospectively evaluated 42 patients (median [range] age 47 years [10 to 79 years]) who underwent TFR and tumor resection at the time of the same surgical procedure between 1990 and 2020 at 12 registered institutions that specialized in tumor treatment in Japan. A total of 55% (23) of the patients were men, and 79% (33) had bone sarcoma. The median (range) follow-up period was 36.5 months (2 to 327 months). Of the 42 patients, 12% (5) were lost to follow-up before 2 years without meeting a study endpoint (postsurgical complications, revision, or amputation), and another 19% (8) died before 2 years with implants intact, leaving 69% (29) of the original group who had either follow-up of at least 2 years or met a study endpoint before the minimum surveillance duration. Another 10% (4) had a minimum of 2 years of follow-up but had not been seen in the past 5 years. Infection was defined as deep-seated infection involving soft tissues, bones, joints, and the area around the implant. We did not consider superficial infections. Implant failure was defined when a patient underwent reimplantation or amputation. The complication and implant failure rates were assessed by the cumulative incidence function method, considering competing events. The Kaplan-Meier method was used to estimate the overall survival rate. RESULTS The 1-month, 6-month, 1-year, and 2-year dislocation rates were 5%, 12%, 14%, and 14%, respectively. The 1-month, 6-month, 1-year, and 2-year infection rates were 5%, 7%, 10%, and 15%, respectively. Multivariable analyses for hip dislocation and infection revealed that resection of the abductor muscles and large tumor size were positively associated with hip dislocation. The 6-month, 1-year, and 2-year local recurrence rates were 5%, 15%, and 15%, respectively. The 6-month, 1-year, 2-year, and 5-year implant failure rates were 5% (95% confidence interval 1% to 15%), 7% (95% CI 2% to 18%), 16% (95% CI 6% to 29%), and 16% (95% CI 6% to 29%), respectively. Multivariable analyses of local recurrence and implant failure that led to reimplantation or amputation revealed that a positive surgical margin was positively associated with local recurrence. The 1-year, 2-year, and 5-year overall patient survival rates were 95% (95% CI 87% to 102%), 77% (95% CI 64% to 91%), and 64% (95% CI 48% to 81%), respectively. CONCLUSION Hip dislocation, infection, and local recurrence were frequently observed in patients who received massive tumor resection and TFR in our study, eventually leading to reimplantation or amputation. Preserving the abductor muscles and resecting the tumor with a wide margin can prevent postoperative dislocation and local recurrence. Future research should focus on patient selection criteria, prevention of hip dislocation, and innovative treatments. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Tomoaki Mori
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Eisuke Kobayashi
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Takenaka
- Musculoskeletal Oncology Service, Osaka International Cancer Institute, Osaka, Japan
| | - Makoto Endo
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
| | - Tomoki Nakamura
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Takeshi Morii
- Department of Orthopaedic Surgery, Kyorin University, Tokyo, Japan
| | - Yukihiro Yoshida
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Takafumi Ueda
- Department of Orthopaedic Surgery, National Hospital Organization Osaka, National Hospital, Osaka, Japan
| | - Hirotaka Kawano
- Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
| | - Akira Kawai
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
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Murray J, Jeyapalan R, Davies M, Sheehan C, Petrie M, Harrison T. Total femoral arthroplasty for non-oncological indications. Bone Joint J 2023; 105-B:888-894. [PMID: 37524348 DOI: 10.1302/0301-620x.105b8.bjj-2022-1372.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Aims Total femoral arthroplasty (TFA) is a rare procedure used in cases of significant femoral bone loss, commonly from cancer, infection, and trauma. Low patient numbers have resulted in limited published work on long-term outcomes, and even less regarding TFA undertaken for non-oncological indications. The aim of this study was to evaluate the long-term clinical outcomes of all TFAs in our unit. Methods Data were collected retrospectively from a large tertiary referral revision arthroplasty unit's database. Inclusion criteria included all patients who underwent TFA in our unit. Preoperative demographics, operative factors, and short- and long-term outcomes were collected for analysis. Outcome was defined using the Musculoskeletal Infection Society (MSIS) outcome reporting tool. Results Overall, 38 TFAs were identified. The mean age was 73 years (42 to 80). All patients underwent TFA for non-oncological indications, most commonly as a consequence of infection (53%) and periprosthetic fracture (26%). The mean follow-up time was ten years (0 to 26); 63% of TFAs were considered a success based upon the MSIS outcome reporting tool. The mean time between TFA and death was 8.5 years (0.2 to 19.2), with two patients dying within one year of surgery. Within the cohort, 66% suffered at least one complication, dislocation being most common (37%); 55% of the total cohort required at least one subsequent operation. In total, 70% of TFAs undertaken for infection were considered infection-free at time of final follow-up. The percentage of mobile patients improved from 52% to 65% between pre- and postoperation, with all patients being able to at least transfer from bed to chair at time of final review. Conclusion This study is the largest in the UK assessing the use of TFA in patients with bone loss secondary to non-oncological conditions. It demonstrates that TFA has a significant complication profile, however it is favourable in terms of mortality and rehabilitation when compared to amputation and disarticulation.
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Affiliation(s)
- James Murray
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rathan Jeyapalan
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Michael Davies
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Ciara Sheehan
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Michael Petrie
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Tim Harrison
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Adzhar AL, Faisham WI, Zulmi W, Azman WS, Sahran Y, Syurahbil AH, Nor-Azman MZ. Long-term Outcome of Total Femur Replacement. Malays Orthop J 2023; 17:21-27. [PMID: 37583532 PMCID: PMC10425001 DOI: 10.5704/moj.2307.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 12/02/2022] [Indexed: 08/17/2023] Open
Abstract
Introduction Total femur replacement is an option instead of amputation for extensive bone tumour or after revision surgery with a massive bone loss. Over a long period of time the patients may need revision surgery, and this might affect the functional outcome. We reviewed all consecutive total femur replacements done for primary and revision surgery of primary bone tumours in our centre to evaluate the long-term functional outcome and survival. Materials and methods All patients who had total femur resection and reconstruction with modular endoprosthesis replacement in our centre from June 1997 to May 2022 were reviewed. The respondents were surveyed through WhatsApp using google form which was translated into Bahasa Malaysia based on the Musculoskeletal Tumour Society Scoring System (MSTS). The data were presented as descriptive data on the final survival of the limb and prosthesis. Results Ten patients underwent total femur replacement. There were eight osteosarcoma, one giant cell tumour and one chondromyxoid fibroma. Three patients with osteosarcoma succumbed to pulmonary metastases; all had good early post-operative functional outcomes without local recurrence. Seven patients were available for long term evaluation of function with a mean follow-up of 17.6 years (ranged 10-25 years). Four patients with total femur replacement had good functional outcomes (60-80%) without revision with 10-25 years follow-up. Three patients experienced acetabulum erosion and chronic pain that required early hip replacements. Two of them were complicated with superior erosions and bone loss and subsequently were managed with massive reconstruction using cemented acetabulum cage reconstruction. The other has diabetes mellitus with chronic infection following revision of distal femur endoprosthesis to total femur replacement and subsequently underwent limited hemipelvectomy after 14 years. Conclusion Total femur replacement offers a good long term functional outcome and prosthesis survival and is a favourable option for limb salvage surgery.
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Affiliation(s)
- A L Adzhar
- Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - W I Faisham
- Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - W Zulmi
- Department of Orthopaedics, Prince Court Medical Centre, Kuala Lumpur, Malaysia
| | - W S Azman
- Department of Plastic Surgery, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Y Sahran
- Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - A H Syurahbil
- Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - M Z Nor-Azman
- Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia
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Wu F, Fang X, Yuan D, Xiong Y, Luo Y, Zhang W, Tu C, Duan H. Preserving the rectus femoris and improving limb function after total femoral prosthesis replacement following resection of femoral malignant tumors. Front Oncol 2023; 13:1149342. [PMID: 36998467 PMCID: PMC10043403 DOI: 10.3389/fonc.2023.1149342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023] Open
Abstract
BackgroundCurrent research is focused on the factors that influence the maintenance of limb function after total femoral replacement. This retrospective study investigated the difference in functional outcomes in patients with invasion of the rectus femoris vs. an intact rectus femoris that underwent total femoral replacement with a modular total femur prosthesis.MethodsThe medical records of patients who underwent total femoral replacement with a modular total femur prosthesis between July 2010 and March 2017 at our institute were retrospectively reviewed. The patients were divided into two groups: group A had invasion of the rectus femoris and group B had an intact rectus femoris. Functional status was assessed using the Musculoskeletal Tumor Society Rating Scale (MSTS) and the Harris Hip Score (HHS). Complications were assessed using the International Society of Limb Salvage classification that was published in 2011 and modified in 2014.ResultsThe mean total MSTS score (23.0 ± 4.8 vs. 17.6 ± 3.1; P = 0.02) and the mean total HHS score (80.17 ± 6.24 vs. 55.38 ± 13.30; P = 0.001) were significantly higher in patients with intact rectus femoris compared with patients with invasion of the rectus femoris. Patients with an intact rectus femoris achieved significantly better limb function (support and gait) and active range of motion (P < 0.05). The overall complication rate was 35.7%.ConclusionsFunctional outcomes after total femoral replacement were significantly better in patients with an intact rectus femoris compared with patients with invasion of the rectus femoris, possibly because more muscle mass can be preserved around the femur in patients with an intact rectus femoris.
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Affiliation(s)
- Fan Wu
- Department of Orthopedics, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics, Zigong Fourth People’s Hospital, Zigong, China
| | - Xiang Fang
- Department of Orthopedics, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Dechao Yuan
- Department of Orthopedics, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Yan Xiong
- Department of Orthopedics, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Yi Luo
- Department of Orthopedics, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Wenli Zhang
- Department of Orthopedics, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Chongqi Tu
- Department of Orthopedics, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Hong Duan
- Department of Orthopedics, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Hong Duan,
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Tsukamoto S, Mavrogenis AF, Masunaga T, Kido A, Honoki K, Tanaka Y, Fujii H, Tanaka Y, Errani C. Megaprosthetic reconstruction of the distal femur with a short residual proximal femur following bone tumor resection: a systematic review. J Orthop Surg Res 2023; 18:68. [PMID: 36707881 PMCID: PMC9881341 DOI: 10.1186/s13018-023-03553-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 01/19/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND To investigate the risk of postoperative function and complications associated with reconstruction methods in patients with short residual proximal femurs (< 12 cm) after resection of distal femoral bone tumors, we performed a systematic review of studies reporting postoperative function and complications in these patients. METHODS Of the 236 studies identified by systematic searches using the Medline, Embase, and Cochrane Central Register of Controlled Trials databases, eight were included (none were randomized controlled trials). In these studies, 106 (68.4%), 12 (7.7%), and 37 (23.9%) patients underwent reconstruction with custom-made megaprostheses with extracortical plates or cross-pins, allograft prosthetic composite (APC), and Compress® compliant pre-stress (CPS) implants, respectively. RESULTS Aseptic loosening occurred slightly more frequently in the APC group than in the other reconstruction methods (APC group, 21%; custom-made megaprosthesis group, 0-17%; CPS implant group, 14%). No differences were noted in the frequencies of implant breakage, fractures, or infections between the three reconstruction methods. Mechanical survival, where endpoint was set as implant removal for any reason, was 80% at seven years in the APC group, 70-77% at 10 years in the custom-made megaprosthesis group, and 68% at nine years in the CPS implant group. Therefore, there appeared to be no difference among the three reconstruction methods with respect to mechanical survival. CONCLUSIONS During megaprosthetic reconstruction of the distal femur with a short residual proximal femur after bone tumor resection, similar results were obtained using custom-made megaprostheses, APCs, and CPS implants.
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Affiliation(s)
- Shinji Tsukamoto
- grid.410814.80000 0004 0372 782XDepartment of Orthopaedic Surgery, Nara Medical University, 840, Shijo-Cho, Kashihara-City, Nara 634-8521 Japan
| | - Andreas F. Mavrogenis
- grid.5216.00000 0001 2155 0800First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 41 Ventouri Street, 15562 Holargos, Athens, Greece
| | - Tomoya Masunaga
- grid.410814.80000 0004 0372 782XDepartment of Orthopaedic Surgery, Nara Medical University, 840, Shijo-Cho, Kashihara-City, Nara 634-8521 Japan
| | - Akira Kido
- grid.410814.80000 0004 0372 782XDepartment of Rehabilitation Medicine, Nara Medical University, 840, Shijo-Cho, Kashihara-City, Nara 634-8521 Japan
| | - Kanya Honoki
- grid.410814.80000 0004 0372 782XDepartment of Orthopaedic Surgery, Nara Medical University, 840, Shijo-Cho, Kashihara-City, Nara 634-8521 Japan
| | - Yuu Tanaka
- Department of Rehabilitation Medicine, Wakayama Professional University of Rehabilitation, 3-1, Minamoto-Cho, Wakayama-City, Wakayama 640-8222 Japan
| | - Hiromasa Fujii
- grid.410814.80000 0004 0372 782XDepartment of Orthopaedic Surgery, Nara Medical University, 840, Shijo-Cho, Kashihara-City, Nara 634-8521 Japan
| | - Yasuhito Tanaka
- grid.410814.80000 0004 0372 782XDepartment of Orthopaedic Surgery, Nara Medical University, 840, Shijo-Cho, Kashihara-City, Nara 634-8521 Japan
| | - Costantino Errani
- grid.419038.70000 0001 2154 6641Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
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You Q, Lu M, Min L, Zhang Y, Luo Y, Zhou Y, Tu C. Hip-preserving reconstruction using a customized cemented femoral endoprosthesis with a curved stem in patients with short proximal femur segments: Mid-term follow-up outcomes. Front Surg 2022; 9:991168. [DOI: 10.3389/fsurg.2022.991168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundShort metaphyseal segments that remain following extensive distal femoral tumor resection can be challenging to manage, as the residual short segments may not be sufficient to accept an intramedullary cemented stem of standard length. The present study was developed to detail preliminary findings and experiences associated with an intra-neck curved stem (INCS) reconstructive approach, with a particular focus on mechanical stability.MethodFrom March 2013 to August 2016, 11 total patients underwent reconstructive procedures using a customized cemented femoral endoprosthesis (CCFE) with an INCS. Measurements of femoral neck-shaft angle values were made before and after this procedure. Radiological outcomes associated with this treatment strategy over an average 63-month follow-up period were additionally assessed. Functionality was assessed based upon Musculoskeletal Tumor Society (MSTS) scores, while a visual analog scale (VAS) was used to rate pre- and postoperative pain, and any complications were noted.ResultsRelative to the preoperative design, no significant differences in femoral neck–shaft angle were observed after this reconstructive procedure (p = 0.410). Postoperatively, the tip of the stem was primarily positioned within the middle third of the femoral head in both lateral and posterior-anterior radiographic, supporting the accuracy of INCS positioning. The average MSTS score for these patients was 25 (range: 21–28), and VAS scores were significantly reduced after surgery (p < 0.0001). One patient exhibited local disease recurrence and ultimately succumbed to lung metastases, while two patients exhibited aseptic loosening. None of the treated patients exhibited complications such as infections, periprosthetic fractures, or prosthetic fractures as of most recent follow-up.ConclusionCCFE with an INCS represents a viable approach to massive femoral diaphyseal defect with short proximal femur repair, as patients can achieve good functional outcomes and early weight-bearing with proper individualized rehabilitative interventions, all while exhibiting low rates of procedure-related complications.
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You Q, Lu M, Min L, Luo Y, Zhang Y, Wang Y, Zheng C, Zhou Y, Tu C. A comparison of cemented and cementless intra-neck curved stem use during hip-preserving reconstruction following massive femoral malignant tumor removal. Front Oncol 2022; 12:933057. [PMID: 36132148 PMCID: PMC9483172 DOI: 10.3389/fonc.2022.933057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPatients who undergo massive femoral malignant tumor (MFMT) resection often exhibit shortened femoral metaphyseal juxta-articular segments. The use of a customized femoral endoprosthesis (CFE) with an intra-neck curved stem (INCS) has emerged as a viable reconstructive surgical strategy for these individuals. Relative to a cemented INCS, it remains unclear as to whether cementless INCS use is associated with improvements in functionality or reconstructive longevity. As such, the present study was conducted to compare functional outcomes, endoprosthetic survival, and endoprosthesis-related complication rates in patients undergoing cemented and cementless INCS implantation.MethodsA total of 24 patients undergoing lower limb salvage and reconstructive surgical procedures utilizing cemented or cementless INCS endoprostheses were retrospectively included. Patient-functional outcomes, endoprosthetic survival, and complication rates were compared as a function of age; diagnosis; the length of femoral resection; residual proximal femur length; Musculoskeletal Tumor Society (MSTS) scores; visual analog scale (VAS) scores; and the rates of implant breakage, periprosthetic infections, periprosthetic fractures, and aseptic loosening.ResultsThe mean follow-up was 56 months. Significant differences in the length of femoral resection (p<0.001) and residual proximal femur length were observed (p<0.001) between the cemented and cementless INCS groups. There were no differences in overall patient survival and aseptic loosening-associated endoprosthesis survival in the cemented and cementless groups. None of the included patients experienced periprosthetic fractures, infections, or implant breakage. Average respective MSTS and VAS scores did not differ between groups.ConclusionFor patients undergoing treatment for MFMTs, the use of a CFE with an INCS has emerged as a viable approach to hip-preserving reconstructive surgery. With appropriately designed individualized rehabilitative programs, good functional outcomes can be achieved for these endoprostheses, which are associated with low complication rates. Moreover, the selection between cemented or cementless INCS in the clinic should be made based on patient-specific factors, with cementless INCS implementation being preferable in younger patients with good-quality bone, the potential for long-term survival, and the osteotomy site near the lesser trochanter, whereas cemented INCS use should be favored for individuals who are older, have a shorter life expectancy, or have poor bone quality.
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Affiliation(s)
- Qi You
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Model worker and Craftsman Talent Innovation Research Studio, Chengdu, China
| | - Minxun Lu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Model worker and Craftsman Talent Innovation Research Studio, Chengdu, China
| | - Li Min
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Model worker and Craftsman Talent Innovation Research Studio, Chengdu, China
| | - Yi Luo
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Model worker and Craftsman Talent Innovation Research Studio, Chengdu, China
| | - Yuqi Zhang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Model worker and Craftsman Talent Innovation Research Studio, Chengdu, China
| | - Yitian Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Model worker and Craftsman Talent Innovation Research Studio, Chengdu, China
| | - Chuanxi Zheng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Model worker and Craftsman Talent Innovation Research Studio, Chengdu, China
| | - Yong Zhou
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Model worker and Craftsman Talent Innovation Research Studio, Chengdu, China
- *Correspondence: Chongqi Tu, ; Yong Zhou,
| | - Chongqi Tu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Model worker and Craftsman Talent Innovation Research Studio, Chengdu, China
- *Correspondence: Chongqi Tu, ; Yong Zhou,
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You Q, Lu M, Min L, Zhang Y, Wang J, Wang Y, Zheng C, Zhou Y, Tu C. Hip-Preserved Reconstruction Using a Customized Cementless Intercalary Endoprosthesis With an Intra-Neck Curved Stem in Patients With an Ultrashort Proximal Femur: Midterm Follow-Up Outcomes. Front Bioeng Biotechnol 2022; 10:795485. [PMID: 35295648 PMCID: PMC8918842 DOI: 10.3389/fbioe.2022.795485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/21/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Hemiarthroplasty is widely used for proximal femoral reconstruction after tumor resection. However, complications of hemiarthroplasty include infection, hip dislocation, and acetabular wear. This study aimed to: (1) evaluate the reliability and validity of a customized cementless intercalary endoprosthesis (CCIE) with an intra-neck curved stem (INCS) to reconstruct femoral diaphyseal defects with an ultrashort proximal femur (UPF); (2) assess the lower extremity function after reconstruction with this endoprosthesis; and (3) identify the postoperative complications associated with the use of this endoprosthesis. Methods: Between October 2015 and May 2019, 13 patients underwent reconstruction with a CCIE with an INCS. The distance from the center of the femoral head to the midline of the body and the apex of the acetabulum was measured preoperatively. Additionally, the distance from the tip of the INCS to the midline of the body and the apex of the acetabulum was measured postoperatively. The femoral neck–shaft angle was also measured pre- and postoperatively. After an average follow-up duration of 46 months, the radiological outcomes of the CCIE with an INCS were analyzed. Function was evaluated with the Musculoskeletal Tumor Society (MSTS) score. Pain was measured using a paper visual analog scale (VAS) pre- and postoperatively, and complications were recorded. Results: Compared with our preoperative design, we found no significant difference in the postoperative distance from the tip of the INCS to the body midline (p = 0.187) and the apex of the acetabulum (p = 0.159), or in the postoperative femoral neck–shaft angle (p = 0.793). Thus, the INCS positions were deemed accurate. The average MSTS score was 26 (range: 24–28), and the VAS score was significantly decreased postoperatively compared with preoperatively (p < 0.0001). No patients developed aseptic loosening, infection, periprosthetic fracture, or prosthetic fracture as of the last follow-up. Conclusion: The CCIE with an INCS was a valid and reliable method for reconstructing femoral diaphyseal defects with a UPF following malignant tumor resection. Postoperative lower extremity function was acceptable, with an appropriate individualized rehabilitation program, and the incidence of complications was low.
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Affiliation(s)
- Qi You
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
- Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Minxun Lu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
- Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Li Min
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
- Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Yuqi Zhang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
- Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Jie Wang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
- Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Yitian Wang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
- Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Chuanxi Zheng
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
- Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Zhou
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
- Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Chongqi Tu, ; Yong Zhou,
| | - Chongqi Tu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
- Bone and Joint 3D-Printing and Biomechanical Laboratory, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Chongqi Tu, ; Yong Zhou,
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11
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Femoral neck fracture to total femoral replacement: a case report. CURRENT ORTHOPAEDIC PRACTICE 2021. [DOI: 10.1097/bco.0000000000001017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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12
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Guerra J, Chaghouri P, Guerra JA, Peters SL. Total Femoral Replacement- A Case Report. Geriatr Orthop Surg Rehabil 2021; 12:21514593211019977. [PMID: 34211799 PMCID: PMC8216370 DOI: 10.1177/21514593211019977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/29/2021] [Indexed: 11/21/2022] Open
Abstract
Total femoral replacement(TFR) is a well-recognized salvage procedure performed after multiple failed endoprosthetic replacements, which result in severely compromised bone stock and damaged structural integrity. TFR is performed as an alternative to lower limb amputation, restoring femoral integrity and enabling patients to resume ambulation. TFR is expected to be performed more frequently as the worldwide rate of revision arthroplasty increases due to improved patient survival rates and their underlying diseases, exceeding the functional life of endoprosthetic arthroplasty. We present a 74-year-old, overweight woman with an extensive surgical history with respect to her right knee. Her right lower extremity x-rays showed a long-cemented stem knee tumour prosthesis and a Garden 4 subcapital fracture of the ipsilateral hip. Due to multiple surgeries of the knee and femur in the past, a total femoral replacement was required to be performed. The procedure was successful, and the expected outcome was met. A successful procedure performed by a skilled and experienced surgical team, a thorough rehabilitation program, and prompt post-operative management of complications, can overcome the high incidence of infection and dislocation to preserve the limb with improved functionality and reduce pain. TFR is a drastic operative intervention that can preserve the quality of life for most patients.
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Affiliation(s)
- Jose Guerra
- Department of Surgery, University of Toronto, Scarborough Health Network, Ontario, Canada
| | - Patrick Chaghouri
- Department of Surgery, University of Toronto, Scarborough Health Network, Ontario, Canada
| | - Jose Andres Guerra
- Department of Surgery, University of Toronto, Scarborough Health Network, Ontario, Canada
| | - Sophia Lorina Peters
- Department of Surgery, University of Toronto, Scarborough Health Network, Ontario, Canada
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13
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Henderson ER, Keeney BJ, Husson EG, Bernthal NM, Ji T, Pala E, Funovics PT, Groundland JS, Lozano-Calderon S, Puchner S, Zoller SD, Ruggieri P, Windhager R, Guo W, Hornicek FJ, Letson GD, Temple HT. Nonmechanical Revision Indications Portend Repeat Limb-Salvage Failure Following Total Femoral Replacement. J Bone Joint Surg Am 2020; 102:1511-1520. [PMID: 32453111 DOI: 10.2106/jbjs.19.01022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is scant evidence to guide decision-making for patients considering total femoral replacement (TFR). We aimed to identify the indication, patient, disease, and surgical technique-related factors associated with failure. We hypothesized that failure occurs more frequently in the setting of revision surgical procedures, with infection as the predominant failure mode. METHODS We performed a retrospective cohort study of patients receiving total femoral endoprostheses for oncological and revision arthroplasty indications; 166 patients met these criteria. Our primary independent variable of interest was TFR for a revision indication (arthroplasty or limb salvage); the primary outcome was failure. Analyses were performed for patient variables (age, sex, diagnosis group, indication), implant variables (model, decade, length, materials), and treatment variables. We analyzed TFR failures with respect to patient factors, operative technique, and time to failure. We conducted bivariate logistic regressions predicting failure and used a multivariate model containing variables showing bivariate associations with failure. RESULTS Forty-four patients (27%) had treatment failure. Failure occurred in 24 (23%) of 105 primary TFRs and in 20 (33%) of 61 revision TFRs; the difference was not significant (p = 0.134) in bivariate analysis but was significant (p = 0.044) in multivariate analysis. The mean age at the time of TFR was 37 years in the primary group and 51 years in the revision group (p = 0.0006). Of the patients who had mechanical failure, none had reoccurrence of their original failure mode, whereas all 8 patients from the nonmechanical cohort had reoccurrence of the original failure mode; this difference was significant (p = 0.0001). CONCLUSIONS TFR has a high failure rate and a propensity for deep infection, especially in the setting of revision indications and prior infection. All failed TFRs performed for revision indications for infection or local recurrence failed by reoccurrence of the original failure mode and resulted in amputation. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Eric R Henderson
- Department of Orthopaedics and the Sarcoma & Connective Tissue Oncology Program, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire
| | - Benjamin J Keeney
- Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire.,Berkley Medical Management Solutions, Overland Park, Kansas
| | - Emily G Husson
- Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire
| | - Nicholas M Bernthal
- University of California at Los Angeles Sarcoma Program, Los Angeles, California
| | - Tao Ji
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Elisa Pala
- Orthopaedic Oncology Unit, University of Padua, Padua, Italy
| | - Philipp T Funovics
- Department of Orthopaedic Surgery, Medical University of Vienna, Vienna, Austria
| | | | | | - Stephan Puchner
- Department of Orthopaedic Surgery, Medical University of Vienna, Vienna, Austria
| | - Stephen D Zoller
- University of California at Los Angeles Sarcoma Program, Los Angeles, California
| | - Pietro Ruggieri
- Orthopaedic Oncology Unit, University of Padua, Padua, Italy
| | - Reinhard Windhager
- Department of Orthopaedic Surgery, Medical University of Vienna, Vienna, Austria
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Francis J Hornicek
- University of California at Los Angeles Sarcoma Program, Los Angeles, California
| | - G Douglas Letson
- Sarcoma Program, H. Lee Moffitt Cancer and Research Institute, Tampa, Florida
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14
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Naveen BM, Sharma Y, Phillip V. Two cases of total bone endoprosthetic reconstructions as limb salvage following resection of rare malignancies of proximal femur and humerus. JOURNAL OF MARINE MEDICAL SOCIETY 2020. [DOI: 10.4103/jmms.jmms_54_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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15
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Muratori F, Mondanelli N, Prifti X, Scoccianti G, Roselli G, Frenos F, Capanna R, Campanacci DA. Total femur prosthesis in oncological and not oncological series. Survival and failures. J Orthop 2019; 17:215-220. [PMID: 31889744 DOI: 10.1016/j.jor.2019.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 11/03/2019] [Indexed: 01/02/2023] Open
Abstract
Total femur prosthesis (TFP) can be used in both oncological and prosthetic revision surgery. A retrospective analysis of 32 patients receiving a TFP at a single Center between 2002 and 2018 was performed. The average follow-up was 60 months. Revision implant free survival (RIFS) of the implants was 87% at 5 and 10 years and 72% at 15 years. Overall implant survival (OIS) of the prosthesis was 90% at 5, 10 and 15 years. Complications observed: two soft tissue failures, two infection failure and one tumor progression failure.
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Affiliation(s)
- Francesco Muratori
- Divisione di Ortopedia Oncologica e Ricostruttiva, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Nicola Mondanelli
- Divisione Ortopedia e Traumatologia, Azienda Ospedaliera Universitaria, Siena, Italy
| | - Xhulio Prifti
- Divisione di Ortopedia Oncologica e Ricostruttiva, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Guido Scoccianti
- Divisione di Ortopedia Oncologica e Ricostruttiva, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Giuliana Roselli
- Istituto di Radiologia, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Filippo Frenos
- Divisione di Ortopedia Oncologica e Ricostruttiva, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | | | - Domenico Andrea Campanacci
- Divisione di Ortopedia Oncologica e Ricostruttiva, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
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16
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Tsuda Y, Fujiwara T, Sree D, Stevenson JD, Evans S, Abudu A. Physeal-preserving endoprosthetic replacement with short segment fixation in children with bone sarcomas. Bone Joint J 2019; 101-B:1144-1150. [PMID: 31474137 DOI: 10.1302/0301-620x.101b9.bjj-2018-1333.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to report the results of custom-made endoprostheses with extracortical plates plus or minus a short, intramedullary stem aimed at preserving the physis after resection of bone sarcomas in children. PATIENTS AND METHODS Between 2007 and 2017, 18 children aged less than 16 years old who underwent resection of bone sarcomas, leaving ≤ 5 cm of bone from the physis, and reconstruction with a custom-made endoprosthesis were reviewed. Median follow-up was 67 months (interquartile range 45 to 91). The tumours were located in the femur in 11 patients, proximal humerus in six, and proximal tibia in one. RESULTS The five-year overall survival rate was 78%. No patient developed local recurrence. The five-year implant survival rate was 79%. In all, 11 patients (61%) developed a complication. Seven patients (39%) required further surgery to treat the complications. Implant failures occurred in three patients (17%) including one patient with aseptic loosening and two patients with implant or periprosthetic fracture. The preserved physis continued to grow at mean 3.3 cm (0 to 14). The mean Musculoskeletal Society score was 88% (67% to 97%). CONCLUSION Custom-made endoprostheses that aim to preserve the physis are a safe and effective option for preserving physeal growth, limb length, and joint function with an acceptable rate of complications. Cite this article: Bone Joint J 2019;101-B:1144-1150.
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Affiliation(s)
- Y Tsuda
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK.,Tokyo University, Bunkyo, Tokyo, Japan
| | - T Fujiwara
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - D Sree
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - J D Stevenson
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - S Evans
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - A Abudu
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
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17
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Maupin JJ, Corning E, Steinmetz RG, White J. Creating a dual articulating antibiotic spacer for management of an infected total femur prosthesis hemiarthroplasty. Arthroplast Today 2019; 5:482-485. [PMID: 31886393 PMCID: PMC6920719 DOI: 10.1016/j.artd.2019.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 06/25/2019] [Accepted: 07/02/2019] [Indexed: 11/20/2022] Open
Abstract
The gold standard for management of chronic periprosthetic joint infections is a 2-stage revision arthroplasty with the first stage being explantation, debridement, and placement of a spacer. While there are implants designed to manage periprosthetic infections in hip and knee arthroplasty, there are not any commercially available implants designed to specifically manage an infected total femur megaprosthesis. This creates a unique surgical challenge and requires custom construction of a spacer to be performed by the surgeon intraoperatively. Here, we present our surgical technique for manufacturing a dual articulating total femur spacer. This technique facilitates range of motion at both the hip and knee joints, provides stability for axial loading in the extremity, and preserves the acetabulum while the patient undergoes antibiotic therapy to eradicate the infection.
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Affiliation(s)
- Jeremiah Jacob Maupin
- Department of Orthopaedic Surgery and Rehabilitation, University of Oklahoma, Oklahoma City, OK, USA
| | - Evan Corning
- Department of Orthopaedic Surgery and Rehabilitation, University of Oklahoma, Oklahoma City, OK, USA
| | - Raymond Garrett Steinmetz
- Department of Orthopaedic Surgery and Rehabilitation, University of Oklahoma, Oklahoma City, OK, USA
| | - Jeremy White
- Department of Orthopaedic Surgery and Rehabilitation, University of Oklahoma, Oklahoma City, OK, USA
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18
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Kakimoto T, Matsumine A, Asanuma K, Matsubara T, Nakamura T, Sudo A. The clinical outcomes of total femur prosthesis in patients with musculoskeletal tumors. SICOT J 2019; 5:23. [PMID: 31250806 PMCID: PMC6598423 DOI: 10.1051/sicotj/2019020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 06/01/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction: Reconstruction using a total femur prosthesis (TFP) remains a challenging procedure in musculoskeletal tumor surgery. The purpose of this study was to show the clinical outcomes of total femur replacement (TFR) in our institute. Methods: Nine patients underwent reconstruction with a TFP after the wide resection of malignant bone and soft-tissue tumors of the femur between January 2003 and April 2014. The mean age of the patients at the time of TFR was 47.5 years, and the mean follow-up period was 52.9 months. The histological diagnoses were as follows: bone sarcoma (n = 4), soft-tissue sarcoma invading the femoral bones (n = 4), and metastatic bone tumor (n = 1). Results: The oncological outcomes were as follows: three patients achieved continuous disease free, two patients were alive with disease, and four patients died from disease. The 3- and 5-year overall survival rates were 88.9% and 55.6%, respectively. The rate of the overall survival in patients with primary bone tumors (100% at 5 years) was significantly better than that in patients with primary soft tissue sarcomas (0% at 5 years) (p = 0.015). A deep infection occurred postoperatively in one patient, but the patient was successfully treated with surgical debridement and revision surgery. There were no patients who showed dislocation or aseptic loosening. The mean Musculo-Skeletal Tumor Society functional score was 58.5% (46.7–80.0), with scores of 65.5% in patients with a primary bone tumor and 50.8% in those with a primary soft-tissue sarcoma. Discussion: In the present study, the patients who underwent TFR due to bone invasion by soft tissue sarcoma had a worse prognosis than the bone sarcoma patients.
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Affiliation(s)
- Takuya Kakimoto
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie 514-8507, Japan
| | - Akihiko Matsumine
- Department of Orthopedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, Matsuoka-shimoaizuki 23-3, Eiheiji, Fukui 910-1193, Japan
| | - Kunihiro Asanuma
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie 514-8507, Japan
| | - Takao Matsubara
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie 514-8507, Japan
| | - Tomoki Nakamura
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie 514-8507, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie 514-8507, Japan
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19
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Lenze U, Knebel C, Lenze F, Consalvo S, Lazic I, Breden S, Rechl H, von Eisenhart-Rothe R. [Total endoprosthetic replacement of femur, humerus and tibia]. DER ORTHOPADE 2019; 48:555-562. [PMID: 31190111 DOI: 10.1007/s00132-019-03762-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Improvements in diagnostics and effectiveness of chemotherapy have resulted in most patients with primary malignant bone tumours being candidates for limb salvage surgery. Herewith, the use of modern modular tumour endoprostheses allows for the replacement of all big joints and even entire long bones such as the femur, humerus and tibia. In this article, we focus on individual prerequisites for and challenges with performing a total endoprosthetic reconstruction of the above-mentioned anatomic structures. Additionally, data from the literature with regards to functional outcome, problems and complications are presented.
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Affiliation(s)
- U Lenze
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, TU München, München, Deutschland.
| | - C Knebel
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, TU München, München, Deutschland
| | - F Lenze
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, TU München, München, Deutschland
| | - S Consalvo
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, TU München, München, Deutschland
| | - I Lazic
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, TU München, München, Deutschland
| | - S Breden
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, TU München, München, Deutschland
| | - H Rechl
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, TU München, München, Deutschland
| | - R von Eisenhart-Rothe
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, TU München, München, Deutschland
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20
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Total femur replacement in non-oncologic indications: Functional and radiological outcomes from a French survey with a mean 6 years' follow-up. Orthop Traumatol Surg Res 2019; 105:591-598. [PMID: 31027981 DOI: 10.1016/j.otsr.2018.12.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 11/25/2018] [Accepted: 12/06/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION There are few published studies on total femur replacement (TFR) because its indications are rare. Other than malignant diseases, the indications extend to revisions and interprosthetic femur fractures; however, the outcomes of these indications have not been well defined. The aim of this retrospective survey was to analyze the complication rate and functional outcomes of these newer indications. HYPOTHESIS The morbidity and outcomes after TFR are comparable to those reported in the literature for non-cancer indications. MATERIAL AND METHODS Between 1997 and 2016, 29 TFR procedures were done at 6 French teaching hospitals in 15 women and 14 men, average age 68±14 years [32-85]. The primary indication was degenerative joint disease in the hip and/or knee in 16 cases, mechanical failure of the implant used after tumor resection in 11 cases and femur fracture in 2 cases. The mean number of surgical procedures before TFR was 3.6 (maximum 5) at the hip and 4.5 (maximum 10) at the knee. Six different models were implanted consisting of a rotational hinge knee (except in one case); 20 patients received a dual mobility system and 9 a standard hip replacement bearing. The femoral shaft was partially conserved 21/29 times and the trochanter 25/29 times. RESULTS Five patients suffered a general complication and 12 suffered a local complication (including 4 hematomas and 2 hip dislocations). Eight patients (28.6%) suffered a surgical site infection, although three had a prior infection. Among the 12 patients with a history of infection or progressive infection before the TFR, 9 healed and 3 had the infection continue. At a minimum follow-up of 2 years and mean of 6 years, 23 TFR implants were still in place and not infected; the other 6 had been removed or were infected, including one patient who underwent disarticulation. The median survival of the non-infected TFR was 15 years. At 10 years, 70% of TFR implants were still in place and non-infected. Walking was possible with or without a cane in 15 patients (51.7%), with two canes or a walker in 12 patients (41.3%) and impossible in 2 patients. Active knee flexion averaged 79.4°±30.3° [0°-120°]; 17 patients (62.9%) had 90° or more flexion; two patients (7.4%) had no flexion. The extension deficit averaged 3.7°±7°[-20° to 10°] and 20 patients had no flexion deformity. The leg length difference averaged 1.3cm±2.3 [0-10]; 19 patients (67.8%) had no difference in leg length. DISCUSSION Our starting hypothesis was confirmed for the complication rate and clinical outcomes. The benefits of dual mobility cups are emphasized. While the indications for TFR are rare, they will likely increase in the coming years. LEVEL OF EVIDENCE IV, Retrospective cohort study….
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21
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Medellin MR, Fujiwara T, Clark R, Stevenson JD, Parry M, Jeys L. Mechanisms of failure and survival of total femoral endoprosthetic replacements. Bone Joint J 2019; 101-B:522-528. [PMID: 31038993 DOI: 10.1302/0301-620x.101b5.bjj-2018-1106.r1] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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.
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Affiliation(s)
- M R Medellin
- Royal Orthopaedic Hospital, Birmingham, UK.,Instituto Nacional de Cancerología, Bogotá, Colombia
| | - T Fujiwara
- Royal Orthopaedic Hospital, Birmingham, UK
| | - R Clark
- Royal Orthopaedic Hospital, Birmingham, UK
| | | | - M Parry
- Royal Orthopaedic Hospital, Birmingham, UK.,Aston University Medical School, Birmingham, UK
| | - L Jeys
- Royal Orthopaedic Hospital, Birmingham, UK.,School of Life and Health Sciences, Aston University, Birmingham, UK
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Wu F, Fang X, Lang Z, Liu H, Xiong Y, Zhang W, Luo Y, Tu C, Duan H. [Total femoral replacement for treating femur malignant tumor]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:18-22. [PMID: 30644255 DOI: 10.7507/1002-1892.201807052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To investigate the procedure and effectiveness of total femoral replacement for treating femur malignant tumor. Methods The clinical data of 9 patients with femoral malignant tumors who underwent total femoral replacement between July 2013 and March 2017 were retrospectively analyzed. There were 5 males and 4 females, aged 16-75 years with an average of 44.8 years. The disease duration ranged from 2 to 6 months with an average of 3.5 months. There were 5 cases of osteosarcoma (3 cases were staged as Enneking ⅡB, 2 cases were staged as Enneking Ⅲ), 1 case of malignant fibrosarcoma (staged as Enneking ⅡB), 1 case of chondrosarcoma (staged as Enneking ⅠB), 2 cases of femoral muti-metastasis of lung cancer with pathological fracture. The visual analogue scale (VAS) score and the quality of life (QOL) score of the tumor patients were evaluated before operation and at 3 months after operation. The Musculoskeletal Tumor Society (MSTS) score and Harris hip score (HHS) were evaluated at last follow-up. Results Nine patients were followed up 11-58 months, with an average of 21 months. No complication such as wound infection, joint dislocation, and nerve injury occurred. One patient developed popliteal vein thrombosis, and 2 patients with osteosarcoma died of tumor progression. The VAS score and QOL score at 3 months after operation were 3.2±1.2 and 40.6±5.4 respectively, which were significantly improved when compared with preoperative ones (5.9±0.8 and 22.3±4.2 respectively) ( t=11.314, P=0.000; t=-7.794, P=0.000). At last follow-up, the MSTS score was 15-29 with an average of 21.1, and the HHS score was 44-90 with an average of 66.5. Conclusion Total femoral replacement is an effective limb salvage procedure for the treatment of femoral malignant tumors, which can effectively restore the weight-bearing and walking function, relieve pain, and improve the quality of life.
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Affiliation(s)
- Fan Wu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;SectionⅠDepartment of Orthopedics, the Fourth People's Hospital of Zigong City, Zigong Sichuan, 643000, P.R.China
| | - Xiang Fang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Zhigang Lang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;Department of Osteopathy, Sichuan Provincial Orthopedic Hospital, Chengdu Sichuan, 610041, P.R.China
| | - Hongyuan Liu
- Department of Orthopedics, Sichuan Provincial Fifth People's Hospital, Chengdu Sichuan, 610031, P.R.China
| | - Yan Xiong
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Wenli Zhang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Yi Luo
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Chongqi Tu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Hong Duan
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
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Medellin MR, Fujiwara T, Clark R, Jeys LM. Comparison of minimally invasive and non-invasive systems in lengthening total femoral prostheses. Bone Joint J 2018; 100-B:1640-1646. [DOI: 10.1302/0301-620x.100b12.bjj-2018-0135.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aim of this study was to describe, analyze, and compare the survival, functional outcome, and complications of minimally invasive (MI) and non-invasive (NI) lengthening total femoral prostheses. Patients and Methods A total of 24 lengthening total femoral prostheses, 11 MI and 13 NI, were implanted between 1991 and 2016. The characteristics, complications, and functional results were recorded. There were ten female patients and ten male patients. Their mean age at the time of surgery was 11 years (2 to 41). The mean follow-up was 13.2 years (seven months to 29.25 years). A survival analysis was performed, and the failures were classified according to the Modified Henderson System. Results The overall implant survival was 79% at five, ten, and 20 years for MI prostheses, and 84% at five years and 70% at ten years for NI prostheses. At the final follow-up, 13 prostheses did not require further surgery. The overall complication rate was 46%. The mean revision-free implant survival for MI and NI prostheses was 59 months and 49 months, respectively. There were no statistically significant differences in the overall implant survival, revision-free survival, or the distribution of complications between the two types of prosthesis. Infection rates were also comparable in the groups (9% vs 7%; p = 0.902). The rate of leg-length discrepancy was 54% in MI prostheses and 23% in NI prostheses. In those with a MI prosthesis, there was a smaller mean range of movement of the knee (0° to 62° vs 0° to 83°; p = 0.047), the flexion contracture took a longer mean time to resolve after lengthening (3.3 months vs 1.07 months; p < 0.001) and there was a lower mean Musculoskeletal Tumor Society (MSTS) score (24.7 vs 27; p = 0.295). Conclusion The survival and complications of MI and NI lengthening total femoral prostheses are comparable. However, patients with NI prosthesis have more accurate correction of leg-length discrepancy, a better range of movement of the knee and an improved overall function.
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Affiliation(s)
- M. R. Medellin
- Consultant in Orthopaedic Oncology and Reconstructive Surgery, Royal Orthopaedic Hospital, Birmingham, UK
| | - T. Fujiwara
- Consultant in Orthopaedic Oncology and Reconstructive Surgery, Royal Orthopaedic Hospital, Birmingham, UK
| | - R. Clark
- Consultant in Orthopaedic Oncology and Reconstructive Surgery, Royal Orthopaedic Hospital, Birmingham, UK
| | - L. M. Jeys
- Consultant in Orthopaedic Oncology and Reconstructive Surgery, Royal Orthopaedic Hospital, Birmingham, UK
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Wu F, Fang X, Lang Z, Liu H, Duan H. [Advances in total femur replacement]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:1346-1350. [PMID: 30215485 DOI: 10.7507/1002-1892.201804006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To summarize the advances of total femur replacement in recent years. Methods The literature related to total femur replacement was reviewed, and the indications, techniques, prosthesis design, complications, rehabilitation, and function were summarized. Results The indication of total femur replacement is a wide involvement of the femur, skip lesions and a huge bone defect in revision. Watson-Jone is the main incision in the proximal, and then the full length of the thigh to the patella. Vascular and nerve bundle, abduction muscles are well protected, and combined or costumed prosthesis are replaced. The prosthesis design progresses, showing a diversified prostheses. Complication is frequent and varied. Rehabilitation in early stage is physical therapy, weight training is evolutionary. The main function evaluation system is Musculoskeletal Tumor Society (MSTS) score. Conclusion Total femur replacement is effective in limb salvage. Large sample size and long-term follow-up study should be carried out to unify indications and functional exercise standards and reduce postoperative complications.
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Affiliation(s)
- Fan Wu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;Department of Orthopedics, Fourth People's Hospital of Zigong, Zigong Sichuan, 643000, P.R.China
| | - Xiang Fang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Zhigang Lang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Hongyuan Liu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Hong Duan
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
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Sevelda F, Waldstein W, Panotopoulos J, Kaider A, Funovics PT, Windhager R. Is Total Femur Replacement a Reliable Treatment Option for Patients With Metastatic Carcinoma of the Femur? Clin Orthop Relat Res 2018; 476:977-983. [PMID: 29480890 PMCID: PMC5916617 DOI: 10.1007/s11999.0000000000000125] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The majority of metastatic bone lesions to the femoral bone can be treated without surgery or with minimally invasive intramedullary nailing. In rare patients with extensive metastatic disease to the femur, total femur replacement may be the only surgical alternative to amputation; however, little is known about this approach. QUESTIONS/PURPOSES In a highly selected small group of patients with metastatic carcinoma of the femur, we asked: (1) What was the patient survivorship after this treatment? (2) What was the implant survivorship free from all-cause revision and amputation, and what complications were associated with this treatment? (3) What functional outcomes were achieved by patients after total femur replacement for this indication? METHODS Eleven patients (three men, eight women) with a mean age of 64 years (range, 41-78 years) received total femur replacements between 1986 and 2016; none were lost to followup. The most common primary disease was breast cancer. In general, during this period, our indications for this procedure were extensive metastatic disease precluding internal fixation or isolated proximal or distal femur replacement, and an anticipated lifespan exceeding 6 months. Our contraindication for this procedure during this time was expected lifespan less than 6 months. Patient survival was assessed by Kaplan-Meier analysis; implant survival free from revision surgery and amputation were assessed by competing risk analysis. Function was determined preoperatively and 6 to 12 weeks postoperatively with the Musculoskeletal Tumor Society (MSTS) score normalized to a 100-point scale, with higher scores representing better function from a longitudinally maintained institutional database. RESULTS Eleven patients died at a median of 5 months (range, 1-31 months) after surgery. One-year revision-free and limb survival were 82% (95% CI, 51%-98%) and 91% (95% CI, 61%-99%), respectively. Reasons for reoperation were hip dislocation, infection and local recurrence in one patient each. The latter two complications resulted in amputation in two patients. The median MSTS score was 32 (range, 13-57). CONCLUSIONS Despite attempts to select patients who might have anticipated greater life expectancy, eight of 11 patients died by 6 months after surgery, and an additional two patients had undergone an amputation at 8 and at 17 months postoperatively. Most patients undergoing total femur replacement in this series did not recover from the procedure by the time they died, despite our best attempts to perform the procedure in patients whom we thought would live at least 6 months. Based on this, we believe that most patients with extensive metastatic disease to the femur should be offered palliative care, rather than major reconstruction. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Florian Sevelda
- F. Sevelda, W. Waldstein, J. Panotopoulos, P. T. Funovics, R. Windhager, Department of Orthopaedic Surgery, Medical University of Vienna, Vienna, Austria A. Kaider, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
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Du Z, Tang S, Yang R, Tang X, Ji T, Guo W. Use of an Artificial Ligament Decreases Hip Dislocation and Improves Limb Function After Total Femoral Prosthetic Replacement Following Femoral Tumor Resection. J Arthroplasty 2018; 33:1507-1514. [PMID: 29366726 DOI: 10.1016/j.arth.2017.12.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/10/2017] [Accepted: 12/14/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Hip dislocation is a major complication of total femoral prosthetic reconstruction (TFR) after femoral tumor resection. Hip dislocation can occur because of inadequate functional abductor musculature, inadequate hip capsule repair, or a long lever arm after total femur replacement. To eliminate the negative effects of these factors on the risk of hip dislocation, the use of artificial ligaments may help to increase the stability of the hip joint. We aimed to determine whether application of an artificial ligament would improve limb function and active range of movement (ROM) after TFR. METHODS Fifty-eight patients who underwent femoral tumor resection and TFR were included. A band-shaped artificial ligament was wrapped spirally around the proximal site of the total femur prosthesis for periacetabular soft tissue reconstruction in 12 patients. The other 46 patients did not consent to receiving the artificial ligament. Complications including hip dislocation and infection, limb function, and active hip ROM were compared between patients who did and did not receive the artificial ligament. RESULTS The hip dislocation rate was lower in the patients who received the artificial ligament. The risk of deep infection did not differ between groups. The group that received the ligament also achieved better limb function and active ROM on flexion and abduction. CONCLUSION Patients treated with total femur resection and endoprosthetic replacement with an artificial ligament for periacetabular soft tissue reconstruction had a more stable hip joint, better limb function, and greater active hip ROM than did patients who did not receive an artificial ligament.
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Affiliation(s)
- Zhiye Du
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China; Key Laboratory for Musculoskeletal Tumor of Beijing, Peking University People's Hospital, Beijing, People's Republic of China
| | - Shun Tang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China; Key Laboratory for Musculoskeletal Tumor of Beijing, Peking University People's Hospital, Beijing, People's Republic of China
| | - Rongli Yang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China; Key Laboratory for Musculoskeletal Tumor of Beijing, Peking University People's Hospital, Beijing, People's Republic of China
| | - Xiaodong Tang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China; Key Laboratory for Musculoskeletal Tumor of Beijing, Peking University People's Hospital, Beijing, People's Republic of China
| | - Tao Ji
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China; Key Laboratory for Musculoskeletal Tumor of Beijing, Peking University People's Hospital, Beijing, People's Republic of China
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China; Key Laboratory for Musculoskeletal Tumor of Beijing, Peking University People's Hospital, Beijing, People's Republic of China
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Toepfer A, Harrasser N, Petzschner I, Pohlig F, Lenze U, Gerdesmeyer L, von Eisenhart-Rothe R, Mühlhofer H, Suren C. Is total femoral replacement for non-oncologic and oncologic indications a safe procedure in limb preservation surgery? A single center experience of 22 cases. Eur J Med Res 2018; 23:5. [PMID: 29338761 PMCID: PMC5771193 DOI: 10.1186/s40001-018-0302-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 01/05/2018] [Indexed: 02/01/2023] Open
Abstract
Background Several surgical options for the reconstruction of massive bone defects have been described and include biologic methods with autografts and allografts, and the use of tumor endoprostheses (total femoral replacement, TFR). Several types of modular TFR are available, but nevertheless unpredictable outcomes and high complication rates have been described from most authors. The present study aims to compare results after TFR performed with modular total femur prosthesis MML (Fa. ESKA/Orthodynamics) in patients with and without malignant disease. Methods Retrospective chart review and functional investigation (Musculoskeletal Tumor Society (MSTS) score, Harris Hip Score (HHS), Oxford Knee Score (OKS), SF-12 Health Survey, and failure classification according to Henderson) of TFR cases from 1995 to 2011. Indications for TFR were malignant tumor resection from the femur (n = 9, Group A) or failure of a revision arthroplasty without history of malignant disease (n = 13, Group B). Results Thirty-six patients were treated during the study period, of whom 22 could be investigated clinically after a mean follow-up of 63 months. Overall failure rate for TFR was 59.1%, leading to 38 surgical revisions. The most common failure mechanisms were Type I (soft tissue), followed by Type IV (infection) and Type III (mechanical failure). Mean MSTS score out of 30 was 13 (range 1–25), with significantly higher scores in Group A (mean 19, range 3–25) than Group B (mean 9, range 1–15). Conclusion TFR is an established procedure to restore femoral integrity. However, complication rates are considerably high, and depend mainly on the age at initial reconstruction.
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Affiliation(s)
- Andreas Toepfer
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, 81547, Munich, Germany.
| | - Norbert Harrasser
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, 81547, Munich, Germany
| | | | - Florian Pohlig
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, 81547, Munich, Germany
| | - Ulrich Lenze
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, 81547, Munich, Germany
| | - Ludger Gerdesmeyer
- Departmant of Orthopaedic Surgery and Traumatology, University of Schleswig-Holstein, Kiel, Germany
| | | | - Heinrich Mühlhofer
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, 81547, Munich, Germany
| | - Christian Suren
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, 81547, Munich, Germany
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Agrawal A, Agrawal V, Yadav S, Soni SK, Pawar SK. A Case Report of Dual Incision Technique for Total Femur Arthroplasty as a Salvage Procedure in Infected Non-Unions. J Orthop Case Rep 2017; 7:44-47. [PMID: 29181352 PMCID: PMC5702703 DOI: 10.13107/jocr.2250-0685.844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Total femur arthroplasty (TFA) is a rare salvage limb procedure which serves as an effective alternative to limb amputation. Most commonly, it is indicated for oncologic orthopedic cases, and very few cases of a purely traumatic history for TFA have been documented. The decision to perform this complex procedure involves paying careful attention to reconstructive needs and functional expectations of the patient. Alternatives to this procedure are quite detrimental and include hip disarticulation and above-the-knee amputation. Case Report A 66-year-old woman with a history of hypertension, and parkinsonism was brought into the outpatient department of a tertiary care hospital. She has undergone a procedure for proximal femur nailing on her left hip in 2013 due to a trauma-related fracture. However, after the development of a series of complications, she underwent revision surgery on her left hip 6 times by different surgeons. This included surgeries for implant removal and fixation of a custom-made bipolar hemi-replacement hip, followed by a cemented bipolar hip hemi- replacement with plating and cerclage wires followed by infection, the treatment of which entailed implant removal and placement of an antibiotic cement. This was followed by a long stem constrained cemented total hip arthroplasty which also failed. The surgeon then made the decision to perform a TFA. 12-month follow-up post-operatively showed neither peri-prosthetic infection or inflammation nor any leg length discrepancy. The functional outcome on lower extremity function scale showed improvement from 0 pre-operatively to 31 at 12-month follow- up. Conclusion TFA serves as a viable technique for salvage of the lower extremity in cases of infected non-unions. However, a thorough evaluation of the particular case in the hand should be made before reaching a conclusion.
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Affiliation(s)
| | - Vinod Agrawal
- Department of Orthopedics, Lilavati Hospital, Bandra Reclamation, Mumbai, Maharashtra, India
| | - Sandeepkumar Yadav
- Department of Orthopedics, Lilavati Hospital, Bandra Reclamation, Mumbai, Maharashtra, India
| | - Shushil K Soni
- Department of Orthopedics, Lilavati Hospital, Bandra Reclamation, Mumbai, Maharashtra, India
| | - Sawan Kumar Pawar
- Department of Orthopedics, Lilavati Hospital, Bandra Reclamation, Mumbai, Maharashtra, India
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Yoshida Y, Osaka S, Tokuhashi Y. Total femur replacement for Ewing’s sarcoma after wide resection of the proximal femur: a long-term follow-up case study. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0501.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background: Total femur replacement is a relatively rarely performed procedure for the reconstruction of an affected limb after resection of a malignant bone tumor.
Objective: Report total femur replacement in a 17-year-old male patient after wide resection of the right femur for involvement of the proximal segment of the bone by Ewing’s sarcoma.
Results: The complications that often arose from the use of the tumor prostheses after the tumor resection, e.g., infection and migration/dislocation of the artificial bonehead, were overcome successfully. The patient has been under follow-up for a relatively long period of time (16 years) since the surgery. The operated limb function is now rated at 70% according to the rating system by Musculo-Skeletal Tumor Society (MSTS). The patient has almost completely regained his ability to walk and carries on with activities of daily living.
Conclusion: If appropriate measures are taken to deal with the complications, favorable function of the operated limb can be expected to be maintained for long periods after reconstruction using this technique.
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Affiliation(s)
- Yukihiro Yoshida
- Department of Orthopedic Surgery, Nihon University School of Medicine, 30-1, Oyaguchikami-cho, Itabashi-ku, Tokyo 173-8610, Japan
| | - Shunzo Osaka
- Department of Orthopedic Surgery, Nerima Hikarigaoka Hospital, Nippon University, Nerima Hikarigaoka, Tokyo 173-8610, Japan
| | - Yasuaki Tokuhashi
- Department of Orthopedic Surgery, Nerima Hikarigaoka Hospital, Nippon University, Nerima Hikarigaoka, Tokyo 173-8610, Japan
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Toepfer A, Harrasser N, Petzschner I, Pohlig F, Lenze U, Gerdesmeyer L, Pförringer D, Toepfer M, Beirer M, Crönlein M, von Eisenhart-Rothe R, Mühlhofer H. Short- to long-term follow-up of total femoral replacement in non-oncologic patients. BMC Musculoskelet Disord 2016; 17:498. [PMID: 27955655 PMCID: PMC5154048 DOI: 10.1186/s12891-016-1355-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 11/30/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Compromised bone stock and heavily impaired structural integrity after multiple endoprosthetic revision surgeries can lead to a comparable condition as encountered in musculoskeletal tumor surgery. Total femoral replacement (TFR) can restore femoral integrity and allow patients to resume ambulation. Even though several authors reported their results of TFR, so far many questions are still on debate: Which patients are at risk to experience low functional outcome? Do complications and clinical outcome after TFR depend on the indication for the surgery (e.g. periprosthetic fractures or aseptic loosening) or the age of the patients? The purpose of the present study was to compare complication rates after TFR performed with modular total femur prosthesis MML (Fa. ESKA/Orthodynamics) in patients without malignant disease. METHODS We conducted a retrospective chart review and functional investigation of patients treated with a TFR for non-oncologic conditions from 1995 to 2015 and a minimum follow-up of 2 years. Complications were recorded according to the Henderson-Classification; outcome was evaluated with established clinical scores. The indication for TFR was periprosthetic fracture (Group A, n = 11) or aseptic loosening (Group B, n = 7) with massive bone defect of the femur deemed unsuitable for conventional arthroplastic or biologic reconstruction. RESULTS Eighteen patients matched the inclusion criteria and could be investigated clinically after a mean follow-up of 80 months (range: 28-132). Before TFA, all patients had previously undergone multiple operations (range: 1-8). The overall failure rate for any reason was 72% (n = 13/18), leading to a total of 37 surgical revisions with total exchange of TFR in 22% (n = 4/18). Most common failure mechanism was Type I (soft tissue), followed by Type IV (infection) and Type III (mechanical failure). According to Enneking's functional evaluation method (MSTS-Score), the function ranged from 1 to 15 with a mean of 10 ± 4 out of 30. CONCLUSION TFR is a salvage procedure to restore mechanical integrity and regain functional ability after extensive femoral bone loss. Outcome of the patients in the present study did mainly depend on the age at reconstruction and not on the indication for TFR.
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Affiliation(s)
- Andreas Toepfer
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, 81547 Munich, Germany
| | - Norbert Harrasser
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, 81547 Munich, Germany
| | | | - Florian Pohlig
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, 81547 Munich, Germany
| | - Ulrich Lenze
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, 81547 Munich, Germany
| | - Ludger Gerdesmeyer
- Department of Orthopaedic Surgery and Traumatology, University of Schleswig, Holstein, Germany
| | - Dominik Pförringer
- Department of Trauma Surgery, Technical University of Munich, Munich, Germany
| | - Marcel Toepfer
- Department of Nephrology and Dialysis, Klinikum Weilheim, Weilheim, Germany
| | - Marc Beirer
- Department of Trauma Surgery, Technical University of Munich, Munich, Germany
| | - Moritz Crönlein
- Department of Trauma Surgery, Technical University of Munich, Munich, Germany
| | | | - Heinz Mühlhofer
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, 81547 Munich, Germany
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The Significance of Rectus Femoris for the Favorable Functional Outcome After Total Femur Replacement. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e630. [PMID: 27257560 PMCID: PMC4874274 DOI: 10.1097/gox.0000000000000610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 12/30/2015] [Indexed: 11/26/2022]
Abstract
Background: In treatment of tumors, we usually reconstruct after resection of the entire femur using only metallic modular endoprostheses among many procedures and defined it as a total femur replacement. We studied the interrelation between the preservation of rectus femoris and the functional outcome after total femur replacement. Methods: We rated the functional outcomes of 21 patients who underwent total femur replacement. We categorized the subjects into 2 groups: group A (rectus femoris preserved) and group B (rectus femoris unpreserved). We examined them based on the Mann-Whitney U test between the 2 groups in average through the Musculoskeletal Tumor Society functional scores. Results: The average score of group A was 20 of 25 (11–25; 80%), whereas the average score of group B was 10 of 25 (4–13; 40%). There was significant difference between the groups (P = 0.00168877). Conclusion: We found that the preservation of rectus femoris is imperative for achieving the favorable functional outcome in total femur replacement.
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Zheng K, Yu XC, Xu SF, Wang L. Total Femur Replacement for Treatment of Chondrosarcoma Involving the Entire Femur. Orthop Surg 2016; 7:286-7. [PMID: 26311106 DOI: 10.1111/os.12191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Kai Zheng
- Department of Orthopaedics, General Hospital of Jinan Military Commanding Region, Jinan, China
| | - Xiu-chun Yu
- Department of Orthopaedics, General Hospital of Jinan Military Commanding Region, Jinan, China
| | - Song-feng Xu
- Department of Orthopaedics, General Hospital of Jinan Military Commanding Region, Jinan, China
| | - Lei Wang
- Department of Orthopaedics, General Hospital of Jinan Military Commanding Region, Jinan, China
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Liu T, Zhang X, Zhang Q, Zhang X, Guo X. Total femoral reconstruction with custom prosthesis for osteosarcoma. World J Surg Oncol 2016; 14:93. [PMID: 27030028 PMCID: PMC4815190 DOI: 10.1186/s12957-016-0852-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 03/24/2016] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to assess total femur replacement for the treatment of femoral osteosarcomas. Methods Between January 1995 and January 2012, 21 patients with a mean age of 21.8 years old were treated for femoral osteosarcomas with total femur replacement. All tumors were staged according to Enneking’s criteria with one stage IIA case and 20 stage IIB cases. Results The survival of patients with osteosarcoma without metastases was 66.7 % at 5 years. Twelve patients were alive with an overall mean follow-up of 71.2 months, and the mean postoperative functional score was 72.5 % at their last follow-up. Superficial infection occurred in two patients, which were resolved by changing dressing and intravenous antibiotics. Deep infection occurred in one patient, which was an amputation by hip disarticulation. Patella fracture occurred in one patient, which was treated by open reduction and tension band fixation. Local recurrence was seen in one patient, which was an amputation by hip disarticulation. Pulmonary metastases were observed in nine patients and all the patients subsequently died of disease within 12 months. Aseptic loosening in tibial stem occurred in three patients, whose whole prosthesis was revised. Conclusions Total femur replacement is a reliable method to restore mechanical and functional results after extensive resection of the femur.
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Affiliation(s)
- Tang Liu
- Department of Orthopaedics, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People's Republic of China
| | - Xianghong Zhang
- Department of Orthopaedics, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People's Republic of China
| | - Qing Zhang
- Department of Orthopaedics, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People's Republic of China.
| | - Xiangsheng Zhang
- Department of Orthopaedics, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People's Republic of China
| | - Xiaoning Guo
- Department of Orthopaedics, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People's Republic of China
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Total Femur Replacement After Tumor Resection: Limb Salvage Usually Achieved But Complications and Failures are Common. Clin Orthop Relat Res 2015; 473:2079-87. [PMID: 25832007 PMCID: PMC4419011 DOI: 10.1007/s11999-015-4282-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 03/24/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Primary bone or soft tissue tumors of the femur sometimes present with severe and extensive bone destruction, leaving few limb-salvage options other than total femur replacement. However, there are few data available regarding total femur replacement and, in particular, regarding implant failures. QUESTIONS/PURPOSES We asked: (1) What are the revision-free and overall implant survival rates of conventional total femur replacements in patients treated for sarcoma of the femur or soft tissues? (2) What are the revision-free and overall implant survival rates of expandable total femur replacements in skeletally immature patients? (3) Using the comprehensive International Society of Limb Salvage failure-mode classification, what types of complications occur with conventional and expandable total femur replacements? PATIENTS AND METHODS Our retrospective, single-center cohort study was based on data prospectively collected for 50 patients who received a total femur replacement after tumor resection for indications other than carcinoma or metastatic disease. Of the 50 patients, six (12%) were lost to followup before 6 months. Ten of the remaining 44 patients received expandable implants. The mean followup was 57 months (range, 1-280 months) and 172 months (range, 43-289 months) for patients who underwent conventional and expandable total femur replacements, respectively. For implant survival, competing risk analyses were used. RESULTS At 5 years, revision-free implant survival of conventional total femur replacements was 48% (95% CI, 0.37-0.73), and overall implant survival was 97% (95% CI, 0.004-0.20). Five-year revision-free implant survival of expandable total femur replacements was 30% (95% CI, 0.47-1.00) and overall implant survival was 100%. With conventional total femur replacements soft tissue failures occurred in 13 of 34 patients, structural failures in three, infection in six, and local tumor progression in one. No patient had aseptic loosening with conventional total femur replacements, but hip disarticulation occurred in two patients owing to extensive wound-healing problems and infection. With expandable total femur replacements soft tissue failure, aseptic loosening, and infection occurred in one patient each of 10, and structural failures in three of 10 (two periprosthetic fractures, one loosening of an enhanced tendon anchor). No hip disarticulations were performed. Additionally expandable total femur replacement-related failures included hip instability in eight of 10 patients, contractures attributable to massive scar tissue in six, and defect of the implant's expansion mechanism in four patients. CONCLUSIONS Although the indications for total femoral resection are rare, we think that total femur replacement is a reasonable treatment option for reconstruction of massive femoral bone defects after tumor resection in adults and skeletally immature patients, and results in limb salvage in most patients. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Qu H, Guo W, Yang R, Tang X, Yan T, Li D, Yang Y, Zang J. Cortical strut bone grafting and long-stem endoprosthetic reconstruction following massive bone tumour resection in the lower limb. Bone Joint J 2015; 97-B:544-9. [PMID: 25820896 DOI: 10.1302/0301-620x.97b4.34695] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We determined the efficacy of a devitalised autograft (n = 13) and allograft (n = 16) cortical strut bone graft combined with long-stem endoprosthetic reconstruction in the treatment of massive tumours of the lower limb. A total of 29 patients (18 men:11 women, mean age 20.1 years (12 to 45) with a ratio of length of resection to that of the whole prosthesis of > 50% were treated between May 2003 and May 2012. The mean follow-up was 47 months (15 to 132). The stem of the prosthesis was introduced through bone graft struts filled with cement, then cemented into the residual bone. Bone healing was achieved in 23 patients (86%). The mean Musculoskeletal Tumour Society functional score was 85% (57 to 97). The five-year survival rate of the endoprostheses was 81% (95% confidence intervals 67.3 to 92.3). The mean length of devitalised autografts and allografts was 8.6 cm (5 to 15), which increased the ratio of the the length of the stem of the prosthesis to that of the whole length of the prosthesis from a theoretical 35% to an actual 55%. Cortical strut bone grafting and long-stem endoprosthetic reconstruction is an option for treating massive segmental defects following resection of a tumour in the lower limb. Patients can regain good function with a low incidence of aseptic loosening. The strut graft and the residual bone together serve as a satisfactory bony environment for a revision prosthesis, if required, once union is achieved.
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Affiliation(s)
- H Qu
- People's Hospital, Peking University, Xizhimen Nan 11, Xicheng District, Beijing, 100044, China
| | - W Guo
- People's Hospital, Peking University, Xizhimen Nan 11, Xicheng District, Beijing, 100044, China
| | - R Yang
- People's Hospital, Peking University, Xizhimen Nan 11, Xicheng District, Beijing, 100044, China
| | - X Tang
- People's Hospital, Peking University, Xizhimen Nan 11, Xicheng District, Beijing, 100044, China
| | - T Yan
- People's Hospital, Peking University, Xizhimen Nan 11, Xicheng District, Beijing, 100044, China
| | - D Li
- People's Hospital, Peking University, Xizhimen Nan 11, Xicheng District, Beijing, 100044, China
| | - Y Yang
- People's Hospital, Peking University, Xizhimen Nan 11, Xicheng District, Beijing, 100044, China
| | - J Zang
- People's Hospital, Peking University, Xizhimen Nan 11, Xicheng District, Beijing, 100044, China
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Pan K, Chan W, Shanmugam P, Ong G, Kamaruddin F, Tan S. Large volume osteosarcomas of the femur treated with total femoral replacement. Malays Orthop J 2014; 8:32-6. [PMID: 25347294 PMCID: PMC4093546 DOI: 10.5704/moj.1403.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Patients with extensive malignancies involving the femur
often require total femoral replacement when their limbs can
be salvaged. Reported series are small and involve
heterogeneity of tumours. We present nine patients with
osteosarcomas of the femur treated at our institution between
2003 and 2010 with a mean follow-up of 27 (6 to 56)
months. Their ages ranged from 9 to 17 (mean 14 years).
They had large volume tumours (mean 911 cm3) and
presented late with a mean of 5.5 months from the onset of
symptoms to definitive treatment. All patients underwent
resection and total femur replacement. Six patients have
died and two are alive with good function at the time of this
report. One was lost to follow-up. These patients require a
high level of treatment care and have a guarded prognosis.
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Affiliation(s)
- Kl Pan
- Department of Orthopaedics, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kuching, Malaysia
| | - Wh Chan
- Department of Orthopaedics, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kuching, Malaysia
| | - P Shanmugam
- Department of Orthopaedics, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kuching, Malaysia
| | - Gb Ong
- Department of Paediatric Oncology, Sarawak General Hospital, Kuching, Malaysia
| | - F Kamaruddin
- Department of Orthopaedics, Sarawak General Hospital, Kuching, Malaysia
| | - S Tan
- Department of Radiology, Sarawak General Hospital, Kuching, Malaysia
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Clement ND, MacDonald D, Ahmed I, Patton JT, Howie CR. Total femoral replacement for salvage of periprosthetic fractures. Orthopedics 2014; 37:e789-95. [PMID: 25350621 DOI: 10.3928/01477447-20140825-55] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 01/30/2014] [Indexed: 02/03/2023]
Abstract
Patients with complex periprosthetic fracture patterns of the femur may ultimately require amputation. Some authors have described the use of mega-endoprostheses as a salvage procedure. This study reports functional outcome, complications, and implant and patient survival after total femoral replacement (TFR) for salvage of periprosthetic fracture of the femur. A prospective database of 20 consecutive patients who underwent TFR for salvage of a periprosthetic fracture was compiled. Patient demographics, mobility information, and preoperative and postoperative Short Form 12-item Survey (SF-12) and 1-year Toronto Extremity Salvage Score (TESS) data were recorded. Postoperative complications were obtained from the hospital database and patient medical notes. One patient was lost to follow-up and was excluded from analysis. The study included 8 men and 11 women, with a mean age of 68.4 years. No significant difference was noted in the prefracture physical (4.4; P=.13) or mental (0.3; P=.78) component scores of the SF-12 compared with 1-year scores. The TESS at 1 year was 69%. However, patients were more likely to require a walking aid postoperatively (P<.0001). One-fourth of the patients had a postoperative medical complication. In addition, 1 patient had a dislocation and 2 patients had a periprosthetic infection. The implant survival rate was 86% at 10 years; however, the 10-year mortality rate was 58%. Although TFR for salvage of a periprosthetic fracture of the femur offers good functional outcome and implant survival, it is at the expense of postoperative complications, and TFR is associated with a high long-term mortality rate.
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Dieckmann R, Henrichs MP, Gosheger G, Höll S, Hardes J, Streitbürger A. Short-stem reconstruction for megaendoprostheses in case of an ultrashort proximal femur. BMC Musculoskelet Disord 2014; 15:190. [PMID: 24885859 PMCID: PMC4067112 DOI: 10.1186/1471-2474-15-190] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 05/23/2014] [Indexed: 11/10/2022] Open
Abstract
Background Tumors of the distal femur and diaphysis with proximal metaphyseal extension into the femur present a challenge for limb salvage. The conventional treatment consists of limb salvage with total femur replacement. This case study aims to present preliminary results and experience with short-stem reconstruction, focusing on the mechanical stability of the procedure. Methods Sixteen short stems were implanted in 15 patients. The patients’ mean age was 33,3 years (range 11–73). In 10 patients, the stem was used for distal femur reconstruction, in one patient for diaphyseal reconstruction, and in four for a stump lengthening procedure. All of the patients had a primary sarcoma in their history. The mean follow-up period was 37 months (range 5–95 months). The clinical and functional follow-up data were analyzed. Results Ten patients (67%) were still alive at the time of evaluation. Three complications associated with the stem were noted. In one case, there was aseptic loosening after 58 months; in another, aseptic loosening occurred because the diameter of the stem had initially been too small; and in one case, there was breakage of the fixation screw, without any clinical symptoms. The average Musculoskeletal Tumor Society score for all patients was 23 (range 9–28). The mean result for the distal femur replacement was 24 (range 22–28). None of the surviving patients with distal femur replacements needed any crutches or had a Trendelenburg limp. Both living patients who underwent a stump lengthening procedure were able to walk with an exoprosthesis. Conclusions The short stem is a good solution that can prevent or delay proximal femur resection in patients with tumors extending into the proximal metaphyseal femur. Additional risks of proximal femur resection, such as dislocation, opening of another oncological compartment, Trendelenburg limp, and chondrolysis can be avoided.
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Affiliation(s)
- Ralf Dieckmann
- Department of Orthopedics and Tumor Orthopedics, University of Münster, Albert-Schweitzer-Campus 1, A1, 48149 Münster, Germany.
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Puri A, Gulia A. The results of total humeral replacement following excision for primary bone tumour. ACTA ACUST UNITED AC 2012; 94:1277-81. [PMID: 22933503 DOI: 10.1302/0301-620x.94b9.29697] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Rarely, the extent of a malignant bone tumour may necessitate resection of the complete humerus to achieve adequate oncological clearance. We present our experience with reconstruction in such cases using a total humeral endoprosthesis (THER) in 20 patients (12 male and eight female) with a mean age of 22 years (6 to 59). We assessed the complications, the oncological and functional outcomes and implant survival. Surgery was performed between June 2001 and October 2009. The diagnosis included osteosarcoma in nine, Ewing's sarcoma in eight and chondrosarcoma in three. One patient was lost to follow-up. The mean follow-up was 41 months (10 to 120) for all patients and 56 months (25 to 120) in survivors. There were five local recurrences (26.3%) and 11 patients were alive at time of last follow-up, with overall survival for all patients being 52% (95% confidence interval (CI) 23.8 to 74) at five years. The mean Musculoskeletal Tumor Society score for the survivors was 22 (73%; 16 to 23). The implant survival was 95% (95% CI 69.5 to 99.3) at five years. The use of a THER in the treatment of malignant tumours of bone is oncologically safe; it gives consistent and predictable results with low rates of complication.
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Affiliation(s)
- A Puri
- Tata Memorial Hospital, E Borges Road, Parel, Mumbai 400012, India.
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Puri A, Gulia A, Chan WH. Functional and oncologic outcomes after excision of the total femur in primary bone tumors: Results with a low cost total femur prosthesis. Indian J Orthop 2012; 46:470-4. [PMID: 22912524 PMCID: PMC3421939 DOI: 10.4103/0019-5413.98834] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The extent of tumor may necessitate resection of the complete femur rarely to achieve adequate oncologic clearance in bone sarcomas. We present our experience with reconstruction in such cases using an indigenously manufactured, low-cost, total femoral prosthesis (TFP). We assessed the complications of the procedure, the oncologic and functional outcomes, and implant survival. MATERIALS AND METHODS Eight patients (four males and four females) with a mean age of 32 years, operated between December 2003 and June 2009, had a TFP implanted. The diagnosis included osteogenic sarcoma (5), Ewing's sarcoma (1), and chondrosarcoma (2). Mean followup was 33 months (9-72 months) for all and 40 months (24-72 months) in survivors. They were evaluated by Musculoskeletal Tumor Society score, implant survival as well as patient survival. RESULTS There was one local recurrence and five of seven patients are currently alive at the time of last followup. The Musculoskeletal Tumor Society score for patients ranged from 21 to 25 with a mean of 24 (80%). The implant survival was 88% at 5 years with only one TFP needing removal because of infection. CONCLUSIONS A TFP in appropriately indicated patients with malignant bone tumors is oncologically safe. A locally manufactured, cost-effective implant provided consistent and predictable results after excision of the total femur with good functional outcomes.
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Affiliation(s)
- Ajay Puri
- Department of Orthopaedic Oncology, Tata Memorial Hospital, Mumbai, India,Address for correspondence: Prof. Ajay Puri, Department of Orthopaedic Oncology, Room No: 26, Tata Memorial Hospital, Borges Road, Parel, Mumbai – 400 012, India. E-mail:
| | - Ashish Gulia
- Department of Orthopaedic Oncology, Tata Memorial Hospital, Mumbai, India
| | - Wai Hoong Chan
- Department of Orthopaedics, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Malaysia
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Yoshida Y, Osaka S, Kojima T, Taniguchi M, Osaka E, Tokuhashi Y. Revision of tumor prosthesis of the knee joint. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2011; 22:387-394. [PMID: 22754428 PMCID: PMC3376781 DOI: 10.1007/s00590-011-0848-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Accepted: 07/30/2011] [Indexed: 11/27/2022]
Abstract
Background Among 40 patients with primary malignant tumors of the knee joint who underwent reconstruction of the affected limb with tumor prosthesis, revision was required in 7 due to stem breakage or loosening. Subjects and methods In the 7 cases undergoing revision, conditions and background factors at the time of breakage, the breakage site, time of revision, models of previous and new prostheses, stem diameters before and after revision, details of the revision (blood loss, operative time), and the presence or absence of adjuvant therapy were determined. Results The replacement site was the distal femur in 5 and proximal tibia in 2. Revision was performed 6 years and 2 months after the previous prosthesis placement on average. The broken prosthesis model was KMFTR in 4 and HMRS and the physio-hinge type in one each. Revision due to loosening was performed in a case requiring replacement with Growing Kotz prosthesis. The model was switched to HMRS in 3, and the stem diameter was changed to 12 mm in 3 KMFTR breakage cases. The mean stem diameters were 11.2 and 10.2 mm in the non-revision and revision groups. The respective resection rates were 36 and 45%. The mean functional evaluation was 70.1% before and 76.2% after revision. Conclusion To reduce the risk of tumor prosthesis breakage, the amount of bone resection should be limited to 30% or less in the affected bone, the stem diameter should be at least 12 mm, and the stem shape should be fitted to the anatomical shape of the femur.
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Affiliation(s)
- Yukihiro Yoshida
- Department of Orthopedic Surgery, Nihon University School of Medicine, 30-1, Oyaguchikami-cho, Itabashi-ku, Tokyo 173-8610 Japan
| | - Shunzo Osaka
- Nerima Hikarigaoka Hospital, Nihon University, 2-11-1, Hikarigaoka, Nerima-ku, Tokyo Japan
| | - Toshio Kojima
- Department of Orthopedic Surgery, Nihon University School of Medicine, 30-1, Oyaguchikami-cho, Itabashi-ku, Tokyo 173-8610 Japan
| | - Masafumi Taniguchi
- Department of Orthopedic Surgery, Nihon University School of Medicine, 30-1, Oyaguchikami-cho, Itabashi-ku, Tokyo 173-8610 Japan
| | - Eiji Osaka
- Nerima Hikarigaoka Hospital, Nihon University, 2-11-1, Hikarigaoka, Nerima-ku, Tokyo Japan
| | - Yasuaki Tokuhashi
- Department of Orthopedic Surgery, Nihon University School of Medicine, 30-1, Oyaguchikami-cho, Itabashi-ku, Tokyo 173-8610 Japan
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Jones KB, Griffin AM, Chandrasekar CR, Biau D, Babinet A, Deheshi B, Bell RS, Grimer RJ, Wunder JS, Ferguson PC. Patient-oriented functional results of total femoral endoprosthetic reconstruction following oncologic resection. J Surg Oncol 2011; 104:561-5. [PMID: 21695701 DOI: 10.1002/jso.22003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 05/31/2011] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Functional outcomes following oncologic total femoral endoprosthetic reconstruction (TFR) are lacking. We compared patient-oriented functional results of TFRs to proximal femur and distal femur reconstructions (PFR and DFR). We also compared function and complications with regard to knee and hip componentry. METHODS Fifty-four TFR patients were identified from three institutional prospective databases. Forty-one had fixed- and 13 had rotating-hinge knees, 37 hemiarthroplasty and 17 total hip arthroplasty componentry. Toronto Extremity Salvage Scores (TESS) for n = 27 were compared between groups and to cohorts of PFR (n = 31) and DFR (n = 85) patients using the Mann-Whitney U-test. RESULTS Follow-up averaged 4 years. Mechanical complications included five hip dislocations and one femoral malrotation. Four dislocations were in fixed-hinge implants, all in those lacking abductor reattachment. TESS averaged 69.3 ± 17.8, statistically decreased from DFR (P = 0.002) and PFR patients (P = 0.036). No significant differences were detected between patients in the fixed-hinge (n = 18) and rotating-hinge (n = 9) groups (P = 0.944), or total hip (n = 8) and hemiarthroplasty (n = 19) groups (P = 0.633). CONCLUSIONS TFR is reserved for extreme cases of limb salvage, portending a poor prognosis overall. Function reflects additive impairments from PFR and DFR. TFR outcomes differ little with rotating- or fixed-hinge, total hip or hemiarthroplasty implants.
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Affiliation(s)
- Kevin B Jones
- The Department of Orthopaedics, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA.
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