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Clinical Orthopaedics and Related Research®

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01-11-2009 | Symposium: Selected Papers Presented at the 2008 Meeting of the Musculoskeletal Tumor Society

Early Equivalence of Uncemented Press-fit and Compress® Femoral Fixation

Authors: German L. Farfalli, MD, Patrick J. Boland, MD, Carol D. Morris, MD, Edward A. Athanasian, MD, John H. Healey, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 11/2009

Abstract

Bone ingrowth promises more durable biologic fixation of megaprostheses. The relative performance of different types of fixation is unknown. We compared the fixation of two forms of biologically fixed femoral components: an intramedullary uncemented press-fit stem (UCS; Group 1, 50 patients) and a Compress® uncemented fixation (CPS; Group 2, 41 patients). In Group 1, the overall Kaplan-Meier prosthetic survival rates were 85% at 5 and 71% at 10 years. Most failures were long-term developments. Aseptic loosening was the primary cause of failure. Stem diameters less than 13.5 mm and a diaphyseal/stem coefficient greater than 2.5 mm were associated with decreased prosthetic survival. In Group 2, the overall rate of CPS survival was 88% at 5 years. Failure of femoral fixation or fracture during the first year was the main reason for revision. Five-year survival rates were similar between the groups and we observed no difference in the functional success of the implants. We found no failures after 1-year followup in Group 2 (CPS). Any difference in prosthetic survival can only be proven by longer-term study or a randomized trial.

Level of Evidence: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Avedian R, Goldsby RE, Kramer MJ, O’Donnell RJ. Effect of chemotherapy on initial compressive osseointegration of oncologic endoprostheses. Clin Orthop Relat Res. 2007;459:48–53.PubMedCrossRef

Bhangu AA, Kramer MJ, Grimer RJ, O’Donnell RJ. Early distal femoral endoprosthetic survival: cemented stems versus the Compress® implant. Int Orthop. 2006;30:465–472.PubMedCrossRef

Bickels J, Wittig JC, Kollender Y, Henshaw RM, Kellar-Graney KL, Meller I, Malawer M. Distal femoral resection with endoprosthetic reconstruction: a long-term followup study. Clin Orthop Relat Res. 2002;400:225–235.PubMedCrossRef

Bini SA, Johnston JO, Martin DL. Compliant prestress fixation in tumor prostheses: interface retrieval data. Orthopedics. 2000;23:707–712.PubMed

Capanna R, Morris HG, Campanacci D, Del Ben M, Campanacci M. Modular uncemented prosthetic reconstruction after resection of tumours of the distal femur. J Bone Joint Surg Br. 1994;76:178–186.PubMed

Cristofolini L, Bini SA, Toni A. In vitro testing of a novel limb salvage prosthesis for the distal femur. Clin Biomech. 1998;13:608–615.CrossRef

Enneking WF, Dunham W, Gebhardt MC, Malawer M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 1993;286:241–246.PubMed

Finn HA, Simon MA. Limb-salvage surgery in the treatment of osteosarcoma in skeletally immature individuals. Clin Orthop Relat Res. 1991;262:108–118.PubMed

Flint MN, Griffin AM, Bell RS, Ferguson PC, Wunder JS. Aseptic loosening is uncommon with uncemented proximal tibia tumor prostheses. Clin Orthop Relat Res. 2006;450:52–59.PubMedCrossRef

10.

Freedman EL, Eckardt JJ. A modular endoprosthetic system for tumor and non-tumor reconstruction: preliminary experience. Orthopedics. 1997;20:27–36.PubMed

11.

Griffin AM, Parsons JA, Davis AM, Bell RS, Wunder JS. Uncemented tumor endoprostheses at the knee: root causes of failure. Clin Orthop Relat Res. 2005;438:71–79.PubMedCrossRef

12.

Healey JH, Abdeen A, Morris CD, Athanasian EA, Boland PJ. Telescope allograft method to reconstitute the diaphysis in limb salvage surgery. Clin Orthop Relat Res. 2008 Oct 3 [Epub ahead of print].

13.

Horowitz SM, Glasser DB, Lane JM, Healey JH. Prosthetic and extremity survivorship after limb salvage for sarcoma: how long do the reconstructions last? Clin Orthop Relat Res. 1993;293:280–286.PubMed

14.

Jeys LM, Kulkarni A, Grimer RJ, Carter SR, Tillman RM, Abudu A. Endoprosthetic reconstruction for the treatment of musculoskeletal tumors of the appendicular skeleton and pelvis. J Bone Joint Surg Am. 2008;90:1265–1271.PubMedCrossRef

15.

Kawai A, Healey JH, Boland PJ, Athanasian EA, Jeon DG. A rotating-hinge knee replacement for malignant tumors of the femur and tibia. J Arthroplasty. 1999;14:187–196.PubMedCrossRef

16.

Kawai A, Lin PP, Boland PJ, Athanasian EA, Healey JH. Relationship between magnitude of resection, complication, and prosthetic survival after prosthetic knee reconstructions for distal femoral tumors. J Surg Oncol. 1999;70:109–115.PubMedCrossRef

17.

Kawai A, Muschler GF, Lane JM, Otis JC, Healey JH. Prosthetic knee replacement after resection of a malignant tumor of the distal part of the femur. Medium to long-term results. J Bone Joint Surg Am. 1998;80:636–647.PubMedCrossRef

18.

Kneisl JS, Finn HA, Simon MA. Mobile knee reconstructions after resection of malignant tumors of the distal femur. Orthop Clin N Am. 1991;22:105–119.

19.

Kramer MJ, Tanner BJ, Horvai AE, O’Donnell RJ. Compressive osseointegration promotes viable bone at the endoprosthetic interface: retrieval study of Compress(R) implants. Int Orthop. 2008;32:567–571.PubMedCrossRef

20.

Laverdiere C, Kolb EA, Supko JG, Gorlick R, Meyers PA, Maki RG, Wexler L, Demetri GD, Healey JH, Huvos AG, Goorin AM, Bagatell R, Ruiz-Casado A, Guzman C, Jimeno J, Harmon D. Phase II study of ecteinascidin 743 in heavily pretreated patients with recurrent osteosarcoma. Cancer. 2003;98:832–840.PubMedCrossRef

21.

Marshall AD, Mokris JG, Reitman RD, Dandar A, Mauerhan DR. Cementless titanium tapered-wedge femoral stem: 10- to 15-year follow-up. J Arthroplasty. 2004;19:546–552.PubMedCrossRef

22.

Meding JB, Keating EM, Ritter MA, Faris PM, Berend ME. Minimum ten-year follow-up of a straight-stemmed, plasma-sprayed, titanium-alloy, uncemented femoral component in primary total hip arthroplasty. J Bone Joint Surg Am. 2004;86:92–97.PubMed

23.

Meyers PA, Gorlick R, Heller G, Casper E, Lane J, Huvos AG, Healey JH. Intensification of preoperative chemotherapy for osteogenic sarcoma: results of the Memorial Sloan-Kettering (T12) protocol. J Clin Oncol. 1998;16:2452–2458.PubMed

24.

Meyers PA, Heller G, Healey J, Huvos A, Lane J, Marcove R, Applewhite A, Vlamis V, Rosen G. Chemotherapy for nonmetastatic osteogenic sarcoma: the Memorial Sloan-Kettering experience. J Clin Oncol. 1992;10:5–15.PubMed

25.

Meyers PA, Schwartz CL, Krailo M, Kleinerman ES, Betcher D, Bernstein ML, Conrad E, Ferguson W, Gebhardt M, Goorin AM, Harris MB, Healey J, Huvos A, Link M, Montebello J, Nadel H, Nieder M, Sato J, Siegal G, Weiner M, Wells R, Wold L, Womer R, Grier H. Osteosarcoma: a randomized, prospective trial of the addition of ifosfamide and/or muramyl tripeptide to cisplatin, doxorubicin, and high-dose methotrexate. J Clin Oncol. 2005;23:2004–2011.PubMedCrossRef

26.

Mittermayer F, Krepler P, Dominkus M, Schwameis E, Sluga M, Heinzl H, Kotz R. Long-term followup of uncemented tumor endoprostheses for the lower extremity. Clin Orthop Relat Res. 2001;388:167–177.PubMedCrossRef

27.

Mittermeyer F, Windhager R, Dominkus M, Krepler P, Schwamels E, Sluga M, Kotz R, Strasser G. Revision of the Kotz type of tumor endoprosthesis for the lower limb. J Bone Joint Surg Br. 2002;84:401–406.CrossRef

28.

Muscolo DL, Ayerza MA, Aponte-Tinao LA, Ranalletta M. Use of distal femoral osteoarticular allografts in limb salvage surgery. J Bone Joint Surg Am. 2005;87:2449–2455.PubMedCrossRef

29.

Sanjay BKS, Moreau P. Limb salvage surgery in bone tumour with modular endoprosthesis. Int Orthop. 1999;23:41–46.PubMedCrossRef

30.

Shih LY, Sim FH, Pritchard DJ, Rock MG, Chao EY. Segmental total knee arthroplasty after distal femoral resection for tumor. Clin Orthop Relat Res. 1993;292:269–281.PubMed

31.

Torbert JT, Fox EJ, Hosalkar HS, Ogilvie CM, Lackman RD. Endoprosthetic reconstructions: results of long-term followup of 139 patients. Clin Orthop Relat Res. 2005;438:51–59.PubMedCrossRef

32.

Unwin PS, Cannon SR, Grimer RJ, Kemp HBS, Sneath RS, Walker PS. Aseptic loosening in cemented custom-made prosthetic replacements for bone tumours of the lower limb. J Bone Joint Surg Br. 1996;78:5–13.PubMed

33.

Wunder JS, Leitch K, Griffin AM, Davis AM, Bell RS. Comparison of two methods of reconstruction for primary malignant tumors at the knee: a sequential cohort study. J Surg Oncol. 2001;77:89–99.PubMedCrossRef

34.

Zwart HJ, Taminiau AH, Schimmel JW, van Horn JR. Kotz modular femur and tibia replacement. 28 tumor cases followed for 3 (1–8) years. Acta Orthop Scand. 1994;65:315–318.PubMedCrossRef

Title: Early Equivalence of Uncemented Press-fit and Compress® Femoral Fixation
Authors: German L. Farfalli, MD
Patrick J. Boland, MD
Carol D. Morris, MD
Edward A. Athanasian, MD
John H. Healey, MD
Publication date: 01-11-2009
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 11/2009
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-009-0912-9

At a glance: The STEP trials

Springer Medicine

Early Equivalence of Uncemented Press-fit and Compress® Femoral Fixation

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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