Outcomes of Cemented Distal Femoral Replacement Using “Line to Line” Technique With All-Polyethylene Tibial Implant for Tumors

Tayara, Bader; Nooh, Anas; Chalopin, Antoine; Goulding, Krista; Turcotte, Robert

doi:10.1016/j.arth.2021.03.033

Cited by 5 publications

(8 citation statements)

References 51 publications

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“…25,27 Most recently, Tayara demonstrated only one case of aseptic loosening at 21 years postoperatively out of 125 patients who underwent distal femoral replacement with line-to-line cementation. 28 While this technique is not supported by implant manufacturers, line-to-line cementing, along with the use of bowed stems, may provide increased rotational stability and improve long-term survival of cemented stems. 29 On-growth collars adjacent to the cut edge of the femur may enhance long-term fixation, as well.…”

Section: Cemented Fixationmentioning

confidence: 99%

Distal femoral replacement – Cemented or cementless? Current concepts and review of the literature

Christ

Hornicek

Fabbri

2021

Journal of Clinical Orthopaedics and Trauma

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Distal femoral endoprosthetic replacement has been successfully used to reconstruct distal femoral defects after tumor resection for over four decades. Despite continued advances, aseptic loosening continues to be the most common failure mode after infection. Debate still exists about a variety of design features and the optimal fixation method remains controversial. To date, no large-scale study or meta-analysis has demonstrated the superiority of one fixation technique over another. While the classic dichotomy of cemented versus cementless stems is well-known, the contemporary surgeon needs to fully understand the optimal clinical setting for each type of fixation technique and additional strategies to maximize implant stability. In clinical practice, the choice of fixation must be tailored to the individual patient. The surgeon must consider whether the operation is being performed for primary sarcoma or metastatic carcinoma, the presence of distant metastases, age, comorbidities, and whether radiotherapy has been previously given or will be required at the site of fixation. The best strategy for each patient optimizes tumor control and appropriately weighs risks of fixation failure versus the expected patient survival. This review will explore cemented and uncemented distal femoral replacement and highlight modern concepts to optimize each technique.

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Section: Cemented Fixationmentioning

confidence: 99%

Distal femoral replacement – Cemented or cementless? Current concepts and review of the literature

Christ

Hornicek

Fabbri

2021

Journal of Clinical Orthopaedics and Trauma

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“…However, few reports have specifically examined the tibial component, so it is unclear how this rate of aseptic loosening of the tibial component (3/55) compares with other historical groups. One recent study suggests that these components achieve durable fixation, with no cases of aseptic loosening and a small number (6) sustaining mechanical failure of the tibial component out of 125 patients[ 8 ]. This speaks to the advantage of line-to-line cement technique on the femur, and durable fixation of the APT, with predictable long-term failure like our study.…”

Section: Discussionmentioning

confidence: 99%

“…Metal-backed and all-polyethylene tibial components are available, both of which can be fixed to the bone with fully cemented, hybrid, or in some cases cementless fashion. However, there is a paucity of literature examining the survivorship of distal femoral replacements (DFRs) with respect to the type of tibial component or fixation used[ 8 , 9 ]. Furthermore, the majority of available studies fail to describe the type of tibial component or fixation used[ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes of cemented distal femur replacements with all-polyethylene tibial components for oncologic indications

Christ¹,

Chung²,

Urness³

et al. 2023

World J Orthop

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BACKGROUND Endoprosthetic distal femoral replacement (DFR) is a well-established salvage procedure following resection of malignant tumors within the distal femur. Use of an all-polyethylene tibial (APT) component is cost-effective and avoids failure due to locking-mechanism issues and backside wear, but limits modularity and the option for late liner exchange. Due to a paucity of literature we sought to answer three questions: (1) What are the most common modes of implant failure for patients undergoing cemented DFR with APT for oncologic indications? (2) What is the survivorship, rate of all-cause reoperation, and rate of revision for aseptic loosening of these implants? And (3) Is there a difference in implant survivorship or patient demographics between cemented DFRs with APT performed as a primary reconstruction vs those performed as a revision procedure? AIM To assess outcomes of cemented DFRs with APT components used for oncologic indications. METHODS After Institutional Review Board approval, a retrospective review of consecutive patients who underwent DFR between December 2000 to September 2020 was performed using a single-institutional database. Inclusion criteria consisted of all patients who underwent DFR with a GMRS ® (Global Modular Replacement System, Stryker, Kalamazoo, MI, United States) cemented distal femoral endoprosthesis and APT component for an oncologic indication. Patients undergoing DFR for non-oncologic indications and patients with metal-backed tibial components were excluded. Implant failure was recorded using Henderson's classification and survivorship was reported using a competing risks analysis. RESULTS 55 DFRs (55 patients) with an average age of 50.9 ± 20.7 years and average body mass index of 29.7 ± 8.3 kg/m 2 were followed for 38.8 ± 54.9 mo (range 0.2-208.4). Of these, 60.0% were female and 52.7% were white. The majority of DFRs with APT in this cohort were indicated for oncologic diagnoses of osteogenic sarcoma ( n = 22, 40.0%), giant cell tumor ( n = 9, 16.4%), and metastatic carcinoma ( n = 8, 14.6%). DFR with APT implantation was performed as a primary procedure in 29 patients (52.7%) and a revision procedure in 26 patients (47.3%). Overall, twenty patients (36.4%) experienced a postoperative complication requiring reoperation. The primary modes of implant failure included Henderson Type 1 (soft tissue failure, n = 6, 10.9%), Type 2 (aseptic loosening, n = 5, 9.1%), and Type 4 (infection, n = 6, 10.9%). There were no significant differences in patient demographics or rates of postoperative complications between the primary procedure and revision procedure subgroups. In total, 12 patients (21.8%) required a revision while 20 patien...

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“…In a cadaver study where the biomechanical behavior of French femoral stems was assessed, excessive stem or cement subsidence and cement degradation were not observed [8]. In a study of 125 distal femur replacements implanted using this technique, one patient with aseptic loosening and one fracture of the morse taper were identified [13]. When standard cementing and line-to-line cementing was compared in patients undergoing hip arthroplasty, line-to-line cemented implants migrated less in retroversion, with no difference in subsidence [12].…”

Section: Timing and Factors Common Among Broken Stemsmentioning

confidence: 99%

What Factors Are Associated With Stem Breakage in Distal Femoral Endoprosthetic Replacements Undertaken for Primary Bone Tumors?

Steadman

Rowell

Sommerville

2023

Clin Orthop Relat Res

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Background The advantages of distal femoral replacement prostheses for reconstructions after tumors are well known; one such implant, the Global Modular Replacement System (GMRS), has been widely used since 2003. Although implant breakage has been reported, the frequency of this event has varied across different studies. Questions/purposes (1) What percentage of patients who underwent distal femur resection and replacement using the GMRS for primary bone tumors at one center experienced stem breakage? (2) At what timepoints did these breakages occur, and what factors were common among the stems that broke? Methods We performed a retrospective study of all patients who underwent distal femur resection and replacement using the GMRS for a diagnosis of primary bone sarcoma by the Queensland Bone and Soft-tissue Tumor service from 2003 to 2020 who had a minimum of 2 years of follow-up. Standard follow-up for primary bone sarcoma involves radiographic imaging of the femur at 6 weeks and 3 months postoperatively and yearly thereafter. From a chart review, we identified patients with femoral stem breakage. Patient and implant details were recorded and analyzed. A total of 116 patients had undergone a distal femoral replacement with the GMRS prosthesis for primary bone sarcoma; however, 6.9% (eight of 116 patients) died before completing the 2-year follow-up period and were excluded. Of the remaining 108 patients, 15% (16 patients) had died at the time of this review; however, given that they completed the 2-year follow‐up period and did not experience stem breakage, they were included. Furthermore, 15% (16 patients) were considered lost to follow-up and excluded because they have not been seen in the past 5 years but were not known to have died or experienced stem breakage. This left 92 patients for analysis. Results Stem breakages were identified in 5.4% (five of 92) of patients. All stem breakages occurred in stem diameters 11 mm or less with a porous body construct; the percentage of patients with breakage in this group was 16% (five of 31). All patients with stem fracture demonstrated minimal ongrowth to the porous coated body. The median time to stem fracture was 10 years (range 2 to 12 years); however, two of the five stems broke within 3 years. Conclusion We recommend the use of a larger-diameter GMRS cemented stem (> 11 mm), and either the line-to-line cementing method or an uncemented stem from an alternative company should be considered in order to achieve this larger stem in smaller canals. If a stem less than 12 mm in diameter must be used or there is evidence of minimal ongrowth, then close follow-up and prompt investigation of new symptoms should occur. Level of Evidence Level IV, therapeutic study.

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Outcomes of Cemented Distal Femoral Replacement Using “Line to Line” Technique With All-Polyethylene Tibial Implant for Tumors

Cited by 5 publications

References 51 publications

Distal femoral replacement – Cemented or cementless? Current concepts and review of the literature

Distal femoral replacement – Cemented or cementless? Current concepts and review of the literature

Clinical outcomes of cemented distal femur replacements with all-polyethylene tibial components for oncologic indications

What Factors Are Associated With Stem Breakage in Distal Femoral Endoprosthetic Replacements Undertaken for Primary Bone Tumors?

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