Short-stem reconstruction for megaendoprostheses in case of an ultrashort proximal femur

BMC Musculoskeletal Disorders

Arne Streitbürger¹  Jendrik Hardes¹  Steffen Höll¹  Georg Gosheger¹  Marcel-Philipp Henrichs¹  Ralf Dieckmann¹ 

[1] Department of Orthopedics and Tumor Orthopedics, University of Münster, Albert-Schweitzer-Campus 1, A1, 48149 Münster, Germany

关键词: Short stem;    Limb salvage;    Aseptic loosening;    Tumor;    Distal femur replacement;   

Others  :  1125608
DOI  :  10.1186/1471-2474-15-190

 received in 2014-01-16, accepted in 2014-05-23,  发布年份 2014

【 摘 要 】

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.

【 授权许可】

   
2014 Dieckmann et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Figure 5.

【 参考文献 】

• [1]Ahmed AR: Total femur replacement. Arch Orthop Trauma Surg 2010, 130:171-176.
• [2]Kalra S, Abudu A, Murata H, Grimer RJ, Tillman RM, Carter SR: Total femur replacement: primary procedure for treatment of malignant tumours of the femur. Eur J Surg Oncol 2010, 36:378-383.
• [3]Marcove RC, Lewis MM, Rosen G, Huvos AG: Total femur and total knee replacement. A preliminary report. Clin Orthop Relat Res 1977, 126:147-152.
• [4]Pennekamp PH, Wirtz DC, Durr HR: Proximal and total femur replacement. Oper Orthop Traumatol 2012, 24:215-226.
• [5]Ruggieri P, Bosco G, Pala E, Errani C, Mercuri M: Local recurrence, survival and function after total femur resection and megaprosthetic reconstruction for bone sarcomas. Clin Orthop Relat Res 2010, 468:2860-2866.
• [6]Morris HG, Capanna R, Campanacci D, Del Ben M, Gasbarrini A: Modular endoprosthetic replacement after total resection of the femur for malignant tumour. Int Orthop 1994, 18:90-95.
• [7]Skaliczki G, Antal I, Kiss J, Szalay K, Skaliczki J, Szendroi M: Functional outcome and life quality after endoprosthetic reconstruction following malignant tumours around the knee. Int Orthop 2005, 29:174-178.
• [8]Gosheger G, Gebert C, Ahrens H, Streitbuerger A, Winkelmann W, Hardes J: Endoprosthetic reconstruction in 250 patients with sarcoma. Clin Orthop Relat Res 2006, 450:164-171.
• [9]Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ: A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res 1993, 286:241-246.
• [10]Bernthal NM, Schwartz AJ, Oakes DA, Kabo JM, Eckardt JJ: How long do endoprosthetic reconstructions for proximal femoral tumors last? Clin Orthop Relat Res 2010, 468:2867-2874.
• [11]Donati D, Zavatta M, Gozzi E, Giacomini S, Campanacci L, Mercuri M: Modular prosthetic replacement of the proximal femur after resection of a bone tumour a long-term follow-up. J Bone Joint Surg (Br) 2001, 83:1156-1160.
• [12]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, 104:561-565.
• [13]Abrams GD, Gajendran VK, Mohler DG, Avedian RS: Surgical technique: methods for removing a Compress(R) compliant prestress implant. Clin Orthop Relat Res 2012, 470:1204-1212.
• [14]Bhangu AA, Kramer MJ, Grimer RJ, O’Donnell RJ: Early distal femoral endoprosthetic survival: cemented stems versus the Compress implant. Int Orthop 2006, 30:465-472.
• [15]Calvert GT, Cummings JE, Bowles AJ, Jones KB, Wurtz LD, Randall RL: A dual-center review of compressive osseointegration for fixation of massive endoprosthetics: 2- to 9-year followup. Clin Orthop Relat Res 2014, 472:822-829.
• [16]Kramer MJ, Tanner BJ, Horvai AE, O’Donnell RJ: Compressive osseointegration promotes viable bone at the endoprosthetic interface: retrieval study of compress implants. Int Orthop 2008, 32:567-571.
• [17]Pedtke AC, Wustrack RL, Fang AS, Grimer RJ, O’Donnell RJ: Aseptic failure: how does the Compress((R)) implant compare to cemented stems? Clin Orthop Relat Res 2012, 470:735-742.
• [18]Cannon CP, Eckardt JJ, Kabo JM, Ward WG Sr, Kelly CM, Wirganowicz PZ, Asavamongkolkul A, Nieves R, Eilber FR: Custom cross-pin fixation of 32 tumor endoprostheses stems. Clin Orthop Relat Res 2003, 417:285-292.
• [19]Henderson ER, Groundland JS, Pala E, Dennis JA, Wooten R, Cheong D, Windhager R, Kotz RI, Mercuri M, Funovics PT, Hornicek FJ, Temple HT, Ruggieri P, Letson GD: Failure mode classification for tumor endoprostheses: retrospective review of five institutions and a literature review. J Bone Joint Surg Am 2011, 93:418-429.
• [20]Yari P, Dijkstra PU, Geertzen JH: Functional outcome of hip disarticulation and hemipelvectomy: a cross-sectional national descriptive study in the Netherlands. Clin Rehabil 2008, 22:1127-1133.