Functional and oncologic outcomes after excision of the total femur in primary bone tumors: Results with a low cost total femur prosthesis

Puri, Ajay; Gulia, Ashish; Chan, Wai Hoong

doi:10.4103/0019-5413.98834

Cited by 27 publications

(31 citation statements)

References 12 publications

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“…These data are considerably higher compared to infection rates described in the recent literature with a reported range from 0 to 35% in TFR [3–5, 7–9, 11]. A possible explanation for these high infection rates is the number of revision surgeries prior to implantation of TFR (56 in 18 patients).…”

Section: Discussionmentioning

confidence: 69%

“…The most common cause for Type I failure was aseptic wound dehiscence ( n = 11), followed by hip dislocation ( n = 5) and knee arthrofibrosis ( n = 2). In the literature, reported rates vary between 0% and 45% [3–5, 7, 11] for Type I complications. It is known from large series with primary hip arthroplasty that 75% of dislocations occur within the first two months after implantation [15].…”

Section: Discussionmentioning

confidence: 99%

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Short- to long-term follow-up of total femoral replacement in non-oncologic patients

Toepfer

Harrasser

Petzschner

et al. 2016

BMC Musculoskelet Disord

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BackgroundCompromised bone stock and heavily impaired structural integrity after multiple endoprosthetic revision surgeries can lead to a comparable condition as encountered in musculoskeletal tumor surgery. Total femoral replacement (TFR) can restore femoral integrity and allow patients to resume ambulation. Even though several authors reported their results of TFR, so far many questions are still on debate: Which patients are at risk to experience low functional outcome? Do complications and clinical outcome after TFR depend on the indication for the surgery (e.g. periprosthetic fractures or aseptic loosening) or the age of the patients? The purpose of the present study was to compare complication rates after TFR performed with modular total femur prosthesis MML (Fa. ESKA/Orthodynamics) in patients without malignant disease.MethodsWe conducted a retrospective chart review and functional investigation of patients treated with a TFR for non-oncologic conditions from 1995 to 2015 and a minimum follow-up of 2 years. Complications were recorded according to the Henderson-Classification; outcome was evaluated with established clinical scores. The indication for TFR was periprosthetic fracture (Group A, n = 11) or aseptic loosening (Group B, n = 7) with massive bone defect of the femur deemed unsuitable for conventional arthroplastic or biologic reconstruction.ResultsEighteen patients matched the inclusion criteria and could be investigated clinically after a mean follow-up of 80 months (range: 28–132). Before TFA, all patients had previously undergone multiple operations (range: 1–8). The overall failure rate for any reason was 72% (n = 13/18), leading to a total of 37 surgical revisions with total exchange of TFR in 22% (n = 4/18). Most common failure mechanism was Type I (soft tissue), followed by Type IV (infection) and Type III (mechanical failure). According to Enneking’s functional evaluation method (MSTS-Score), the function ranged from 1 to 15 with a mean of 10 ± 4 out of 30.ConclusionTFR is a salvage procedure to restore mechanical integrity and regain functional ability after extensive femoral bone loss. Outcome of the patients in the present study did mainly depend on the age at reconstruction and not on the indication for TFR.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Short- to long-term follow-up of total femoral replacement in non-oncologic patients

Toepfer

Harrasser

Petzschner

et al. 2016

BMC Musculoskelet Disord

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“…Protocols for postoperative immobilization were described in 19 studies. Two studies reported 6 weeks in an abduction brace following total femoral replacement . The immobilization protocol following limb salvage with a proximal femoral megaprosthetic was not described.…”

Section: Resultsmentioning

confidence: 99%

“…Puri et al reported that hip flexion was limited to 60 degrees for 6 weeks following limb salvage with a total femoral megaprosthetic. Range of motion restrictions following limb salvage with a proximal femoral replacement were not described.…”

Section: Resultsmentioning

confidence: 99%

“…Twenty‐seven of 28 studies reported functional outcomes. The Musculoskeletal Tumor Society (MSTS) system score was the most commonly utilized measure used to quantify function—reported in 26 studies . The range of mean MSTS system scores following limb salvage with TF, PF, DF, and PT megaprosthetics were 19 to 24, 21 to 28.3, 21.8 to 27.3, and 19.8 to 26, respectively.…”

Section: Resultsmentioning

confidence: 99%

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Fitness, Function, and Exercise Training Responses after Limb Salvage With a Lower Limb Megaprosthesis: A Systematic Review

Wilson

Steadman

Beckman

et al. 2019

PM&R

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Objective: To describe the fitness, function, and exercise training responses of patients following reconstruction of the lower limb with a total femoral (TF), proximal femoral (PF), distal femoral (DF), or proximal tibial (PT) megaprosthesis. Type: Systematic review. Literature Survey: Five research databases were searched systematically for original studies published in English from 2006 to 2017 that reported fitness, functioning, or exercise training responses for one or more of the four types of lower limb megaprosthesis listed above.Methodology: Methodologic quality was assessed using a 22-item modified STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist. Synthesis: Of the 5342 articles retrieved, 28 met the inclusion criteria. Thirteen studies reported fitness outcomes, primarily in PT, with none in TF. Impaired knee extensor strength of the affected limb was reported following limb salvage with PF, DF, and PT megaprosthetics. Impaired flexibility was reported following limb salvage with DF and PT megaprosthetics. Functional outcomes were described in all studies and were most commonly reported using the Musculoskeletal Tumor Society (MSTS) system score. Results indicated no clear difference in functional outcomes between megaprosthesis locations. No studies evaluated exercise training responses. Conclusions: This review identified impairments of lower limb strength and flexibility following limb salvage with a lower limb megaprosthesis. Similarity in functional outcomes for all four reported megaprosthetic locations may indicate a lack of sensitivity in outcome measures, including the absence of items assessing higher-level functioning. Exercise interventions that aim to improve fitness and function in this population have not been evaluated but are required given increasing 5-year survival rates. Level of Evidence: I

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Total Femur Replacement After Tumor Resection: Limb Salvage Usually Achieved But Complications and Failures are Common

Sevelda

Schuh

Hofstaetter

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Primary bone or soft tissue tumors of the femur sometimes present with severe and extensive bone destruction, leaving few limb-salvage options other than total femur replacement. However, there are few data available regarding total femur replacement and, in particular, regarding implant failures. Questions/purposes We asked: (1) What are the revisionfree and overall implant survival rates of conventional total femur replacements in patients treated for sarcoma of the femur or soft tissues? (2) What are the revision-free and overall implant survival rates of expandable total femur replacements in skeletally immature patients? (3) Using the comprehensive International Society of Limb Salvage failure-mode classification, what types of complications occur with conventional and expandable total femur replacements? Patients and Methods Our retrospective, single-center cohort study was based on data prospectively collected for 50 patients who received a total femur replacement after tumor resection for indications other than carcinoma or metastatic disease. Of the 50 patients, six (12%) were lost to followup before 6 months. Ten of the remaining 44 patients received expandable implants. The mean followup was 57 months (range, 1-280 months) and 172 months (range, 43-289 months) for patients who underwent conventional and expandable total femur replacements, respectively. For implant survival, competing risk analyses were used. Results At 5 years, revision-free implant survival of conventional total femur replacements was 48% (95% CI, 0.37-0.73), and overall implant survival was 97% (95% CI, 0.004-0.20). Five-year revision-free implant survival of expandable total femur replacements was 30% (95% CI, 0.47-1.00) and overall implant survival was 100%. With

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Functional and oncologic outcomes after excision of the total femur in primary bone tumors: Results with a low cost total femur prosthesis

Cited by 27 publications

References 12 publications

Short- to long-term follow-up of total femoral replacement in non-oncologic patients

Short- to long-term follow-up of total femoral replacement in non-oncologic patients

Fitness, Function, and Exercise Training Responses after Limb Salvage With a Lower Limb Megaprosthesis: A Systematic Review

Total Femur Replacement After Tumor Resection: Limb Salvage Usually Achieved But Complications and Failures are Common

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