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Distal Femoral Replacement in Nontumor Cases with Severe Bone Loss and Instability

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Clinical Orthopaedics and Related Research

Abstract

Severe distal femoral bone loss and instability in revision TKA is challenging. We retrospectively reviewed 39 rotating-hinged distal femoral replacement devices in 37 patients to examine whether improved results were obtainable, using one design, over previously published results. The average age of the patients was 76 years (standard deviation, 10 years). Indications for distal femoral replacement included 11 revision TKAs, 13 periprosthetic fractures, 11 reimplantations, two complex primary TKAs, one distal femoral nonunion, and one acute distal femur fracture. Minimum followup was 24 months (mean, 46 months; range, 24–109 months). Eight patients died during followup. There were five reoperations: two patients with recurrent infection after two-stage treatment, one patient with a periprosthetic fracture treated by open reduction and internal fixation, one patient with late hematogenous infection, and one patient with bearing exchange to treat hyperextension. No failures from aseptic loosening were seen. Knee Society scores improved from 39 preoperatively to 87, and pain scores improved from 18 preoperatively to 43. Distal femoral prosthetic replacement with a tumor-type implant in severe cases provides excellent pain relief and function with a low short-term reoperation rate and an implant survivorship rate of 87% at 46 months.

Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Joanne Adams and Tawnya Tucker for assistance in preparation of this manuscript and completion of this study. We also thank the excellent members of our clinical staff, current and past, who assisted in the care of our patients, including Mike Thomas, PA-C, Kurt Berlekamp, PA-C, Jeff Williams, PA-C, Jenifer Hickman, CNP, Tina Klemp, RN, Doug Brewer, Jackie Russell, RN, Kathie Dodds, RN, Kris Stone, RN, and Bob Waterman, PA-C.

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Authors and Affiliations

  1. Joint Implant Surgeons, Inc, The Ohio State University Medical Center, 7277 Smith’s Mill Road, Suite 200, New Albany, OH, 43054, USA

    Keith R. Berend MD & Adolph V. Lombardi Jr. MD, FACS

  2. Department of Orthopedics, Mount Carmel Health System, Mount Carmel New Albany Surgical Hospital, New Albany, OH, USA

    Keith R. Berend MD & Adolph V. Lombardi Jr. MD, FACS

Authors
  1. Keith R. Berend MD
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  2. Adolph V. Lombardi Jr. MD, FACS
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Correspondence to Keith R. Berend MD.

Additional information

One or more of the authors (KRB, AVL) have received institutional research funding, consulting income, from a commercial interest related to the subject of this manuscript (Biomet, Inc, Warsaw, IN).

Each author certifies that his institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Berend, K.R., Lombardi, A.V. Distal Femoral Replacement in Nontumor Cases with Severe Bone Loss and Instability. Clin Orthop Relat Res 467, 485–492 (2009). https://doi.org/10.1007/s11999-008-0329-x

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  • DOI: https://doi.org/10.1007/s11999-008-0329-x

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