The use of knee mega-prosthesis for the management of distal femoral fractures: A systematic review

Meluzio, MC; Oliva,; Minutillo, F; Ziranu, Antonio; Saccomanno, Mf; Maccauro, Giulio

doi:10.1016/j.injury.2019.08.011

Cited by 31 publications

(27 citation statements)

References 26 publications

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“…Unfortunately, DAIR frequently fails in patients with knee megaprosthesis infection, at least in part due to the persistence of the pathogen on the implant's surface. The use of adjuvant agents that could have local anti-biofilm activity during the DAIR procedure seems to be of importance to control the infection in such patients and could facilitate the success of a potential subsequent suppressive antibiotic treatment (1)(2)(3)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”

Section: Discussionmentioning

confidence: 99%

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The Potential Innovative Use of Bacteriophages Within the DAC® Hydrogel to Treat Patients With Knee Megaprosthesis Infection Requiring “Debridement Antibiotics and Implant Retention” and Soft Tissue Coverage as Salvage Therapy

et al. 2020

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Section: Discussionmentioning

confidence: 99%

“…Knee megaprosthesis is used for patients with bone cancer or trauma that requires distal femur resection (1). Infection, which occurs in 3-40% in such patients, is one of the most terrible complications (2,3).…”

Section: Introductionmentioning

confidence: 99%

The Potential Innovative Use of Bacteriophages Within the DAC® Hydrogel to Treat Patients With Knee Megaprosthesis Infection Requiring “Debridement Antibiotics and Implant Retention” and Soft Tissue Coverage as Salvage Therapy

et al. 2020

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“…Megaprosthetic replacement is commonly performed in lower-limb reconstruction after tumor resections [ 16 , 17 , 18 , 19 ] as well as increasingly after trauma [ 20 , 21 , 22 ] or failed primary endoprosthetic replacement [ 23 , 24 ]. Despite their high rates of long-term sequelae including infection, mechanical and soft tissue failures, and loosening, patients benefit from surgery by being able to use their lower extremities in activities of daily living.…”

Section: Discussionmentioning

confidence: 99%

What Opinions Do Tumor Reconstructive Surgeons Have about Sports Activity after Megaprosthetic Replacement in Hip and Knee? Results of the MoReSports Expert Opinion Online Survey

Hobusch

Keusch

Tsuchiya

et al. 2020

JCM

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Sports activity has many benefits in cancer survivors. A key one is having sport activity contribute to the well-being of the individual. However, there are no guidelines about the intensity and kind of postoperative mobility workouts after hip or knee megaprosthetic treatment. Opinion research about sports after modular bone and joint replacement may provide an understanding of surgeons’ attitudes on sports activity after megaprostheses of the hip and knee joint. A web survey with members of three international professional organizations of orthopedic tumor reconstructive surgeons was conducted between September 2016 and January 2018. Members were invited via personalized emails by the European Musculoskeletal Oncology Society (EMSOS), the International Society of Limb Salvage (ISOLS), and the Musculoskeletal Tumor Society (MSTS). The questionnaire included 26 questions. A total of 149 surgeons started the survey, and 76 finished the entire survey (American Association for Public Opinion Research (AAPOR) second response rate (RR2) EMSOS: 12.3%; ISOLS: 21.9%; MSTS: n/a). More than half of the respondents encourage sarcoma survivors after megaprosthetic treatment to reach an activity level that would allow them to regularly participate in active sporting events of University of California, Los Angeles (UCLA) activity level 7 and higher. Orthopedic tumor reconstructive surgeons do fear a number of complications (periprosthetic fracture, allograft failure/fracture, loosening, prosthetic or bearing failure, and early polyethylene wear) due to sports activity after modular bone–joint replacement, but they actually witness fewer complications than they conceptually anticipated. According to the surgeons’ opinions, between four to seven types of sports after surgery could reasonably be recommended depending on the type of hip or knee procedures. This survey provides insights into opinions on what could be recommended, what could be allowed if surgeons and their patients agree on the potential negative outcome, and which sports should definitely not be allowed after hip and knee megaprostheses.

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“…However, in such cases, a long-term non-weight bearing period is necessary for effective healing. Furthermore, the union rate of conservative treatment for periprosthetic fractures around the knee is not high [8,9]. Few patients are capable of restoring their walking ability, even after the long-term non-weight bearing period, which is required for conservative treatment.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of circular external fixator in periprosthetic fractures around the knee

Nozaka

Miyakoshi

Hongo

et al. 2020

BMC Musculoskelet Disord

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Background The incidence of periprosthetic fractures after total joint arthroplasty (TJA) is rising due to an increasing number of TJAs performed annually and the growing elderly population. In many elderly patients with periprosthetic fractures, the bone strength is lowered due to the deterioration of bone quality and a decrease in bone quantity; rigid fixation of the fracture is difficult. It is a challenging operation for orthopedic surgeons. The usefulness of circular external fixation for periprosthetic fractures has been reported in several case studies. The aim of this study was to investigate the rate of union and complications associated with circular external fixation in periprosthetic fractures around the knee. Methods We included 19 patients with periprosthetic femur and tibial fractures who underwent osteosynthesis using a circular external fixator and had at least 2 years of follow-up. All patients had comorbidities and high risks associated with anesthesia. Tourniquets were not used in any of the patients. There were no cases in which the skin incision was placed, and the closed reduction technique was used in all cases. Results A 100% union rate was achieved with no serious complications. All fractures healed after a mean time of 14.3 ± 5.2 weeks (range, 8–38 weeks). The walking ability was the same level as before the injury in 13 cases. Discussion There are many comorbidities associated with periprosthetic fractures in elderly patients. Double-plate or revision surgery were largely invasive and had high risks associated with anesthesia. Circular external fixation is a feasible and effective treatment option because it provides stable fixation, prompt postoperative mobilization, and has no major complications, especially in elderly patients who are treated for periprosthetic fractures. Conclusion Circular external fixation is a safe and reliable method for periprosthetic fractures around the knee in elderly patients. Level of evidence Level IV, retrospective case series.

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The use of knee mega-prosthesis for the management of distal femoral fractures: A systematic review

Cited by 31 publications

References 26 publications

The Potential Innovative Use of Bacteriophages Within the DAC® Hydrogel to Treat Patients With Knee Megaprosthesis Infection Requiring “Debridement Antibiotics and Implant Retention” and Soft Tissue Coverage as Salvage Therapy

The Potential Innovative Use of Bacteriophages Within the DAC® Hydrogel to Treat Patients With Knee Megaprosthesis Infection Requiring “Debridement Antibiotics and Implant Retention” and Soft Tissue Coverage as Salvage Therapy

What Opinions Do Tumor Reconstructive Surgeons Have about Sports Activity after Megaprosthetic Replacement in Hip and Knee? Results of the MoReSports Expert Opinion Online Survey

Effectiveness of circular external fixator in periprosthetic fractures around the knee

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