Modular tumor prostheses: are current stem designs suitable for distal femoral reconstruction? A biomechanical implant stability analysis in Sawbones

Bischel, Oliver; Nadorf, Jan; Klein, S B; Gantz, Simone; Jakubowitz, Eike; Kretzer, Jan Philippe; Arnholdt, Joerg; Seeger, Jörn Bengt

doi:10.1007/s00402-019-03158-y

Cited by 7 publications

(4 citation statements)

References 20 publications

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“…The artificial bone used in the present work consists of bone-like polyurethane foam. It is validated in several further studies 13 14 15 as a homogeneous material allowing reproducible results. However, human bone does not have this homogeneity, which should affect the transfer of the study to the clinical site and should be taken into account.…”

Section: Discussionmentioning

confidence: 87%

Pull-off resistance of a screwless implant-abutment connection and surface evaluation after cyclic loading

et al. 2021

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PURPOSE The aim of this study was to investigate to what extent cyclic load affects the screwless implant-abutment connection for Morse taper dental implants. MATERIALS AND METHODS 16 implants (SICvantage max) and 16 abutments (Swiss Cross) were used. The screwless implant-abutment connection was subjected to 10,000 cycles of axial loading with a maximum force of 120 N. For the pull-off testing, before and after the same cyclic loading, the required force for disconnecting the remaining 6 implant-abutment connections was measured. The surface of 10 abutments was examined using a scanning electron microscope 120× before and after loading. RESULTS The pull-off test showed a significant decrease in the vertical force required to pull the abutment from the implant with mean 229.39 N ± 18.23 before loading, and 204.30 N ± 13.51 after loading ( P <.01). Apart from the appearance of polished surface areas and slight signs of wear, no visible damages were found on the abutments. CONCLUSION The deformation on the polished abutment surface might represent the result of micro movements within the implant-abutment connection during loading. Although there was a decrease of the pull-off force values after cyclic loading, this might not have a notable effect on the clinical performance.

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Section: Discussionmentioning

confidence: 87%

Pull-off resistance of a screwless implant-abutment connection and surface evaluation after cyclic loading

et al. 2021

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“…Fuchs et al are in agreement with this observation, defining a remnant bone stock of less than 5 cm in length as a contraindication for the use of segmental prostheses using standard stems [ 2 ]. An in vitro study by Bischel et al also found indications that stem properties may vary depending on implantation site and publishing that tapered stem designs seem to be favorable in larger defects whereas the hexagonal may be advantageous in defects located more distally [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Reconstruction survival of segmental megaendoprostheses: a retrospective analysis of 28 patients treated for intercalary bone defects after musculoskeletal tumor resections

Streitbürger

Hardes

Nottrott

et al. 2020

Arch Orthop Trauma Surg

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Introduction Intercalary endoprosthetic reconstructions have been reserved for patients with a limited life expectancy due to reports of high rates of early mechanical and reconstruction failure. Materials and methods In this study, we retrospectively analyzed 28 patients who underwent intercalary endoprosthetic reconstruction of the femur (n = 17) or tibia (n = 11) regarding reconstruction survival and causes of complications and reconstruction failure. Results A total of 56 stems were implanted in this collective, 67.9% of which were implanted using cementation. Eight different stem designs were implanted. The mean patient age at the time of operation was 42.3 years. The mean bone defect needing reconstruction measured 18.5 cm. Resection margins were clear in 96.4% of patients. Of twenty-six complications, five were not implant-associated. We observed infection in 10.7% (n = 3) and traumatic periprosthetic fracture in 3.6% (n = 1) of cases. The most frequent complication was aseptic stem loosening (ASL) (53.8%; n = 14) occurring in eight patients (28.6%). The metaphyseal and meta-diaphyseal regions of femur and tibia were most susceptible to ASL with a rate of 39.1% and 31.3% respectively. No ASLs occurred in epiphyseal or diaphyseal location. Overall reconstruction survival was 43.9% and 64.3% including patients who died of disease with their implant intact. Overall limb survival was 72.7%. Conclusions Proper planning of segmental reconstructions including stem design with regard to unique anatomical and biomechanical properties is mandatory to address the high rates of ASL in metaphyseal and metadiaphyseal stem sites. With continued efforts of improving stem design in these implantation sites and decreasing rates of mechanical failure, indications for segmental megaendoprostheses may also extend to younger patients with the localized disease for their advantages of early weight bearing and a lack of donor-site morbidity.

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“…Piakong et al 12 suggested that a curved stem with a larger diameter could reduce the revision rate. Bischel et al 13 . proposed that a hexagonal medullary stem apex design might reduce the prosthesis failure rate.…”

Section: Introductionmentioning

confidence: 99%

“…suggested that a curved stem with a larger diameter could reduce the revision rate. Bischel et al 13 …”

Section: Introductionmentioning

confidence: 99%

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

Zheng

2022

Orthopaedic Surgery

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Objective To measure the full‐length anteroposterior and lateral radiographs of lower limbs after the resection of a tumor in the distal femur and tumor‐type knee prosthesis replacement and to analyze the factors leading to aseptic loosening of the prosthesis. Methods A total of 26 cases of tumor‐type knee prosthesis replacement or revision due to the distal femoral tumor at our hospital from January 2007 to December 2019 were retrospectively analyzed. The patients were divided into the loosening and unloosening groups depending on whether aseptic loosening occurred after surgery. Full‐length anteroposterior and lateral radiographs of lower limbs were used to measure bone resection length, length of prosthesis, distance of proximal apex of the medullary stem of the femoral prosthesis from the maximum arc of the anterior femoral arch, diameter of the medullary stem, etc. Data were analyzed, and the risk factors for aseptic loosening of the prosthesis were explored. Results The ratio of the prosthetic length to the femoral length (63.72 ± 5.21) and the ratio of the femoral medullary stem diameter to the femoral diameter (26.03 ± 8.45) were smaller in the loosening group than in the unloosening group. The difference was statistically significant (p < 0.05). The distance between the apex of the medullary stem and the maximum arc of the anterior femoral arch was significantly shorter in the loosening group (3.47 ± 2.96) than in the unloosening group, and the difference was statistically significant (p < 0.05). The measurement of the lower limb alignment showed significant differences between the loosening and unloosening groups in terms of HKAA, mLDFA, and distance between the lower limb alignment and the center of the knee joint (p < 0.05). The logistic regression analysis showed that less than 30% ratio between the medullary stem diameter and the femoral diameter, less than 3 cm distance between the apex of the medullary stem and the maximum curvature of the anterior arch of the femur, distance between the lower limb alignment and the center of the knee joint, and presence of varus knee and valgus knee after the surgery were the risk factors for aseptic loosening of the prosthesis. Conclusions The diameter of the femoral medullary stem of the prosthesis, the apex position of the prosthetic stem, and the lower limb alignment are the risk factors for aseptic loosening of the prosthesis.

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Modular tumor prostheses: are current stem designs suitable for distal femoral reconstruction? A biomechanical implant stability analysis in Sawbones

Cited by 7 publications

References 20 publications

Pull-off resistance of a screwless implant-abutment connection and surface evaluation after cyclic loading

Pull-off resistance of a screwless implant-abutment connection and surface evaluation after cyclic loading

Reconstruction survival of segmental megaendoprostheses: a retrospective analysis of 28 patients treated for intercalary bone defects after musculoskeletal tumor resections

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

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