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Journal of Bone and Joint Surgery - British Volume, Vol 89-B, Issue 12, 1632-1637.
doi: 10.1302/0301-620X.89B12.19481  
Copyright © 2007 by British Editorial Society of Bone and Joint Surgery
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The long-term results of endoprosthetic replacement of the proximal tibia for bone tumours

G. J. C. Myers, FRCS, Orthopaedic Specialist Registrar1; A. T. Abudu, FRCS, Consultant Orthopaedic Oncology Surgeon1; S. R. Carter, FRCS, Consultant Orthopaedic Oncology Surgeon1; R. M. Tillman, FRCS, Consultant Orthopaedic Oncology Surgeon1; and R. J. Grimer, FRCS, Consultant Orthopaedic1

1 Oncology Surgeon Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK.

Correspondence should be sent to Mr R. J. Grimer; e-mail: rob.grimer{at}roh.nhs.uk

We have investigated whether improvements in design have altered the outcome for patients undergoing endoprosthetic replacement of the proximal tibia following resection of a tumour. Survival of the implant and ‘servicing’ procedures have been documented using a prospective database.

A total of 194 patients underwent a proximal tibial replacement, with 95 having a fixed-hinge design and 99 a rotating-hinge with a hydroxyapatite collar; their median age was 21.5 years (10 to 74). At a mean follow-up of 14.7 years (5 to 29), 115 patients remain alive. The risk of revision for any reason in the fixed-hinge group was 32% at five years, 61% at ten years and 75% at 15 and 20 years, and in the rotating-hinge group 12% at five years, 25% at ten years and 30% at 15 years. Aseptic loosening was the most common reason for revision in the fixed-hinge knees, fracture of the implant in the early design of rotating hinges and infection in the current version. The risk of revision for aseptic loosening in the fixed-hinge knees was 46% at ten years. This was reduced to 3% in the rotating-hinge knee with a hydroxyapatite collar. The cemented, rotating hinge design currently offers the best chance of long-term survival of the prosthesis.




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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General