Comparative Analysis of Early Follow‐up of Biologic Fixation and Cemented Stem Fixation for Femoral Tumor Prosthesis

Abstract

Objective To compare the safety and efficacy between biologic fixation and traditional cement stems for the fixation of distal femoral prostheses for reconstruction following tumor resection. Methods Retrospective analysis was performed of patients who received a first distal femoral tumor prosthesis, with a rotating hinge, in the Department of Orthopaedic Oncology of Beijing Jishuitan Hospital between October 2011 and January 2016. Two hundred and sixty eligible cases were enrolled, with a cemented fixation used in 199 of these cases and a biologic fixation in 61 cases. Survival rates and survival time of prostheses were analyzed, with prosthetic failure considered as the endpoint event for survival time of the prosthesis. Kaplan–Meier survival curve and the log‐rank test were used to compare survival rates between the two types of fixation methods, and factors that may affect the survival rate of prosthesis were evaluated. Results Of the 260 cases forming our study group, 138 were males and 122 females, with 102 males and 97 females in the cemented fixation group (mean age, 25.8 years; range, 8–72 years) and 36 males and 25 females in the biologic fixation group (mean age, 25.5 years; range, 12–59 years). Osteosarcoma was the most common type of tumor (188 cases, 72.3%), of which 145 cases (72.9%) were in the cemented and 45 cases (72.1%) in the biologic fixation group. Among the 260 cases enrolled into the study group, 13 patients were lost to follow‐up. The average duration of follow‐up for the remaining 247 cases was 28.8 months (median, 28.8 months; range, 4–61 months). The 3‐year overall survival rate of prostheses was 87.2% for the biologic fixation group and 80.4% in the cemented fixation group (P = 0.389). The 3‐year mechanical survival rate (excluding cases of infection and oncologic progression) was 100% for the biologic fixation and 97.6% for the cemented fixation group (P = 0.468). Complications were identified in 21 cases: 3 cases (5%) in the biologic and 18 cases (9.6%) in the cemented fixation group (P = 0.264). Two revisions were required in the cemented fixation group, but no revision was required in the biologic fixation group. A total of 10 patients required amputation after prosthesis implantation. Of these, 7 cases (4 cement and 3 biologic) were due to tumor recurrence; 3 cases were due to infection, with all cases occurring in the cement fixation group. Conclusion The current study provides a baseline reference for future mid‐term to long‐term follow‐up, laying the foundation for further studies and comparison of the incidence of aseptic loosening of both types of prosthesis.

What is the Cumulative Incidence of Revision Surgery and What Are the Complications Associated With Stemmed Cementless Nonextendable Endoprostheses in Patients 18 Years or Younger With Primary Bone Sarcomas About the Knee

“…Previous authors used uncemented tumor prostheses in adult tumor patients to lower the incidence of aseptic loosening [14,21,22]. In skeletally immature patients, perioperative chemotherapy can lead to a substantial reduction of bone mineral density and the use of uncemented implants in these patients could be associated with a higher rate of revision surgery due to aseptic loosening, fracture, Table 1.…”

“…Cemented tumor endoprostheses are commonly used for lower limb reconstruction in bone tumor patients and have demonstrated long-term survivorship [24]. Recent reports showed similar success rates with cementless implants in adult patients [17,21,22]. However, in children and adolescent patients, perioperative chemotherapy can disturb the bone turnover rate and reduce bone mineral density [18,19].…”

Radiographic Assessment of Aseptic Loosening of Tumor‐Type Knee Prosthesis in Distal Femur

“…A smaller diameter percentage not only led to lower mechanical strength of the medullary cavity stem but also meant that a thicker bone cement needed to be filled between the medullary cavity stem and the medullary cavity, making the bone cement not only poor in torsion resistance but also nondegradable. The debris generated by the wear of bone cement might activate T cells and macrophages around the prosthesis and osteoclasts and cause osteolysis 20,21 . Therefore, using a large amount of bone cement to fill the gap between the medullary canal stem and the bone cortex is not recommended; instead, a medullary canal stem that fits the thickness of the femoral medullary cavity from the beginning to reduce the loosening rate should be chosen 12,22 .…”

Modular intercalary prosthetic reconstruction for malignant and metastatic tumours of the proximal femur

“…Endoprosthesis is increasingly used for reconstruction after resection of proximal femur tumors, and is a good option. There have been a variety of reports on modular intercalary prosthetic reconstruction for the diaphysis of upper and lower extremities 15 , however, there is no one report specializing in this method for the proximal femur; there is insufficient data, and we must determine how to achieve better results.…”