Fixed-hinge cemented modular implants: An effective reconstruction technique following primary distal femoral bone tumor resection. A 136-case multicenter series - 21/03/20

Doi : 10.1016/j.otsr.2019.10.029

Jean Camille Mattei ^a,⁎ , Benjamin Chapat ^b, Benjamin Ferembach ^c, Louis-Romée Le Nail ^c, Vincent Crenn ^b, Paul Bizzozero ^a, Geoffroy Venton ^d, Marjorie Kerzoncuf ^e, Anderson Loundnou ^f, David Backstein ^g, Ibrahim Alshaygy ^g, Antony Griffin ^g, Jay Wunder ^g, David Biau ^h, François Gouin ^b, Philippe Rosset ^c, Alexandre Rochwerger ^a
^a Service d’orthopédie et traumatologie 3A, Aix-Marseille université, hôpital Nord, AP–HM, chemin des Bourrély, 13015 Marseille, France
^b Service d’orthopédie, hôtel Dieu, CHU de Nantes, université de Nantes, 5, allée de l’Île Gloriette, 44093 Nantes, France
^c Service d’orthopédie, université de Tours, hôpital Trousseau, avenue de la République, 37170 Chambray-lès-Tours, France
^d Service d’oncologie, Aix-Marseille université, hôpital de la Timone, AP–HM, boulevard Jean-Moulin, 13005 Marseille, France
^e Service de rééducation fonctionnelle, Aix-Marseille université, hôpital de la Timone, AP–HM, boulevard Jean-Moulin, 13005 Marseille, France
^f Unité de recherche en santé publique et maladies chroniques, faculté de médecine, Aix-Marseille université, hôpital de la Timone, boulevard Jean-Moulin, 13005 Marseille, France
^g Department of orthopedics, University of Toronto, Mount Sinai hospital, 600, University Avenue, ON M5G 1X5 Toronto, Canada
^h Service d’orthopédie, Paris-Descartes université, hôpital Cochin, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France

^⁎Corresponding author. Hôpital Nord, 3A Pavillon Mistral, chemin des Bourrely, 13015 Marseille, France.Hôpital Nord3A Pavillon Mistral, chemin des BourrelyMarseille13015France

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Abstract

Background

Reconstruction by endoprosthesis is widespread after bone tumor resection. The design and type of fixation and of hinge remain a matter of debate. The aim of the present study was to assess survival, complications and functional results in a homogeneous series of adult patients undergoing bone defect reconstruction following distal femoral tumor resection, using a single model of fixed-hinge cemented endoprosthesis, at a minimum 5 years’ follow-up.

Hypothesis

The study hypotheses were that loosening and infection are the main causes of failure, and that this type of reconstruction is reliable following distal femoral resection.

Patients and methods

All patients aged over 17 years undergoing reconstruction using the Stanmore Mets® fixed-hinge cemented modular endoprosthesis following distal femoral resection for primary bone tumor in 4 French reference centers between 2004 and 2013 were included. Epidemiological data, MSTS functional score, clinical and radiological examination results, complications and survival with types of failure according to the Henderson classification were assessed.

Results

One hundred and thirty-six patients (68 male, 68 female; mean age, 41.2 years [range, 17–77 years]) were included. Mean follow-up was 81 months [range, 61–134 months]. Thirty-two patients (38%) experienced a total 67 complications requiring surgical revision: mainly infection (n=28) or mechanical failure (n=26). Overall implant survival was 78% at 5 years. There were 30 implant failures on the Henderson classification. Mean MSTS score was 82%.

Discussion

The present results are comparable to those of the literature and for other types of reconstruction. Recent meta-analyses suggest that type of hinge and of stem fixation have little effect on implant survival. International comparative studies are needed to determine the exact role of each type of reconstruction according to the patient profile.