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Aseptic Loosening Rates in Distal Femoral Endoprostheses: Does Stem Size Matter?

  • Symposium: 2010 Musculoskeletal Tumor Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Long-term survival of distal femoral endoprosthetic replacements is largely affected by aseptic loosening. It is unclear whether and to what degree surgical technique and component selection influence the risk of loosening.

Questions/purposes

We (1) established the overall failure and aseptic loosening rates in a tumor population and asked (2) whether stem diameter and specifically the diaphysis-to-stem ratio predicts loosening, and (3) whether resection percentage correlates with failure.

Methods

We retrospectively reviewed the charts of all 93 patients in whom 104 distal femoral replacements had been performed from 1985 to 2008. We extracted the following data: age, need for revision surgeries, tumor diagnosis, adjunct treatment, and implant characteristics. We reviewed radiographs and determined stem size, bone diaphyseal width, and resection percentage of the femur. Kaplan-Meier survivorship was calculated for all implant failures and failures resulting from aseptic loosening. We evaluated radiolucent lines in patients with radiographic followup over 5 years. We identified independent risk factors for loosening. The minimum followup for radiographic evaluation was 5 years (mean, 12.7 years; range, 5.4–23.5 years).

Results

Overall implant survival for 104 stems in 93 patients was 73.3% at 10 years, 62.8% at 15 years, and 46.1% at 20 years. Survival from aseptic loosening was 94.6% at 10 and 15 years and 86.5% at 20 years. Of the variables analyzed, only bone:stem ratio independently predicted aseptic failure. Patients with stable implants had larger stem sizes and lower bone:stem ratios than those with loose implants (14.5 mm versus 10.7 mm and 2.02 versus 2.81, respectively).

Conclusions

Our data suggest durability relates to selecting stems that fill the canal.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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References

  1. Ahlmann ER, Menendez LR, Kermani C, Gotha H. Survivorship and clinical outcome of modular endoprosthetic reconstruction for neoplastic disease of the lower limb. J Bone Joint Surg Br. 2006;88:790–795.

    Article  PubMed  CAS  Google Scholar 

  2. Bickels J, Wittig JC, Kollender Y, Henshaw RM, Kellar-Graney KL, Meller I, Malawer MM. Distal femur resection with endoprosthetic reconstruction: a long-term followup study. Clin Orthop Relat Res. 2002;400:225–235.

    Article  PubMed  Google Scholar 

  3. Bielack SS, Kempf-Bielack B, Delling G, Exner GU, Flege S, Helmke K, Kotz R, Salzer-Kuntschik M, Werner M, Winkelmann W, Zoubek A, Jurgens H, Winkler K. Prognostic factors in high-grade osteosarcoma of the extremities or trunk: an analysis of 1,702 patients treated on neoadjuvant cooperative osteosarcoma study group protocols. J Clin Oncol. 2002;20:776–790.

    Article  PubMed  Google Scholar 

  4. Brigman BE, Hornicek FJ, Gebhardt MC, Mankin HJ. Allografts about the knee in young patients with high-grade sarcoma. Clin Orthop Relat Res. 2004;421:232–239.

    Article  PubMed  Google Scholar 

  5. Cannon SR. Massive prostheses for malignant bone tumours of the limbs. J Bone Joint Surg Br. 1997;79:497–506.

    Article  PubMed  CAS  Google Scholar 

  6. Chen WM, Chen TH, Huang CK, Chiang CC, Lo WH. Treatment of malignant bone tumours by extracorporeally irradiated autograft-prosthetic composite arthroplasty. J Bone Joint Surg Br. 2002;84:1156–1161.

    Article  PubMed  CAS  Google Scholar 

  7. Farfalli GL, Boland PJ, Morris CD, Athanasian EA, Healey JH. Early equivalence of uncemented press-fit and Compress femoral fixation. Clin Orthop Relat Res. 2009;467:2792–2799.

    Article  PubMed  Google Scholar 

  8. Gebhardt MC, Flugstad DI, Springfield DS, Mankin HJ. The use of bone allografts for limb salvage in high-grade extremity osteosarcoma. Clin Orthop Relat Res. 1991;270:181–196.

    PubMed  Google Scholar 

  9. Gitelis S, Piasecki P. Allograft prosthetic composite arthroplasty for osteosarcoma and other aggressive bone tumors. Clin Orthop Relat Res. 1991;270:197–201.

    PubMed  Google Scholar 

  10. Goorin AM, Schwartzentruber DJ, Devidas M, Gebhardt MC, Ayala AG, Harris MB, Helman LJ, Grier HE, Link MP. Presurgical chemotherapy compared with immediate surgery and adjuvant chemotherapy for nonmetastatic osteosarcoma: Pediatric Oncology Group Study POG-8651. J Clin Oncol. 2003;21:1574–1580.

    Article  PubMed  CAS  Google Scholar 

  11. Harrington KD, Johnston JO, Kaufer HN, Luck JV Jr, Moore TM. Limb salvage and prosthetic joint reconstruction for low-grade and selected high-grade sarcomas of bone after wide resection and replacement by autoclaved [corrected] autogeneic grafts [erratum appears in Clin Orthop Relat Res. 1987;216:312]. Clin Orthop Relat Res. 1986;211:180–214.

    Google Scholar 

  12. Kawai A, Lin PP, Boland PJ, Athanasian EA, Healey JH. Relationship between magnitude of resection, complication, and prosthetic survival after prosthetic knee reconstructions for distal femoral tumors. J Surg Oncol. 1999;70:109–115.

    Article  PubMed  CAS  Google Scholar 

  13. Link MP, Goorin AM, Miser AW, Green AA, Pratt CB, Belasco JB, Pritchard J, Malpas JS, Baker AR, Kirkpatrick JA. The effect of adjuvant chemotherapy on relapse-free survival in patients with osteosarcoma of the extremity. N Engl J Med. 1986;314:1600–1606.

    Article  PubMed  CAS  Google Scholar 

  14. Myers GJ, Abudu AT, Carter SR, Tillman RM, Grimer RJ, Myers GJC Endoprosthetic replacement of the distal femur for bone tumours: long-term results [erratum appears in J Bone Joint Surg Br. 2007;89:706]. J Bone Joint Surg Br. 2007;89:521–526.

    Article  PubMed  CAS  Google Scholar 

  15. Rosen G, Marcove RC, Huvos AG, Caparros BI, Lane JM, Nirenberg A, Cacavio A, Groshen S. Primary osteogenic sarcoma: eight-year experience with adjuvant chemotherapy. J Cancer Res Clin Oncol. 1983;106(Suppl):55–67.

    Article  PubMed  Google Scholar 

  16. Shah AD, Taylor SJ, Hua J, Taylor SJG. Correlation of radiographic and telemetric data from massive implant fixations. J Biomech. 2006;39:1304–1314.

    Article  PubMed  CAS  Google Scholar 

  17. Sharma S, Turcotte RE, Isler MH, Wong C. Cemented rotating hinge endoprosthesis for limb salvage of distal femur tumors. Clin Orthop Relat Res. 2006;450:28–32.

    Article  PubMed  Google Scholar 

  18. Sharma S, Turcotte RE, Isler MH, Wong C. Experience with cemented large segment endoprostheses for tumors. Clin Orthop Relat Res. 2007;459:54–59.

    Article  PubMed  Google Scholar 

  19. Shehadeh A, Noveau J, Malawer M, Henshaw R. Late complications and survival of endoprosthetic reconstruction after resection of bone tumors. Clin Orthop Relat Res. 2010;468:2885–2895.

    Article  PubMed  Google Scholar 

  20. Smith WS, Struhl S. Replantation of an autoclaved autogenous segment of bone for treatment of chondrosarcoma. Long-term follow up. J Bone Joint Surg Am. 1988;70:70–75.

    PubMed  CAS  Google Scholar 

  21. Springer BD, Sim FH, Hanssen AD, Lewallen DG. The modular segmental kinematic rotating hinge for nonneoplastic limb salvage. Clin Orthop Relat Res. 2004;421:181–187.

    Article  PubMed  Google Scholar 

  22. Unwin PS, Cannon SR, Grimer RJ, Kemp HB, Sneath RS, Walker PS. Aseptic loosening in cemented custom-made prosthetic replacements for bone tumours of the lower limb. J Bone Joint Surg Br. 1996;78:5–13.

    PubMed  CAS  Google Scholar 

  23. Unwin PS, Cobb JP, Walker PS. Distal femoral arthroplasty using custom-made prostheses. The first 218 cases. J Arthroplasty. 1993;8:259–268.

    Article  PubMed  CAS  Google Scholar 

  24. Uyttendaele D, De Schryver A, Claessens H, Roels H, Berkvens P, Mondelaers W. Limb conservation in primary bone tumours by resection, extracorporeal irradiation and re-implantation. J Bone Joint Surg Br. 1988;70:348–353.

    PubMed  CAS  Google Scholar 

  25. Wirganowicz PZ, Eckardt JJ, Dorey FJ, Eilber FR, Kabo JM. Etiology and results of tumor endoprosthesis revision surgery in 64 patients. Clin Orthop Relat Res. 1999;358:64–74.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Oncology, Washington Cancer Institute, Washington Hospital Center, 110 Irving Street, NW, Washington, DC, 20010, USA

    Jenna B. Noveau BS & Robert M. Henshaw MD

  2. Department of Orthopaedic Surgery and Rehabilitation, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA

    Patrick F. Bergin MD

  3. Department of Radiology, Washington Hospital Center, 110 Irving Street, NW, Washington, DC, 20010, USA

    James S. Jelinek MD

Authors
  1. Patrick F. Bergin MD
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  2. Jenna B. Noveau BS
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  3. James S. Jelinek MD
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  4. Robert M. Henshaw MD
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Corresponding author

Correspondence to Robert M. Henshaw MD.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the reporting of this case and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at Washington Cancer Institute, Washington Hospital Center, Washington, DC, USA.

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Bergin, P.F., Noveau, J.B., Jelinek, J.S. et al. Aseptic Loosening Rates in Distal Femoral Endoprostheses: Does Stem Size Matter?. Clin Orthop Relat Res 470, 743–750 (2012). https://doi.org/10.1007/s11999-011-2081-x

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  • DOI: https://doi.org/10.1007/s11999-011-2081-x

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