Clinical outcomes of cemented distal femur replacements with all-polyethylene tibial components for oncologic indications
Endoprosthetic distal femoral replacement (DFR) is a well-established salvage procedure following resection of malignant tumors within the distal femur. Use of an all-polyethylene tibial (APT) component is cost-effective and avoids failure due to locking-mechanism issues and backside wear, but limit...
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Veröffentlicht in: | World journal of orthopedics 2023-04, Vol.14 (4), p.218-230 |
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creator | Christ, Alexander B Chung, Brian C Urness, Matthew Mayer, Lucas W Gettleman, Brandon S Heckmann, Nathanael D Menendez, Lawrence R |
description | Endoprosthetic distal femoral replacement (DFR) is a well-established salvage procedure following resection of malignant tumors within the distal femur. Use of an all-polyethylene tibial (APT) component is cost-effective and avoids failure due to locking-mechanism issues and backside wear, but limits modularity and the option for late liner exchange. Due to a paucity of literature we sought to answer three questions: (1) What are the most common modes of implant failure for patients undergoing cemented DFR with APT for oncologic indications? (2) What is the survivorship, rate of all-cause reoperation, and rate of revision for aseptic loosening of these implants? And (3) Is there a difference in implant survivorship or patient demographics between cemented DFRs with APT performed as a primary reconstruction
those performed as a revision procedure?
To assess outcomes of cemented DFRs with APT components used for oncologic indications.
After Institutional Review Board approval, a retrospective review of consecutive patients who underwent DFR between December 2000 to September 2020 was performed using a single-institutional database. Inclusion criteria consisted of all patients who underwent DFR with a GMRS
(Global Modular Replacement System, Stryker, Kalamazoo, MI, United States) cemented distal femoral endoprosthesis and APT component for an oncologic indication. Patients undergoing DFR for non-oncologic indications and patients with metal-backed tibial components were excluded. Implant failure was recorded using Henderson's classification and survivorship was reported using a competing risks analysis.
55 DFRs (55 patients) with an average age of 50.9 ± 20.7 years and average body mass index of 29.7 ± 8.3 kg/m
were followed for 38.8 ± 54.9 mo (range 0.2-208.4). Of these, 60.0% were female and 52.7% were white. The majority of DFRs with APT in this cohort were indicated for oncologic diagnoses of osteogenic sarcoma (
= 22, 40.0%), giant cell tumor (
= 9, 16.4%), and metastatic carcinoma (
= 8, 14.6%). DFR with APT implantation was performed as a primary procedure in 29 patients (52.7%) and a revision procedure in 26 patients (47.3%). Overall, twenty patients (36.4%) experienced a postoperative complication requiring reoperation. The primary modes of implant failure included Henderson Type 1 (soft tissue failure,
= 6, 10.9%), Type 2 (aseptic loosening,
= 5, 9.1%), and Type 4 (infection,
= 6, 10.9%). There were no significant differences in patient demographics |
doi_str_mv | 10.5312/wjo.v14.i4.218 |
format | Article |
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those performed as a revision procedure?
To assess outcomes of cemented DFRs with APT components used for oncologic indications.
After Institutional Review Board approval, a retrospective review of consecutive patients who underwent DFR between December 2000 to September 2020 was performed using a single-institutional database. Inclusion criteria consisted of all patients who underwent DFR with a GMRS
(Global Modular Replacement System, Stryker, Kalamazoo, MI, United States) cemented distal femoral endoprosthesis and APT component for an oncologic indication. Patients undergoing DFR for non-oncologic indications and patients with metal-backed tibial components were excluded. Implant failure was recorded using Henderson's classification and survivorship was reported using a competing risks analysis.
55 DFRs (55 patients) with an average age of 50.9 ± 20.7 years and average body mass index of 29.7 ± 8.3 kg/m
were followed for 38.8 ± 54.9 mo (range 0.2-208.4). Of these, 60.0% were female and 52.7% were white. The majority of DFRs with APT in this cohort were indicated for oncologic diagnoses of osteogenic sarcoma (
= 22, 40.0%), giant cell tumor (
= 9, 16.4%), and metastatic carcinoma (
= 8, 14.6%). DFR with APT implantation was performed as a primary procedure in 29 patients (52.7%) and a revision procedure in 26 patients (47.3%). Overall, twenty patients (36.4%) experienced a postoperative complication requiring reoperation. The primary modes of implant failure included Henderson Type 1 (soft tissue failure,
= 6, 10.9%), Type 2 (aseptic loosening,
= 5, 9.1%), and Type 4 (infection,
= 6, 10.9%). There were no significant differences in patient demographics or rates of postoperative complications between the primary procedure and revision procedure subgroups. In total, 12 patients (21.8%) required a revision while 20 patients (36.4%) required a reoperation, resulting in three-year cumulative incidences of 24.0% (95%CI 9.9%-41.4%) and 47.2% (95%CI 27.5%-64.5%), respectively.
This study demonstrates modest short-term survivorship following cemented DFR with APT components for oncologic indications. Soft tissue failure and endoprosthetic infection were the most common postoperative complications in our cohort.</description><identifier>ISSN: 2218-5836</identifier><identifier>EISSN: 2218-5836</identifier><identifier>DOI: 10.5312/wjo.v14.i4.218</identifier><identifier>PMID: 37155507</identifier><language>eng</language><publisher>United States: Baishideng Publishing Group Inc</publisher><subject>Retrospective Cohort Study</subject><ispartof>World journal of orthopedics, 2023-04, Vol.14 (4), p.218-230</ispartof><rights>The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.</rights><rights>The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved. 2023</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c321t-7c7d29596ef07cea4894bc14c6d36987221d8f822fc9232ea0374a8530577b643</citedby><cites>FETCH-LOGICAL-c321t-7c7d29596ef07cea4894bc14c6d36987221d8f822fc9232ea0374a8530577b643</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10122776/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10122776/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37155507$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Christ, Alexander B</creatorcontrib><creatorcontrib>Chung, Brian C</creatorcontrib><creatorcontrib>Urness, Matthew</creatorcontrib><creatorcontrib>Mayer, Lucas W</creatorcontrib><creatorcontrib>Gettleman, Brandon S</creatorcontrib><creatorcontrib>Heckmann, Nathanael D</creatorcontrib><creatorcontrib>Menendez, Lawrence R</creatorcontrib><title>Clinical outcomes of cemented distal femur replacements with all-polyethylene tibial components for oncologic indications</title><title>World journal of orthopedics</title><addtitle>World J Orthop</addtitle><description>Endoprosthetic distal femoral replacement (DFR) is a well-established salvage procedure following resection of malignant tumors within the distal femur. Use of an all-polyethylene tibial (APT) component is cost-effective and avoids failure due to locking-mechanism issues and backside wear, but limits modularity and the option for late liner exchange. Due to a paucity of literature we sought to answer three questions: (1) What are the most common modes of implant failure for patients undergoing cemented DFR with APT for oncologic indications? (2) What is the survivorship, rate of all-cause reoperation, and rate of revision for aseptic loosening of these implants? And (3) Is there a difference in implant survivorship or patient demographics between cemented DFRs with APT performed as a primary reconstruction
those performed as a revision procedure?
To assess outcomes of cemented DFRs with APT components used for oncologic indications.
After Institutional Review Board approval, a retrospective review of consecutive patients who underwent DFR between December 2000 to September 2020 was performed using a single-institutional database. Inclusion criteria consisted of all patients who underwent DFR with a GMRS
(Global Modular Replacement System, Stryker, Kalamazoo, MI, United States) cemented distal femoral endoprosthesis and APT component for an oncologic indication. Patients undergoing DFR for non-oncologic indications and patients with metal-backed tibial components were excluded. Implant failure was recorded using Henderson's classification and survivorship was reported using a competing risks analysis.
55 DFRs (55 patients) with an average age of 50.9 ± 20.7 years and average body mass index of 29.7 ± 8.3 kg/m
were followed for 38.8 ± 54.9 mo (range 0.2-208.4). Of these, 60.0% were female and 52.7% were white. The majority of DFRs with APT in this cohort were indicated for oncologic diagnoses of osteogenic sarcoma (
= 22, 40.0%), giant cell tumor (
= 9, 16.4%), and metastatic carcinoma (
= 8, 14.6%). DFR with APT implantation was performed as a primary procedure in 29 patients (52.7%) and a revision procedure in 26 patients (47.3%). Overall, twenty patients (36.4%) experienced a postoperative complication requiring reoperation. The primary modes of implant failure included Henderson Type 1 (soft tissue failure,
= 6, 10.9%), Type 2 (aseptic loosening,
= 5, 9.1%), and Type 4 (infection,
= 6, 10.9%). There were no significant differences in patient demographics or rates of postoperative complications between the primary procedure and revision procedure subgroups. In total, 12 patients (21.8%) required a revision while 20 patients (36.4%) required a reoperation, resulting in three-year cumulative incidences of 24.0% (95%CI 9.9%-41.4%) and 47.2% (95%CI 27.5%-64.5%), respectively.
This study demonstrates modest short-term survivorship following cemented DFR with APT components for oncologic indications. Soft tissue failure and endoprosthetic infection were the most common postoperative complications in our cohort.</description><subject>Retrospective Cohort Study</subject><issn>2218-5836</issn><issn>2218-5836</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNpVkUFPJCEQhYlxsxrX6x4NRy_dNtA09MmYibomJl52z4Shqx0MDS3Qmvn3ojNrlEuRvK9eVeUh9Js0NWeEXrw-hfqFtLVta0rkATqmpVRcsu7wy_8Inab01JTXNVyQ_ic6YoJwzhtxjLYrZ7012uGwZBMmSDiM2MAEPsOAB5ty0UaYlogjzE7vpIRfbd5g7Vw1B7eFvNk68ICzXdvCF6M5-A9uDBEHb4ILj9Zg64cyLNvg0y_0Y9Quwem-nqB_N9d_V3-q-4fbu9XVfWUYJbkSRgy0530HYyMM6Fb27dqQ1nQD63opypmDHCWlo-kpo6AbJlotOSu3inXXshN0ufOdl_UEgylbRe3UHO2k41YFbdV3xduNegwvijSEUiG64nC-d4jheYGU1WSTAee0h7AkRSUhvOsFkwWtd6iJIaUI4-cc0qj3zFTJTJXMlG1VCag0nH3d7hP_nxB7A_Yxltk</recordid><startdate>20230418</startdate><enddate>20230418</enddate><creator>Christ, Alexander B</creator><creator>Chung, Brian C</creator><creator>Urness, Matthew</creator><creator>Mayer, Lucas W</creator><creator>Gettleman, Brandon S</creator><creator>Heckmann, Nathanael D</creator><creator>Menendez, Lawrence R</creator><general>Baishideng Publishing Group Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20230418</creationdate><title>Clinical outcomes of cemented distal femur replacements with all-polyethylene tibial components for oncologic indications</title><author>Christ, Alexander B ; Chung, Brian C ; Urness, Matthew ; Mayer, Lucas W ; Gettleman, Brandon S ; Heckmann, Nathanael D ; Menendez, Lawrence R</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c321t-7c7d29596ef07cea4894bc14c6d36987221d8f822fc9232ea0374a8530577b643</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Retrospective Cohort Study</topic><toplevel>online_resources</toplevel><creatorcontrib>Christ, Alexander B</creatorcontrib><creatorcontrib>Chung, Brian C</creatorcontrib><creatorcontrib>Urness, Matthew</creatorcontrib><creatorcontrib>Mayer, Lucas W</creatorcontrib><creatorcontrib>Gettleman, Brandon S</creatorcontrib><creatorcontrib>Heckmann, Nathanael D</creatorcontrib><creatorcontrib>Menendez, Lawrence R</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>World journal of orthopedics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Christ, Alexander B</au><au>Chung, Brian C</au><au>Urness, Matthew</au><au>Mayer, Lucas W</au><au>Gettleman, Brandon S</au><au>Heckmann, Nathanael D</au><au>Menendez, Lawrence R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical outcomes of cemented distal femur replacements with all-polyethylene tibial components for oncologic indications</atitle><jtitle>World journal of orthopedics</jtitle><addtitle>World J Orthop</addtitle><date>2023-04-18</date><risdate>2023</risdate><volume>14</volume><issue>4</issue><spage>218</spage><epage>230</epage><pages>218-230</pages><issn>2218-5836</issn><eissn>2218-5836</eissn><abstract>Endoprosthetic distal femoral replacement (DFR) is a well-established salvage procedure following resection of malignant tumors within the distal femur. Use of an all-polyethylene tibial (APT) component is cost-effective and avoids failure due to locking-mechanism issues and backside wear, but limits modularity and the option for late liner exchange. Due to a paucity of literature we sought to answer three questions: (1) What are the most common modes of implant failure for patients undergoing cemented DFR with APT for oncologic indications? (2) What is the survivorship, rate of all-cause reoperation, and rate of revision for aseptic loosening of these implants? And (3) Is there a difference in implant survivorship or patient demographics between cemented DFRs with APT performed as a primary reconstruction
those performed as a revision procedure?
To assess outcomes of cemented DFRs with APT components used for oncologic indications.
After Institutional Review Board approval, a retrospective review of consecutive patients who underwent DFR between December 2000 to September 2020 was performed using a single-institutional database. Inclusion criteria consisted of all patients who underwent DFR with a GMRS
(Global Modular Replacement System, Stryker, Kalamazoo, MI, United States) cemented distal femoral endoprosthesis and APT component for an oncologic indication. Patients undergoing DFR for non-oncologic indications and patients with metal-backed tibial components were excluded. Implant failure was recorded using Henderson's classification and survivorship was reported using a competing risks analysis.
55 DFRs (55 patients) with an average age of 50.9 ± 20.7 years and average body mass index of 29.7 ± 8.3 kg/m
were followed for 38.8 ± 54.9 mo (range 0.2-208.4). Of these, 60.0% were female and 52.7% were white. The majority of DFRs with APT in this cohort were indicated for oncologic diagnoses of osteogenic sarcoma (
= 22, 40.0%), giant cell tumor (
= 9, 16.4%), and metastatic carcinoma (
= 8, 14.6%). DFR with APT implantation was performed as a primary procedure in 29 patients (52.7%) and a revision procedure in 26 patients (47.3%). Overall, twenty patients (36.4%) experienced a postoperative complication requiring reoperation. The primary modes of implant failure included Henderson Type 1 (soft tissue failure,
= 6, 10.9%), Type 2 (aseptic loosening,
= 5, 9.1%), and Type 4 (infection,
= 6, 10.9%). There were no significant differences in patient demographics or rates of postoperative complications between the primary procedure and revision procedure subgroups. In total, 12 patients (21.8%) required a revision while 20 patients (36.4%) required a reoperation, resulting in three-year cumulative incidences of 24.0% (95%CI 9.9%-41.4%) and 47.2% (95%CI 27.5%-64.5%), respectively.
This study demonstrates modest short-term survivorship following cemented DFR with APT components for oncologic indications. Soft tissue failure and endoprosthetic infection were the most common postoperative complications in our cohort.</abstract><cop>United States</cop><pub>Baishideng Publishing Group Inc</pub><pmid>37155507</pmid><doi>10.5312/wjo.v14.i4.218</doi><tpages>13</tpages><oa>free_for_read</oa></addata></record> |
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source | Baishideng "World Journal of" online journals; EZB-FREE-00999 freely available EZB journals; PubMed Central |
subjects | Retrospective Cohort Study |
title | Clinical outcomes of cemented distal femur replacements with all-polyethylene tibial components for oncologic indications |
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