Distal femoral reconstruction following failed total knee arthroplasty is accompanied with risk for complication and reduced joint function

Abstract

BackgroundSubstantial bone loss following failed total knee arthroplasty (TKA) represents a major challenge in revision arthroplasty, that can require distal femoral reconstruction (DFR). In this study, we aimed to assess the clinical outcome and the complication frequencies of individuals who underwent DFR with modular megaprostheses. Additionally, we aimed to compare functional outcome measures after DFR in these sophisticated cases to an age-matched control group of total knee prostheses to quantify the potential loss of function.MethodsA retrospective chart review of 30 consecutive patients after DFR from 1997 to 2017 with a mean age of 74.38 years (± 10.1) was performed. Complications were classified according to the Henderson classification. Knee Society Score (KSS) was calculated and range of motion (ROM) was assessed.ResultsThirteen (43.3%) patients had at least one complication requiring revision surgery. Revision-free survival was 74.8% at one year, 62.5% at three and 40.9% at 10 years post-op. Soft-tissue failure complications were found in three (10.0%) patients, aseptic loosening in four (13.3%) patients, structural failure in one (3.3%) patient and infection in eight (26.6%) patients. Of those with infection, five (16.6%) experienced ongoing prosthetic joint infection and three (10.0%) developed new infection after distal femur reconstruction. Patients with DFR achieved 69.3% of KSS pain score, 23.1% KSS function score and 76.2% of ROM compared to patients with primary TKA.ConclusionsDFR after failed TKA represents a treatment procedure with high risk for complication in this particular group. Despite the prospect of rapid postoperative mobilization, reduced functionality, range of motion and mobilization have to be considered when choosing this treatment option.

Non-neoplastic indications and outcomes of the proximal and distal femur megaprosthesis: a critical review

“…The Knee Society Score improved from a preoperative median of 20 to a postoperative median of 80 [27]. Out of three studies, only Vertesich et al [27] mentioned revision and implant survival in their study. Revision was required in three cases, and the implant survival was 74.8% at 1 year and 40.9% at 10 years ( Table 4).…”

Survivorship of Megaprostheses in Revision Hip and Knee Arthroplasty for Septic and Aseptic Indications: A Retrospective, Multicenter Study With Minimum 2-Year Follow-Up

“…The leading cause of complication in the septic cohort was infection, whereas aseptic loosening, structural failure, and infection were predominant causes in the aseptic cohort. There have been several reports on clinical outcomes of megaprosthesis implantation in nononcologic patients [5,[12][13][14][15][16]. Parvizi et al studied 48 patients who underwent revision arthroplasty with proximal femoral replacement for nononcologic conditions [16].…”

“…High complication rates for distal femoral replacement have been demonstrated in several studies [5,12,13]. Despite this, authors highlight the benefits of improved patient-reported outcomes, earlier mobilization, and limb salvage as reasons to consider a megaprosthesis in appropriately selected patients.…”

What Opinions Do Tumor Reconstructive Surgeons Have about Sports Activity after Megaprosthetic Replacement in Hip and Knee? Results of the MoReSports Expert Opinion Online Survey

“…Megaprosthetic replacement is commonly performed in lower-limb reconstruction after tumor resections [ 16 , 17 , 18 , 19 ] as well as increasingly after trauma [ 20 , 21 , 22 ] or failed primary endoprosthetic replacement [ 23 , 24 ]. Despite their high rates of long-term sequelae including infection, mechanical and soft tissue failures, and loosening, patients benefit from surgery by being able to use their lower extremities in activities of daily living.…”