Proximal femoral reconstruction with modular megaprostheses in non-oncological patients

Döring, Kevin; Vertesich, Klemens; Martelanz, Luca; Staats, Kevin; Böhler, Christoph; Hipfl, Christian; Windhager, Reinhard; Puchner, Stefan

doi:10.1007/s00264-021-05080-8

Cited by 9 publications

(3 citation statements)

References 35 publications

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“…Artificial ligaments can also be used to reduce the dislocation rate [ 89 ]. Post-operative care is of paramount importance with immobilization of the limb operated on in abduction for various post-operative durations, and protected weight-bearing thereafter [ 70 ].…”

Section: Discussionmentioning

confidence: 99%

Megaprosthesis in Non-Oncologic Settings—A Systematic Review of the Literature

Sambri,

Parisi,

Zunarelli

et al. 2023

JCM

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Modular megaprostheses (MPs) are commonly used after bone-tumor resection, but they can offer a limb salvage solution in massive bone defects. The aim of this systematic review of the Literature is to provide a comprehensive data collection concerning the use of MPs in non-oncologic cases, and to provide an overview of this topic, especially from an epidemiologic point of view. Three different databases (PubMed, Scopus, and Web of Science) were searched for relevant articles, and further references were obtained by cross-referencing. Sixty-nine studies met the inclusion criteria, reporting on cases of MP in non-oncologic cases. A total of 2598 MPs were retrieved. Among these, 1353 (52.1%) were distal femur MPs, 941 (36.2%) were proximal femur MPs, 29 (1.4%) were proximal tibia MPs and 259 (10.0%) were total femur MPs. Megaprostheses were most commonly used to treat periprosthetic fractures (1158 cases, 44.6%), in particular in the distal femur (859, 74.2%). Overall, complications were observed in 513 cases (19.7%). Type I (soft tissue failures) and type IV (infection) according to the Henderson classification were the most frequent (158 and 213, respectively). In conclusion, patients with severe post-traumatic deformities and/or significant bone loss who have had previous septic complications should be considered as oncologic patients, not because of the disease, but because of the limited therapeutic options available. The benefits of this treatment include relatively short operative times and immediate weight-bearing, thus making MP particularly attractive in the lower limb.

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Section: Discussionmentioning

confidence: 99%

Megaprosthesis in Non-Oncologic Settings—A Systematic Review of the Literature

Sambri,

Parisi,

Zunarelli

et al. 2023

JCM

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“…More recently, Döring et al reported a mixed case series of MPs implanted for non-oncological purposes. Eleven PJIs were treated for PJI, and coating use was not mentioned: 3 were lost at follow up and 5 had a recurrence [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Megaprostheses for the revision of infected hip arthroplasties with severe bone loss

et al. 2022

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Background Periprosthetic hip infections with severe proximal femoral bone loss may require the use of limb salvage techniques, but no agreement exists in literature regarding the most effective treatment. Aim of this study is to analyze the infection eradication rate and implant survival at medium-term follow-up in patients treated with megaprostheses for periprosthetic hip infections with severe bone loss. Methods Twenty-one consecutive patients were retrospectively reviewed at a mean 64-month follow-up (24–120). Functional and pain scores, microbiological, radiological and intraoperative findings were registered. Kaplan Meier survival analysis and log rank test were used for infection free survival and implant survival analyses. Results The infection eradication rate was 90.5%, with an infection free survival of 95.2% at 2 years (95%CI 70.7–99.3) and 89.6%(95%CI 64.3–97.3) at 5 years. Only two patients required major implant revisions for aseptic implant loosening. The most frequent complication was dislocation (38.1%). The major revision-free survival of implants was 95.2% (95%CI 70.7–99.3) at 2 years and 89.6% (95%CI 64.3–97.3) at 5 years. The overall implant survival was 83.35% (CI95% 50.7–93.94) at 2 and 5 years. Subgroup analyses (cemented versus cementless MPs, coated versus uncoated MPs) revealed no significant differences at log rank test, but its reliability was limited by the small number of patients included. Conclusions Proximal femoral arthroplasty is useful to treat periprosthetic hip infections with severe bone loss, providing good functional results with high infection eradication rates and rare major revisions at medium-term follow-up. No conclusions can be drawn on the role of cement and coatings.

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“…However, in the case of very large defects, custom-made (CM) 3D-printed prosthesis and proximal femur (PF) megaprosthesis (MP) have been proposed [16][17][18][19][20][21][22][23][24][25][26][27][28].…”

Section: Introductionmentioning

confidence: 99%

A Combined Use of Custom-Made Partial Pelvic Replacement and Proximal Femur Megaprosthesis in the Treatment of Severe Bone Loss after Multiple Total Hip Arthroplasty Revisions

Fiore,

Paolucci,

Zunarelli

et al. 2023

Prosthesis

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Hip arthroplasty failures (either septic or aseptic) often require multiple revisions, thus leading to severe bone defects. The most common reconstruction methods do not allow the management of severe defects. For this reason, in recent years, techniques borrowed from surgical oncology have been applied in the field of revision surgery to deal with both acetabular and femoral bone losses. In this article, two cases of severe bone deficiency following multiple hip arthroplasty revisions that were treated with a custom-made hip prosthesis combined with a proximal femur megaprosthesis are presented. Both implants were silver coated. A review of the literature was conducted to analyze similar cases treated with either a custom-made prosthesis or a proximal femur megaprosthesis. At the 2-year follow-up, all prostheses were in site without clinical or radiographic signs of implant loosening. No postoperative complications occurred. At the last follow-up, both patients resumed their daily life activities with an MSTS score of 23 and 21, respectively. The combined approach of a proximal femur megaprosthesis with a custom-made partial pelvic replacement is a solution that allows severe bone deficiency cases to be tackled with good functional results. Additionally, silver coating may help prevent recurrence of infection.

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Proximal femoral reconstruction with modular megaprostheses in non-oncological patients

Cited by 9 publications

References 35 publications

Megaprosthesis in Non-Oncologic Settings—A Systematic Review of the Literature

Megaprosthesis in Non-Oncologic Settings—A Systematic Review of the Literature

Megaprostheses for the revision of infected hip arthroplasties with severe bone loss

A Combined Use of Custom-Made Partial Pelvic Replacement and Proximal Femur Megaprosthesis in the Treatment of Severe Bone Loss after Multiple Total Hip Arthroplasty Revisions

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