Patients with Revision Modern Megaprostheses of the Distal Femur Have Improved Disease-Specific and Health-Related Outcomes Compared to Those with Primary Replacements

Abstract

We asked whether there would be any difference between primary and revision modern cemented fixed hinge megaprosthesis of the distal femur in function and activity-related outcomes following treatment of a bone tumor. An identical custom-made fixed hinge cemented megaprosthesis with a hydroxyapatite collar was used in all cases. The main outcomes were joint-specific function, disease-specific activity, and health-related quality of life. Implant survival was also evaluated. Patients in the revision group performed slightly better than patients in the primary group on disease-specific (Toronto Extremity Salvage Score, = 0.033; Musculoskeletal Tumor Society, = 0.072) and health-related outcomes (Short Form 36 [SF-36] physical component, = 0.085; SF-36 mental component, = 0.069) but not on joint-specific outcomes (Knee Society Score, = 0.94). The cumulative probabilities of revision for any reason were 14.5% (7-25%) at 5 years with no statistically significant difference between primary and revision procedures ( = 0.77). In conclusion, patients undergoing a revision have similar joint-specific functional outcome but improved disease-specific and health-related outcomes. Implant survival are similar between groups.

Quantitative preoperative patient assessments are related to survival and procedure outcome for osseous metastases

“…However, those instruments address different aspects of the patient experience. Therefore, the SF-36 remains relevant in oncology, in arthroplasty, and in spine, trauma, foot, sports, and upper extremity surgery, and it has the additional advantage of having been internationally validated [ [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] ]. Finally, as with all observational studies, it is possible that we are not accounting for an unobserved confounder.…”

Two Cases of Polyethylene Granuloma After Distal Femoral Endoprosthesis With All-Polyethylene Tibia

“…Unlike the femoral side [3], tibial side failure appears a less commonly reported complication after DFRs. Despite its frequent use in various designs of DFR, there is limited literature reporting complications specific to all-polyethylene tibial components [3,4]. Interestingly, aseptic loosening of implants has been reported as a culprit source for revisions [1].…”

“…The main complications of DFR include deep infection, aseptic loosening, hardware structural failure, and local recurrence of malignancy [1,2]. As a result, up to 33% of patients with DFR require a revision within 10 years [2][3][4]. However, in contrast to knee arthroplasty with polyethylene components, which may lead to the formation of polyethylene granuloma or pseudotumor [5][6][7][8], such complication of polyethylene granuloma after a DFR was not seemingly reported to date.…”

Classification and Reconstruction of Femoral Bone Defect in the Revision of Aseptic Loosening of Distal Femoral Endoprostheses: A 10-year Multicenter Retrospective Analysis

“…[43] Revision surgery due to complications of tumor prostheses is frequently performed. [2,[5][6][7] Henderson et al [8] identi ed tumor endoprostheses failures and classi ed them into ve modes: soft tissue failure (type 1), aseptic loosening (type 2), structural failure (type 3), infection (type 4), and tumor progression (type 5). Aseptic loosening is the most common failure mode in the literature.…”