Clinical and dynamometric results of hip abductor system repair by trochanteric hydroxyapatite plate with modular implant after resection of proximal femoral tumors - 04/10/19

Doi : 10.1016/j.otsr.2019.08.011

Vincent Crenn ^a,^b,⁎ , Sylvain Briand ^a, Philippe Rosset ^b,^c, Jean-Camille Mattei ^d, Alban Fouasson-Chailloux ^e, Louis-Romée Le Nail ^b,^c, Denis Waast ^a, Mickael Ropars ^f, François Gouin ^a,^b
^a Orthopedics and Trauma Department, University Hospital Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes Cedex 1, France
^b Inserm UMR 1238, Bone sarcomas and remodeling of calcified tissues, faculté de médecine, 1, rue Gaston-Veil, 44035 Nantes cedex 1, France
^c Orthopedics Department, CHU de Tours University Hospital, avenue de la République, 37170 Chambray-lès-Tours, France
^d Orthopedics Department, hôpital Nord, CHU Marseille University, chemin des Bourrely, 13015 Marseille, France
^e Physical Medicine and Rehabilitation Department, hôpital Saint-Jacques, CHU de Nantes University Hospital, 85, rue Saint-Jacques, 44093 Nantes, France
^f Orthopedics and Trauma Department, hôpital Pontchaillou, CHU de Rennes University Hospital, 2, rue Henri-le-Guilloux, 35000 Rennes, France

^⁎Corresponding author at: Clinique chirurgicale orthopédique et traumatologique, CHU de Nantes, Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes Cedex 1, France.Clinique chirurgicale orthopédique et traumatologique, CHU de Nantes, Hôtel-Dieu1, place Alexis-RicordeauNantes Cedex 144093France

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Abstract

Introduction

The capacity of the hydroxyapatite-coated trochanteric screwed plates used with modular hip implants to restore abductor system efficacy after proximal femoral tumor resection has never been assessed. We therefore conducted a retrospective study aiming to: (1) quantitatively evaluate abduction conservation on dynamometry according to use of digastric reinsertion, conserving continuity between the gluteus medius and vastus lateralis muscles, or not, and of standard versus small-offset; (2) assess radiographic trochanteric plate fixation; (3) assess functional scores; and (4) assess complications.

Hypothesis

Trochanteric reinsertion better conserves abduction strength when reinsertion is digastric.

Patients and methods

Thirty-one patients undergoing proximal femoral tumor resection between 2006 and 2016 with reconstruction by Stanmore METS™ modular implant with trochanteric plate were included. Twenty-one had digastric fixation between the gluteus medius and vastus lateralis and 10 had simple trochanteric fixation without digastric continuity. Abduction strength was compared between sides on dynamometer. Sixteen patients had full assessment of muscle strength, by a single observer; there were 8 deaths, 5 patients lost to follow-up, and 2 cases of material removal.

Results

Abduction strength conservation versus the contralateral side was 55.2±23.3% (range, 5.8–86.1%): 66.6±13.0% (46.4–86.1) with versus 36.0±24.7% (5.8–63.2%) without digastric continuity (p=0.01); severe limp rate was 4/21 when digastric continuity was preserved (19%) versus 6/10 (60%) (p=0.04), and radiologic trochanteric reinsertion stability rate was 19/21 (90%) versus 4/10 (40%) (p=0.005). Standard femoral offset conserved greater abduction strength: 64.9±20.0% versus small-offset 45.4±23.2% (p=0.05). Toronto Extremity Salvage Score (TESS) was 89±9.4%, and Musculoskeletal Tumor Society (MSTS) score 75.4±5.4%. There were 6 complications (19%): 4 infections, 1 dislocation, and 1 plate removal; the single dislocation (3%) was in the digastric conservation group. TESS (90.7±7.8% vs 88.3±4) and MSTS score (75.6±4.0% vs 75.1±3.7) and complications [4/21 (19%) vs 2/10 (20%)] did not differ according to digastric or non-digastric reinsertion (p=1).

Conclusions

Abduction strength with a modular implant using a hydroxyapatite-coated trochanteric plate was better conserved by digastric trochanteric reinsertion, resulting in less limping, although the complications rate and functional scores were unaffected. Longer term assessment is needed to confirm this conservation of abduction strength.