Abstract
Lower limb salvage surgery remains a challenge in orthopaedic oncology. Both cemented and cementless, modular, endoprosthetic systems are widely used to treat defects of different sizes. The systems have changed over the years, and each major orthopaedic company offers a modular tumour and revision system for the lower extremities. All systems have worse long-term results compared to conventional total hip or total knee systems. This is due to the large defects that need to be bridged with a more difficult fixation in the diapyhsis of the femur and tibia and a more complex restoration of joint biomechanics. This article summarises the results of several clinical studies with different systems. Newer systems without clinical follow-up are described. We previously reported a prospective study of 50 consecutive patients treated with the MUTARS endoprostheses. The follow-up was 2–7 years. Clinical evaluation showed good results compared to other systems. The review of the literature and our own results do not validate the support or favouring of one specific system. The surgeon should choose a system with which he/she is familiar and that provides the modularity needed intraoperatively to bridge any defect in the lower limbs.
Résumé
Le sauvetage des membres demeure un challenge en oncologie orthopédique. Les prothèses modulaires, cimentées ou non, sont largement utilisées et chaque grand fabriquant offre des systèmes pour reconstruction des membres inférieurs. Tous les systèmes ont de moins bons résultats à long terme que les prothèses conventionnelles de hanche ou de genou. Ceci est due aux larges défauts osseux nécessitant la fixation dans les diaphyses fémorales et tibiales et la difficile restauration de la biomécanique articulaire. Cet article résume les résultats de plusieurs études cliniques avec différents systèmes. Nous avons rapporté une étude prospective de 50 patients traités avec une prothèse MUTARS, avec 2 à 7 ans de recul et un bon résultat comparable aux autres systèmes. La revue de la littérature et notre expérience ne permet pas de conseiller un système particulier. Le chirurgien doit choisir un système avec lequel il est familier et qui lui donne la possibilité opératoire de compenser les pertes de substances du membre inférieur.
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References
Blunn GW, Briggs TW, Cannon SR, Walker PS, Unwin PS, Culligan S, Cobb JP (2000) Cementless fixation for primary segmental bone tumor endoprostheses. Clin Orthop 372:223–230
Bradish CF, Kemp HB, Scales JT, Wilson JN (1987) Distal femoral replacement by custom-made prostheses. Clinical follow-up and survivorship analysis. J Bone Jt Surg Br 69:276–284
Capanna R (1989) Modular Kotz prosthesis-the Rizzoli experience. In: Yamamuro T (ed) New developments for limb salvage in musculoskeletal tumours. Springer, Tokyo, pp 37–44
Capanna R, Morris HG, Campanacci D, Del Ben M, Campanacci M (1994) Modular uncemented prosthetic reconstruction after resection of tumours of the distal femur. J Bone Jt Surg Br 76:178–186
Choong PF, Sim FH, Pritchard DJ, Rock MG, Chao EY (1996) Megaprostheses after resection of distal femoral tumors. A rotating hinge design in 30 patients followed for 2–7 years. Acta Orthop Scand 67:345–351
Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ (1993) A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop 286:241–246
Gerrand CH, Currie D, Grigoris P, Reid R, Hamblen DL (1999) Prosthetic reconstruction of the femur for primary bone sarcoma. Int Orthop 23:286–290
Griffin AM, Parsons JA, Davis AM, Bell RS, Wunder JS (2005) Uncemented tumor endoprostheses at the knee: root causes of failure. Clin Orthop 438:71–79
Heisel C, Breusch SJ, Schmid G, Bernd L (2004) Lower limb salvage surgery with MUTARS endoprostheses: 2 to 7 year results. Acta Orthop Belg 70:142–147
Ilyas I, Kurar A, Moreau PG, Younge DA (2001) Modular megaprosthesis for distal femoral tumors. Int Orthop 25:375–377
Kawai A, Healey JH, Boland PJ, Athanasian EA, Jeon DG (1999) A rotating-hinge knee replacement for malignant tumors of the femur and tibia. J Arthroplasty 14:187–196
Kawai A, Lin PP, Boland PJ, Athanasian EA, Healey JH (1999) Relationship between magnitude of resection, complication, and prosthetic survival after prosthetic knee reconstructions for distal femoral tumors. J Surg Oncol 70:109–115
Kawai A, Muschler GF, Lane JM, Otis JC, Healey JH (1998) Prosthetic knee replacement after resection of a malignant tumor of the distal part of the femur. Medium to long-term results. J Bone Jt Surg Am 80:636–647
Kotz R, Ritschl P, Trachtenbrodt J (1986) A modular femur-tibia reconstruction system. Orthopedics 9:1639–1652
Kotz R (1993) Tumor endoprosthesis in malignant bone tumors. Orthopade 22:160–166
Kotz R, Ritschl P, Kropej D, Capanna R (1990) Cementless modular prostheses. Basic concepts and evolution. Chir Organi Mov 75:177–178
Lindner NJ, Ramm O, Hillmann A, Roedl R, Gosheger G, Brinkschmidt C, Juergens H, Winkelmann W (1999) Limb salvage and outcome of osteosarcoma. The University of Muenster experience. Clin Orthop 358:83–89
Malawer MM, Chou LB (1995) Prosthetic survival and clinical results with use of large-segment replacements in the treatment of high-grade bone sarcomas. J Bone Jt Surg Am 77:1154–1165
Mascard E, Anract P, Touchene A, Pouillart P, Tomeno B (1998) Complications from the hinged GUEPAR prosthesis after resection of knee tumor. 102 cases. Rev Chir Orthop Reparatrice Appar Mot 84:628–637
Mittermayer F, Krepler P, Dominkus M, Schwameis E, Sluga M, Heinzl H, Kotz R (2001) Long-term follow-up of uncemented tumor endoprostheses for the lower extremity. Clin Orthop 388:167–177
Morris HG, Capanna R, Campanacci D, Del Ben M, Gasbarrini A (1994) Modular endoprosthetic replacement after total resection of the femur for malignant tumour. Int Orthop 18:90–95
Ritschl P, Capanna R, Helwig U, Campanacci M, Kotz R (1992) KMFTR (Kotz Modular Femur Tibia Reconstruction System) modular tumor endoprosthesis system for the lower extremity. Z Orthop Ihre Grenzgeb 130:290–293
Roberts P, Chan D, Grimer RJ, Sneath RS, Scales JT (1991) Prosthetic replacement of the distal femur for primary bone tumours. J Bone Jt Surg Br 73:762–769
Shin DS, Choong PF, Chao EY, Sim FH (2000) Large tumor endoprostheses and extracortical bone-bridging: 28 patients followed 10–20 years. Acta Orthop Scand 71:305–311
Shin DS, Weber KL, Chao EY, An KN, Sim FH (1999) Reoperation for failed prosthetic replacement used for limb salvage. Clin Orthop 358:53–63
Unwin PS, Cannon SR, Grimer RJ, Kemp HB, Sneath RS, Walker PS (1996) Aseptic loosening in cemented custom-made prosthetic replacements for bone tumours of the lower limb. J Bone Jt Surg Br 78:5–13
Unwin PS, Cobb JP, Walker PS (1993) Distal femoral arthroplasty using custom-made prostheses. The first 218 cases. J Arthroplasty 8:259–268
Zeegen EN, Aponte-Tinao LA, Hornicek FJ, Gebhardt MC, Mankin HJ (2004) Survivorship analysis of 141 modular metallic endoprostheses at early follow-up. Clin Orthop 420:239–250
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Heisel, C., Kinkel, S., Bernd, L. et al. Megaprostheses for the treatment of malignantbone tumours of the lower limbs. International Orthopaedics (SICOT) 30, 452–457 (2006). https://doi.org/10.1007/s00264-006-0207-7
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DOI: https://doi.org/10.1007/s00264-006-0207-7