Expandable distal femur megaprosthesis: A European Musculoskeletal Oncology Society study on 299 cases.
bone tumor
distal femur
lengthening prosthesis
magnetic
pediatric tumor
Journal
Journal of surgical oncology
ISSN: 1096-9098
Titre abrégé: J Surg Oncol
Pays: United States
ID NLM: 0222643
Informations de publication
Date de publication:
Sep 2020
Sep 2020
Historique:
revised:
25
04
2020
received:
25
04
2020
accepted:
19
05
2020
medline:
9
6
2020
pubmed:
9
6
2020
entrez:
8
6
2020
Statut:
ppublish
Résumé
Expandable distal femur prostheses have become more popular over the last decades, but scientific data is limited. A retrospective study was performed, including cases treated between 1986 and 2019 in 15 European referral centers for bone sarcomas. A total of 299 cases were included. Average follow-up was 80 months (range, 8-287 months). Mean patient age was 10 years. Most (80%) of the implants were noninvasive growers and a fixed hinge knee was used more often (64%) than a rotating hinge. Most prosthetic designs showed good (>80%) implant survival at 10 years, but repeat surgery was required for 63% of the patients. The most frequent reason for revision procedure was the completion of lengthening potential. Noninvasive expandable implants showed less risk of infection compared to invasive growers (11.8% vs 22.9% at 10 years). No difference in aseptic loosening was found between cemented and uncemented stems. This study shows the increasing popularity of expandable distal femur prostheses, with overall good results for function and implant survival. However, repeat surgery is frequently required, especially in patients under the age of 10 years old. Infection is less frequent in noninvasive growers compared to implants that require invasive lengthening procedures.
Sections du résumé
BACKGROUND AND OBJECTIVES
OBJECTIVE
Expandable distal femur prostheses have become more popular over the last decades, but scientific data is limited.
METHODS
METHODS
A retrospective study was performed, including cases treated between 1986 and 2019 in 15 European referral centers for bone sarcomas.
RESULTS
RESULTS
A total of 299 cases were included. Average follow-up was 80 months (range, 8-287 months). Mean patient age was 10 years. Most (80%) of the implants were noninvasive growers and a fixed hinge knee was used more often (64%) than a rotating hinge. Most prosthetic designs showed good (>80%) implant survival at 10 years, but repeat surgery was required for 63% of the patients. The most frequent reason for revision procedure was the completion of lengthening potential. Noninvasive expandable implants showed less risk of infection compared to invasive growers (11.8% vs 22.9% at 10 years). No difference in aseptic loosening was found between cemented and uncemented stems.
CONCLUSIONS
CONCLUSIONS
This study shows the increasing popularity of expandable distal femur prostheses, with overall good results for function and implant survival. However, repeat surgery is frequently required, especially in patients under the age of 10 years old. Infection is less frequent in noninvasive growers compared to implants that require invasive lengthening procedures.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
760-765Informations de copyright
© 2020 Wiley Periodicals LLC.
Références
Gilg MM, Wibmer C, Bergovec M, Grimer RJ, Leithner A. When do orthopaedic oncologists consider the implantation of expandable prostheses in bone sarcoma patients? Sarcoma. 2018;201:3504075.
Beebe K, Benevenia J, Kaushal N, Uglialoro A, Patel N, Patterson F. Evaluation of a noninvasive expandable prosthesis in musculoskeletal oncology patients for the upper and lower limb. Orthopedics. 2010;33(6):396.
Decilveo AP, Szczech BW, Topfer J, Wittig JC. Reconstruction using expandable endoprostheses for skeletally immature patients with sarcoma. Orthopedics. 2017;40(1):e157-e163.
Eckardt JJ, Kabo JM, Kelley CM, et al. Expandable endoprosthesis reconstruction in skeletally immature patients with tumors. Clin Orthop Relat Res. 2000;373:51-61.
Gilg MM, Gaston CL, Parry MC, et al. What is the morbidity of a non-invasive growing prosthesis? Bone Joint J. 2016;98-B(12):1697-1703.
Gupta A, Meswania J, Pollock R, et al. Non-invasive distal femoral expandable endoprosthesis for limb-salvage surgery in paediatric tumours. J Bone Joint Surg Br. 2006;88(5):649-654.
Hwang N, Grimer RJ, Carter SR, Tillman RM, Abudu A, Jeys LM. Early results of a non-invasive extendible prosthesis for limb-salvage surgery in children with bone tumours. J Bone Joint Surg Br. 2012;94(2):265-269.
Picardo NE, Blunn GW, Shekkeris AS, et al. The medium-term results of the Stanmore non-invasive extendible endoprosthesis in the treatment of paediatric bone tumours. J Bone Joint Surg Br. 2012;94(3):425-430.
Henderson ER, O'Connor MI, Ruggieri P, et al. Classification of failure of limb salvage after reconstructive surgery for bone tumours: a modified system Including biological and expandable reconstructions. Bone Joint J. 2014;96-B(11):1436-1440.
Stanitski DF. Limb-length inequality: assessment and treatment options. J Am Acad Orthop Surg. 1999;7(3):143-153.
Schindler OS, Cannon SR, Briggs TW, Blunn GW. Stanmore custom-made extendible distal femoral replacements. Clinical experience in children with primary malignant bone tumours. J Bone Joint Surg Br. 1997;79(6):927-937.
Abudu A, Grimer R, Tillman R, Carter S. The use of prostheses in skeletally immature patients. Orthop Clin North Am. 2006;37(1):75-84.
Sambri A, Staals E, Medellin MR, et al. Stanmore noninvasive extendible endoprosthesis in the treatment of bone sarcoma in the preadolescent. J Surg Oncol. 2019;120(2):176-182.
Gonzalez-Herranz P, Burgos-Flores J, Ocete-Guzman JG, Lopez-Mondejar JA, Amaya S. The management of limb-length discrepancies in children after treatment of osteosarcoma and Ewing's sarcoma. J Pediatr Orthop. 1995;15(5):561-565.
Staals EL, Colangeli M, Ali N, Casanova JM, Donati DM, Manfrini M. Are complications associated with the repiphysis((R)) expandable distal femoral prosthesis acceptable for its continued use? Clin Orthop Relat Res. 2015;473(9):3003-3013.