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Journal of Bone and Joint Surgery - British Volume, Vol 89-B, Issue 8, 1084-1087.
doi: 10.1302/0301-620X.89B8.19236  
Copyright © 2007 by British Editorial Society of Bone and Joint Surgery
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Cementless fixation of megaprostheses using a conical fluted stem in the treatment of bone tumours

J. Bruns, MD, PhD, Professor, Consultant1; G. Delling, MD, PhD, Professor, former Director2; H. Gruber, MD, Senior House Officer3; C. H. Lohmann, MD, PhD, Professor, Senior House Officer3; and C. R. Habermann, MD, PhD, Junior Professor, Senior House Officer4

1 Unit of Orthopaedic Surgery Hospital ‘Alten Eichen’, Diaconical Clinics Hamburg, Juetlaender Allee 48, D-22527 Hamburg, Germany.
2 Department of Osteopathology
3 Department of Orthopaedic Surgery, Centre of Surgical Medicine
4 Department of Diagnostics and Interventional Radiology, Centre of Radiology University Hospital Hamburg-Eppendorf, University of Hamburg Martinistrasse 52,0-20246, Hamburg, Germany

Correspondence should be sent to Dr J. Bruns; e-mail: j.bruns{at}d-k-h.de

We reviewed 25 patients in whom a MUTARS megaprosthesis with a conical fluted stem had been implanted. There were three types of stem: a standard stem was used in 17 cases (three in the proximal femur, nine in the distal femur and five proximal tibia), a custom-made proximal femoral stem in four cases and a custom-made distal femoral stem in four cases. The mean age of the patients was 40.1 years (17 to 70) and the mean follow-up was for 2.5 years (0.9 to 7.4).

At follow-up two patients had died from their disease: one was alive with disease and 22 were disease-free. One of 23 prostheses had been removed for infection and another revised to a cemented stem. The mean Musculoskeletal Tumor Society score was 24.9 (12 to 30) and the mean Karnofsky index was 82% (60% to 100%).

There was no radiological evidence of loosening or subsidence. Stem stress shielding was seen in 11 patients and was marked in five of these.

There were five complications, rupture of the extensor mechanism of the knee after extra-articular resection in two patients, deep venous thrombosis in one, septic loosening in one, and dislocation of the hip in one.

The survival rate after seven years was 87% (95% confidence interval (CI) 83 to 91) for the patients and 95% (95% CI 91 to 99) for the megaprosthesis. A longer follow-up is needed to confirm these encouraging results.




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