Survival and complications in hinged knee reconstruction prostheses after distal femoral or proximal tibial tumor resection: A retrospective study of 161 cases - 08/04/20

Doi : 10.1016/j.otsr.2019.11.027

Matthieu Mazaleyrat ^a,⁎ , Louis-Romée Le Nail ^a, Guillaume Auberger ^b, David Biau ^b, Philippe Rosset ^a, Denis Waast ^c, François Gouin ^c,^d, Paul Bonnevialle ^e, Matthieu Ehlinger ^f, Gilles Pasquier ^g, Gualter Vaz ^d
the
French Society of Orthopedic Surgery, Traumatology (SoFCOT)^h
^a Service de Chirurgie Orthopédique et Traumatologique, Faculté de Médecine, Université de Tours, Centre-Val de Loire, Hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-lès-Tours, France
^b Service de Chirurgie Orthopédique - Hôpital Cochin AP-HP, Université Paris-Descartes, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
^c Service de Chirurgie Orthopédique, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France
^d Centre des Massues, 92, rue Dr Edmond-Locard, 69005 Lyon, France
^e Département Universitaire d’Orthopédie et Traumatologie, Hôpital Pierre-Paul Riquet, CHU de Toulouse, place du Docteur Baylac, 31059 Toulouse, France
^f Service de Chirurgie Orthopédique et de Traumatologie, Hôpital de Hautepierre, CHRU de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
^g Service de Chirurgie Orthopédique, CHRU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France
^h SoFCOT, 56, rue Boissonade, 75014 Paris, France

^⁎Corresponding author.

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Abstract

Introduction

Hinged knee megaprostheses are mainly used for reconstruction after tumor resection. They may incur complications, but this has not been assessed in the French literature, except in small series at short follow-up. We therefore conducted a large-scale nationwide multicenter retrospective study with a minimum 5 years’ follow-up. The objectives were (1) to compare survival between distal femoral and proximal tibial reconstruction prostheses, and (2) to analyze complications and failure.

Hypothesis

Distal femoral hinged reconstruction prostheses show longer survival with fewer complications than proximal tibial prostheses.

Material and methods

One hundred sixty-one patients were included: 118 in the distal femoral group, and 43 in the proximal tibial group. Tumors were mostly osteosarcomas (90 cases) or chondrosarcomas (31 cases). Mean age was 37 years (range, 12-86 years). Complications were assessed on the Henderson classification. Failure was defined by prosthesis anchor exchange or amputation.

Results

At a mean 9 years’ follow-up (range, 5-23 years), implant survival was longer in the distal femoral group: 5- and 10-year survival, 84% [95% CI, 75-89] and 70% [95% CI, 59-79] versus 74% [95% CI, 69-85] and 43% [95% CI, 23-61] (p=0.02). Revision surgery for complications mainly concerned aseptic loosening (19%, 30 cases) or deep infection (16%, 25 cases) and more often involved the proximal tibia (65% vs. 43%, 28 vs. 51 cases; OR 2.4 [95% CI, 1.2-5.1]; p=0.02).

Discussion

Hinged knee reconstruction prosthesis is a solution in tumoral pathology, but with a high risk of complications (loosening and infection) and a higher failure rate in the proximal tibial reconstruction prosthesis.