The Use of Megaprostheses in Nononcologic Lower-Extremity Total Joint Arthroplasty

Mahmoud, Yusuf; Manrique, Jorge; Molloy, Robert; Krebs, Viktor E.; Piuzzi, Nicolás S.

doi:10.2106/jbjs.rvw.21.00185

Cited by 4 publications

(4 citation statements)

References 58 publications

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“…The risk of poor bone health is a major concern for orthopaedic surgery. Patients with osteoporosis or other bone-related conditions are at higher risk of postoperative fractures and adverse surgical outcomes 2,9,[26][27][28][29][30][31][32] . For example, Lindenberg-Larsen et al found that patients with osteoporosis were at increased risk of periprosthetic femoral fracture when undergoing THA 9 .…”

Section: Surgical Risks Associated With Poor Bone Healthmentioning

confidence: 99%

Team Approach: Bone Health Optimization in Orthopaedic Surgery

Pasqualini,

Huffman,

Keller

et al. 2023

JBJS Reviews

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» Bone health optimization (BHO) has become an increasingly important consideration in orthopaedic surgery because deterioration of bone tissue and low bone density are associated with poor outcomes after orthopaedic surgeries.» Management of patients with compromised bone health requires numerous healthcare professionals including orthopaedic surgeons, primary care physicians, nutritionists, and metabolic bone specialists in endocrinology, rheumatology, or obstetrics and gynecology. Therefore, achieving optimal bone health before orthopaedic surgery necessitates a collaborative and synchronized effort among healthcare professionals.» Patients with poor bone health are often asymptomatic and may present to the orthopaedic surgeon for reasons other than poor bone health. Therefore, it is imperative to recognize risk factors such as old age, female sex, and low body mass index, which predispose to decreased bone density.» Workup of suspected poor bone health entails bone density evaluation. For patients without dual-energy x-ray absorptiometry (DXA) scan results within the past 2 years, perform DXA scan in all women aged 65 years and older, all men aged 70 years and older, and women younger than 65 years or men younger than 70 years with concurrent risk factors for poor bone health. All women and men presenting with a fracture secondary to low-energy trauma should receive DXA scan and bone health workup; for fractures secondary to high-energy trauma, perform DXA scan and further workup in women aged 65 years and older and men aged 70 years and older.» Failure to recognize and treat poor bone health can result in poor surgical outcomes including implant failure, periprosthetic infection, and nonunion after fracture fixation. However, collaborative healthcare teams can create personalized care plans involving nutritional supplements, antiresorptive or anabolic treatment, and weight-bearing exercise programs, resulting in BHO before surgery. Ultimately, this coordinated approach can enhance the success rate of surgical interventions, minimize complications, and improve patients' overall quality of life.

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Section: Surgical Risks Associated With Poor Bone Healthmentioning

confidence: 99%

Team Approach: Bone Health Optimization in Orthopaedic Surgery

Pasqualini,

Huffman,

Keller

et al. 2023

JBJS Reviews

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“…Each available surgical procedure has advantages and disadvantages regarding bone preservation, surgical timing, and complexity. For instance, PFR in nononcological salvage procedures has become increasingly popular; however, it has been associated with a reoperation rate of 20.3% and high complication rates 4,5 . Femoral IG with a cemented stem has been linked with good long-term outcomes with an 84.2% 10-year survival rate free of reoperation 6 .…”

mentioning

confidence: 99%

Revision Total Hip Arthroplasty Using a Tibial Cone and Impaction Grafting for Severe Femoral Bone Loss

Ramos,

Rullan-Oliver,

Pasqualini

et al. 2023

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Case: An 84-year-old woman presented 6 years after revision total hip arthroplasty (rTHA) with worsening hip pain and a Paprosky classification IIIB femoral defect. rTHA was performed using a proximal femur replacement. Given her osteoporosis and poor bone stock, a tibial cone and impaction grafting (IG) were used for megaprosthesis fixation. At the 33-month follow-up, the patient was pain-free and radiographs demonstrated a well-fixed implant. Conclusion: In the setting of massive defects of poor-quality bone, novel use of a tibial cone and IG can be implemented to achieve implant fixation and maximize patient outcomes.

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“…In addition, as the number of revision total knee arthroplasty has continued to increase, surgeons are progressively using more megaprosthesis for nononcological cases 2,3 . Nevertheless, despite numerous advances in prosthetic design, which have allowed for optimized longevity, early weight-bearing, and rapid restoration of function after megaprosthetic distal femoral replacement (DFR), failure rates remain high 2 . Furthermore, a systematic review compiled survival rates for rotating-hinge DFR and found a survival of 78.6%, 77.7%, 70.9%, 48.7%, and 42.2% at years 5, 10, 15, 20, and 25, respectively 4 .…”

mentioning

confidence: 99%

“…Limb salvage surgery, including a megaprosthesis or endoprosthetic replacement, is one of the mainstream reconstruction treatments when possible 1 . In addition, as the number of revision total knee arthroplasty has continued to increase, surgeons are progressively using more megaprosthesis for nononcological cases 2,3 . Nevertheless, despite numerous advances in prosthetic design, which have allowed for optimized longevity, early weight-bearing, and rapid restoration of function after megaprosthetic distal femoral replacement (DFR), failure rates remain high 2 .…”

mentioning

confidence: 99%

Tibial Bushing Wear at 28 Years of Follow-up After Rotating-Hinge Distal Femoral Replacement

Tidd,

Pasqualini,

Muschler

et al. 2023

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Case: A 58-year-old woman presented with swelling, stiffness, and pain of the right knee 28 years after rotating-hinge distal femoral replacement after osteosarcoma resection. She underwent revision. There was wear through the entire thickness of the polyethylene tibial sleeve bushing, and the implant was well-fixed. The knee was reassembled with new bushings, sleeves, yoke, axle, poly, and a locking pin. Conclusion: This is the first described case of tibial sleeve bushing wear. It highlights the importance of early detection of potential complications and implant surveillance because it can enable surgeons to intervene with minor procedures, avoiding eventual catastrophic failure.

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The Use of Megaprostheses in Nononcologic Lower-Extremity Total Joint Arthroplasty

Abstract: As the number of primary total joint arthroplasty (TJA) procedures continues to rise, megaprostheses have found an emerging role in more complex revision arthroplasty cases that require additional reconstruction, stability, and restoration of function.

Cited by 4 publications

References 58 publications

Team Approach: Bone Health Optimization in Orthopaedic Surgery

Team Approach: Bone Health Optimization in Orthopaedic Surgery

Revision Total Hip Arthroplasty Using a Tibial Cone and Impaction Grafting for Severe Femoral Bone Loss

Tibial Bushing Wear at 28 Years of Follow-up After Rotating-Hinge Distal Femoral Replacement

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