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Journal of Bone and Joint Surgery - British Volume, Vol 89-B, Issue 4,
521-526.
doi: 10.1302/0301-620X.89B4.18631 Copyright © 2007 by British Editorial Society of Bone and Joint Surgery Endoprosthetic replacement of the distal femur for bone tumoursLONG-TERM RESULTSG. J. C. Myers, MRCS, 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 Orthopaedic Oncology Surgeon11 The 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 investigated whether improvements in design have altered the outcome for patients undergoing endoprosthetic replacement of the distal femur after resection of a tumour. Survival of the implant and ‘servicing’ procedures have been documented using a prospective database, review of the design of the implant and case records. In total, 335 patients underwent a distal femoral replacement, 162 having a fixed-hinge design and 173 a rotating-hinge. The median age of the patients was 24 years (interquartile range 17 to 48). A total of 192 patients remained alive with a mean follow-up of 12 years (5 to 30). The risk of revision for any reason was 17% at five years, 33% at ten years and 58% at 20 years. Aseptic loosening was the main reason for revision of the fixed-hinge knees while infection and fracture of the stem were the most common for the rotating-hinge implant. The risk of revision for aseptic loosening was 35% at ten years with the fixed-hinge knee, which has, however, been replaced by the rotating-hinge knee with a hydroxyapatite collar. The overall risk of revision for any reason fell by 52% when the rotating-hinge implant was used. Improvements in the design of distal femoral endoprostheses have significantly decreased the need for revision operations, but infection remains a serious problem. We believe that a cemented, rotating-hinge prosthesis with a hydroxyapatite collar offers the best chance of long-term survival of the prosthesis. This article has been cited by other articles:
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