Reoperation for Failed Prosthetic Replacement Used for Limb Salvage

Shin, Duk Seop; Weber, Kristin L.; Chao, Edmund Y.S.; An, Kai Nan; Sim, Franklin H.

doi:10.1097/00003086-199901000-00008

Cited by 61 publications

(60 citation statements)

References 10 publications

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“…At a median of 90 months (range, 24-181 months), the median MSTS score of the 21 patients who retained their implant was 27 (range, [24][25][26][27][28][29][30]). An active 90°arc of motion of the affected knee was maintained in 17 (81%) patients.…”

Section: Resultsmentioning

confidence: 99%

“…Existing options include press-fit and cemented stemmed prostheses and APCs. Although they provide the mainstay of available primary and revision constructs, long-term implant survival is often poor at or beyond 5 years [12,20,23,26,28,29,32,33]. Other reconstructive options are also limited due to the severe bone loss that is commonly associated with the prosthetic failure.…”

Section: Discussionmentioning

confidence: 99%

“…sites were analyzed as a single heterogeneous group [20,23,26,28,29,33] (Table 2). A major limitation is that we lack a comparison group of revision patients reconstructed by other methods such as a cemented stem, a press-fit stem, or an APC and are thus limited to comparison with only a handful of published studies.…”

Section: Discussionmentioning

confidence: 99%

“…Severe femoral bone deficiency after fracture or loosening of a prior stem traditionally results in revision to a cemented or largediameter press-fit stemmed implant, an allograft-prosthetic composite (APC) reconstruction, or a total femur replacement [7,23,26,33]. Unfortunately, short residual proximal femur segments cannot be addressed by these options and these constructs have high failure rates, often exceeding 30% at 5 years [20,22,23,26,29,33]. We need to improve our current strategies to preserve or reconstitute the remaining femoral bone stock while creating a more durable revision construct.…”

Section: Introductionmentioning

confidence: 99%

“…Three patients required secondary operations for cortical insufficiency proximal to the anchor plug in bone not spanned by the CPS implant and unrelated to the prosthesis. Median MSTS score was 27 (range, [24][25][26][27][28][29][30]. Conclusions Revision distal femoral replacement arthroplasty after a failed megaprosthesis is often difficult as a result of a lack of adequate bone.…”

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confidence: 99%

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Revision Distal Femoral Arthroplasty With the Compress® Prosthesis Has a Low Rate of Mechanical Failure at 10 Years

Zimel

Farfalli

Zindman

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Patients with failed distal femoral megaprostheses often have bone loss that limits reconstructive options and contributes to the high failure rate of revision surgery. The Compress 1 Compliant Pre-stress (CPS) implant can reconstruct the femur even when there is little remaining bone. It differs from traditional stemmed prostheses because it requires only 4 to 8 cm of residual bone for fixation. Given the poor long-term results of stemmed revision constructs, we sought to determine the failure rate and functional outcomes of the CPS implant in revision surgery. Questions/purposes (1) What is the cumulative incidence of mechanical and other types of implant failure when used to revise failed distal femoral arthroplasties placed after oncologic resection? (2) What complications are characteristic of this prosthesis? (3) What function do patients achieve after receiving this prosthesis? Methods We retrospectively reviewed 27 patients who experienced failure of a distal femoral prosthesis and were revised to a CPS implant from April 2000 to February 2013. Indications for use included a minimum 2.5 mm cortical thickness of the remaining proximal femur, no prior radiation, life expectancy [10 years, and compliance with protected weightbearing for 3 months. The cumulative incidence of failure was calculated for both mechanical (loss of compression between the implant anchor plug and spindle) and other failure modes using a competing risk analysis. Failure was defined as removal of the CPS implant. Followup was a minimum of 2 years or until implant removal. Median followup for patients with [CI], 4%-33%) at both 5 and 10 years. These failures occurred early at a median of 5 months. The cumulative incidence of other failures was 18% (95% CI, 7%-45%) at 5 and 10 years, all of which were deep infection. Three patients required secondary operations for cortical insufficiency proximal to the anchor plug in bone not spanned by the CPS implant and unrelated to the prosthesis. Median MSTS score was 27 (range, 24-30). Conclusions Revision distal femoral replacement arthroplasty after a failed megaprosthesis is often difficult as a result of a lack of adequate bone. Reconstruction with the CPS implant has an 11% failure rate at 10 years. Our results are promising and demonstrate the durable fixation provided by the CPS implant. Further studies to compare the CPS prosthesis and other reconstruction options with respect to survival and functional outcomes are warranted. Level of Evidence Level IV, therapeutic study.

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