Survival of Total Knee Replacement with a Megaprosthesis After Bone Tumor Resection

Abstract

The long-term survival of the knee megaprostheses in this study was poor. Mechanical failure was multifactorial and the leading cause of revision. Use of allograft-prosthesis composites and use of bushings or an antirotation pin appeared to have no mechanical benefits. We recommend that weight control programs and advice about adapting their activity level be offered to patients preoperatively.

The linea aspera as a rotational landmark: an anatomical MRI-based study

“…In this setting, it has been reported that femoral component malrotation was associated with anterior knee pain [2,3]; patellofemoral maltracking, subluxation, and dislocation [17]; stiffness [28]; inadequate patellofemoral mechanics and patella wear [31,32]; early revision [13]; and patient dissatisfaction [4]. Patellofemoral complications following megaprosthesis have also been reported in numerous series [5,6,22,23] including anterior knee pain, subluxation, dislocation, revision, and wear. Interestingly, Schwartz et al reported eight patella resurfacing at the time of revision of an endoprotheses; this occurred more often with fixed hinge than rotating hinge.…”

“…However, these landmarks may be missing when facing significant bone defects. This is notably the case when performing a distal femoral knee megaprostheses after resection of a primary malignant bone tumor [5,6,22] or for the treatment of bone metastasis, comminuted articular fracture, nonunions, failed knee replacements, and periprosthetic fractures [8,9,11,12,18,27,30,33].…”

Proximaler Tibiaersatz mit Transfer des M. Gastrocnemius

“…Die Diagnose erfolgt früher als bei den tief liegenden Tumoren des Becken oder der Wirbelsäule und ermöglicht die für die Prognose wichtige frühe Resektion. Die neben der neoadjuvanten Chemotherapie notwendige Therapie ist die En-bloc-Resektion des Tumors im Gesunden [1,3,5,12,19]. Ursprünglich wurde die Amputation favorisiert, da bei der Resektion folgende Schwierigkeiten zu lösen sind: der große Knochenverlust, die Knieinstabilität und der Wegfall des Streckapparats.…”

“…9, 10, 11). 1. 8 Zugang zur Tumorresektion unter Ausschneiden der Biopsienarbe mit Durchtrennung von Kutis und Subkutis bis zur Darstellung der Faszie.…”

Revision of Broken Knee Megaprostheses: New Solution to Old Problems

“…A large majority of tumors occur in the metaphyseal area in the bones around the knee and the principles of wide resection necessitate resection of the knee. Modern tumor endoprostheses have evolved in the last four decades and today have a reported survival rate of 75% to 90% at 5 years and 59% to 86% at 10 years [2,3,5,9,14,16,18,19]. Most failures are due to aseptic loosening in the modern era.…”