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Published in: International Orthopaedics 7/2017

01-07-2017 | Original Paper

Long-term functional and radiological outcomes of allograft hip prosthesis composite. A fourteen -year follow-up study

Authors: Arnaud Dubory, Eric Mascard, Méryl Dahan, Philippe Anract, Charles Court, Stéphane Boisgard, Brice Viard, Gilles Missenard, SOFCOT (The French Society of Orthopaedic and Trauma Surgery)

Published in: International Orthopaedics | Issue 7/2017

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Abstract

Purpose

Allograft hip composite prosthesis (APC) is a type of reconstruction after resection of the proximal femur. This study aimed to assess long-term outcomes after an APC reconstruction.

Materials and methods

Forty-six patients were retrospectively included (14 revision total hip replacements, 30 primary malignant bone tumors, two metastasis).

Results

The mean length of femoral bone resection was 16.4 cm (7 to 27). With a mean follow-up of 14.7 years (6.3 to 32.6), Postel-Merle d’Aubigné score was 15.7 (8 to 21), Musculoskeletal Tumor Society score at 23.1 or 77% (15 to 29), and abductor strength at 3.4 (2 to 5). Allograft resorption was minor for 20 patients (44.4%), moderate for 13 patients (28.9%), and severe for 12 patients (26.7%). Host-allograft shaft bone fusion was achieved in 37 cases (84.1%). Trochanteric fracture occurred in 26 cases (59.1%). Length of femoral resection, allograft bone resorption, and trochanteric fracture did not have an effect on functional outcomes. At ten years follow-up, overall revision-free and femoral stem survivals were 54.1 ± 0.8% and 81.4 ± 0.6% respectively. No parameter evaluated influenced the survivorship.

Conclusion

APC is a reliable reconstruction adapted for huge proximal femoral bone resections. Trochanteric fracture and allograft bone resorption do not seem to influence functional results.
Level of evidence: Level IV
Literature
1.
go back to reference Horowitz SM, Glasser DB, Lane JM, Healey JH (1993) Prosthetic and extremity survivorship after limb salvage for sarcoma. How long do the reconstructions last? Clin Orthop 293:280–286 Horowitz SM, Glasser DB, Lane JM, Healey JH (1993) Prosthetic and extremity survivorship after limb salvage for sarcoma. How long do the reconstructions last? Clin Orthop 293:280–286
2.
go back to reference Langlais F, Lambotte JC, Collin P, Thomazeau H (2003) Long-term results of allograft composite total hip prostheses for tumors. Clin Orthop 414:197–211CrossRef Langlais F, Lambotte JC, Collin P, Thomazeau H (2003) Long-term results of allograft composite total hip prostheses for tumors. Clin Orthop 414:197–211CrossRef
3.
go back to reference Uchiyama K, Moriya M, Yamamoto T, Fukushima K, Takahira N, Itoman M (2013) Revision total hip arthroplasty using an interlocking stem with an allograft-prosthesis composite. Acta Orthop Belg 79(4):398–405PubMed Uchiyama K, Moriya M, Yamamoto T, Fukushima K, Takahira N, Itoman M (2013) Revision total hip arthroplasty using an interlocking stem with an allograft-prosthesis composite. Acta Orthop Belg 79(4):398–405PubMed
4.
go back to reference Farid Y, Lin PP, Lewis VO, Yasko AW (2006) Endoprosthetic and allograft-prosthetic composite reconstruction of the proximal femur for bone neoplasms. Clin Orthop 442:223–229CrossRefPubMed Farid Y, Lin PP, Lewis VO, Yasko AW (2006) Endoprosthetic and allograft-prosthetic composite reconstruction of the proximal femur for bone neoplasms. Clin Orthop 442:223–229CrossRefPubMed
5.
go back to reference Zehr RJ, Enneking WF, Scarborough MT (1996) Allograft-prosthesis composite versus megaprosthesis in proximal femoral reconstruction. Clin Orthop 322:207–223CrossRef Zehr RJ, Enneking WF, Scarborough MT (1996) Allograft-prosthesis composite versus megaprosthesis in proximal femoral reconstruction. Clin Orthop 322:207–223CrossRef
6.
go back to reference Anract P, Coste J, Vastel L, Jeanrot C, Mascard E, Tomeno B (2000) Proximal femoral reconstruction with megaprosthesis versus allograft prosthesis composite. A comparative study of functional results, complications and longevity in 41 cases. Rev Chir Orthopédique Réparatrice Appar Mot 86(3):278–288 Anract P, Coste J, Vastel L, Jeanrot C, Mascard E, Tomeno B (2000) Proximal femoral reconstruction with megaprosthesis versus allograft prosthesis composite. A comparative study of functional results, complications and longevity in 41 cases. Rev Chir Orthopédique Réparatrice Appar Mot 86(3):278–288
7.
go back to reference Haddad FS, Garbuz DS, Masri BA, Duncan CP, Hutchison CR, Gross AE (2000) Femoral bone loss in patients managed with revision hip replacement: results of circumferential allograft replacement. Instr Course Lect 49:147–162PubMed Haddad FS, Garbuz DS, Masri BA, Duncan CP, Hutchison CR, Gross AE (2000) Femoral bone loss in patients managed with revision hip replacement: results of circumferential allograft replacement. Instr Course Lect 49:147–162PubMed
8.
go back to reference Rasouli MR, Porat MD, Hozack WJ, Parvizi J (2012) Proximal femoral replacement and allograft prosthesis composite in the treatment of periprosthetic fractures with significant proximal bone loss. Orthop Surg 4(4):203–210CrossRefPubMed Rasouli MR, Porat MD, Hozack WJ, Parvizi J (2012) Proximal femoral replacement and allograft prosthesis composite in the treatment of periprosthetic fractures with significant proximal bone loss. Orthop Surg 4(4):203–210CrossRefPubMed
9.
go back to reference Sternheim A, Drexler M, Kuzyk PR, Safir OA, Backstein DJ, Gross AE (2014) Treatment of failed allograft prosthesis composites used for hip arthroplasty in the setting of severe proximal femoral bone defects. J Arthroplasty 29(5):1058–1062CrossRefPubMed Sternheim A, Drexler M, Kuzyk PR, Safir OA, Backstein DJ, Gross AE (2014) Treatment of failed allograft prosthesis composites used for hip arthroplasty in the setting of severe proximal femoral bone defects. J Arthroplasty 29(5):1058–1062CrossRefPubMed
10.
go back to reference Min L, Tang F, Duan H, Zhou Y, Zhang W-L, Shi R et al (2015) Cemented allograft-prosthesis composite reconstruction for the proximal femur tumor. OncoTargets Ther 8:2261–2269 Min L, Tang F, Duan H, Zhou Y, Zhang W-L, Shi R et al (2015) Cemented allograft-prosthesis composite reconstruction for the proximal femur tumor. OncoTargets Ther 8:2261–2269
11.
go back to reference D’Antonio J, McCarthy JC, Bargar WL, Borden LS, Cappelo WN, Collis DK et al (1993) Classification of femoral abnormalities in total hip arthroplasty. Clin Orthop 296:133–139 D’Antonio J, McCarthy JC, Bargar WL, Borden LS, Cappelo WN, Collis DK et al (1993) Classification of femoral abnormalities in total hip arthroplasty. Clin Orthop 296:133–139
12.
go back to reference D’aubigne RM, Postel M (1954) Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am 36-A(3):451–475CrossRefPubMed D’aubigne RM, Postel M (1954) Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am 36-A(3):451–475CrossRefPubMed
13.
go back to reference Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ (1993) A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop 286:241–246 Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ (1993) A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop 286:241–246
14.
go back to reference Gitelis S, Heligman D, Quill G, Piasecki P (1988) The use of large allografts for tumor reconstruction and salvage of the failed total hip arthroplasty. Clin Orthop 231:62–70 Gitelis S, Heligman D, Quill G, Piasecki P (1988) The use of large allografts for tumor reconstruction and salvage of the failed total hip arthroplasty. Clin Orthop 231:62–70
15.
go back to reference Benedetti MG, Bonatti E, Malfitano C, Donati D (2013) Comparison of allograft-prosthetic composite reconstruction and modular prosthetic replacement in proximal femur bone tumors: functional assessment by gait analysis in 20 patients. Acta Orthop 84(2):218–223CrossRefPubMedPubMedCentral Benedetti MG, Bonatti E, Malfitano C, Donati D (2013) Comparison of allograft-prosthetic composite reconstruction and modular prosthetic replacement in proximal femur bone tumors: functional assessment by gait analysis in 20 patients. Acta Orthop 84(2):218–223CrossRefPubMedPubMedCentral
16.
go back to reference Finstein JL, King JJ, Fox EJ, Ogilvie CM, Lackman RD (2007) Bipolar proximal femoral replacement prostheses for musculoskeletal neoplasms. Clin Orthop 459:66–75CrossRefPubMed Finstein JL, King JJ, Fox EJ, Ogilvie CM, Lackman RD (2007) Bipolar proximal femoral replacement prostheses for musculoskeletal neoplasms. Clin Orthop 459:66–75CrossRefPubMed
17.
go back to reference Meding JB, Ritter MA, Davis KE, Hillery M (2015) Cemented and uncemented total hip arthroplasty using the same femoral component. Hip Int J Clin Exp Res Hip Pathol Ther 26(1):62–66 Meding JB, Ritter MA, Davis KE, Hillery M (2015) Cemented and uncemented total hip arthroplasty using the same femoral component. Hip Int J Clin Exp Res Hip Pathol Ther 26(1):62–66
18.
go back to reference Babis GC, Sakellariou VI, O’Connor MI, Hanssen AD, Sim FH (2010) Proximal femoral allograft-prosthesis composites in revision hip replacement: a 12-year follow-up study. J Bone Joint Surg (Br) 92(3):349–355CrossRef Babis GC, Sakellariou VI, O’Connor MI, Hanssen AD, Sim FH (2010) Proximal femoral allograft-prosthesis composites in revision hip replacement: a 12-year follow-up study. J Bone Joint Surg (Br) 92(3):349–355CrossRef
19.
go back to reference Biau DJ, Larousserie F, Thévenin F, Piperno-Neumann S, Anract P (2010) Results of 32 allograft-prosthesis composite reconstructions of the proximal femur. Clin Orthop 468(3):834–845CrossRefPubMed Biau DJ, Larousserie F, Thévenin F, Piperno-Neumann S, Anract P (2010) Results of 32 allograft-prosthesis composite reconstructions of the proximal femur. Clin Orthop 468(3):834–845CrossRefPubMed
20.
go back to reference Langlais F (2002) Major reconstructions of the hip by allograft composite prostheses (long-term follow-up of 34 cases). Bull Acad Natl Med 186(3):661–677; discussion 677–681 Langlais F (2002) Major reconstructions of the hip by allograft composite prostheses (long-term follow-up of 34 cases). Bull Acad Natl Med 186(3):661–677; discussion 677–681
21.
go back to reference Wang J-W, Wang C-J (2004) Proximal femoral allografts for bone deficiencies in revision hip arthroplasty: a medium-term follow-up study. J Arthroplasty 19(7):845–852CrossRefPubMed Wang J-W, Wang C-J (2004) Proximal femoral allografts for bone deficiencies in revision hip arthroplasty: a medium-term follow-up study. J Arthroplasty 19(7):845–852CrossRefPubMed
22.
go back to reference Mu Jung J, Sang Kim C (2014) Analysis of stress distribution around total hip stems custom-designed for the standardized Asian femur configuration. Biotechnol Biotechnol Equip 28(3):525–532CrossRefPubMedPubMedCentral Mu Jung J, Sang Kim C (2014) Analysis of stress distribution around total hip stems custom-designed for the standardized Asian femur configuration. Biotechnol Biotechnol Equip 28(3):525–532CrossRefPubMedPubMedCentral
23.
go back to reference Mayle RE, Paprosky WG (2012) Massive bone loss: allograft-prosthetic composites and beyond. J Bone Joint Surg (Br) 94(11 Suppl A):61–64CrossRef Mayle RE, Paprosky WG (2012) Massive bone loss: allograft-prosthetic composites and beyond. J Bone Joint Surg (Br) 94(11 Suppl A):61–64CrossRef
24.
go back to reference Donati D, Giacomini S, Gozzi E, Mercuri M (2002) Proximal femur reconstruction by an allograft prosthesis composite. Clin Orthop 394:192–200CrossRef Donati D, Giacomini S, Gozzi E, Mercuri M (2002) Proximal femur reconstruction by an allograft prosthesis composite. Clin Orthop 394:192–200CrossRef
25.
go back to reference Biau DJ, Davis A, Vastel L, Tomeno B, Anract P (2008) Function, disability, and health-related quality of life after allograft-prosthesis composite reconstructions of the proximal femur. J Surg Oncol 97(3):210–215CrossRefPubMed Biau DJ, Davis A, Vastel L, Tomeno B, Anract P (2008) Function, disability, and health-related quality of life after allograft-prosthesis composite reconstructions of the proximal femur. J Surg Oncol 97(3):210–215CrossRefPubMed
26.
go back to reference Qu H, Guo W, Yang R, Tang X, Yan T, Li D et al (2015) Cortical strut bone grafting and long-stem endoprosthetic reconstruction following massive bone tumour resection in the lower limb. Bone Joint J 97-B(4):544–549 Qu H, Guo W, Yang R, Tang X, Yan T, Li D et al (2015) Cortical strut bone grafting and long-stem endoprosthetic reconstruction following massive bone tumour resection in the lower limb. Bone Joint J 97-B(4):544–549
Metadata
Title
Long-term functional and radiological outcomes of allograft hip prosthesis composite. A fourteen -year follow-up study
Authors
Arnaud Dubory
Eric Mascard
Méryl Dahan
Philippe Anract
Charles Court
Stéphane Boisgard
Brice Viard
Gilles Missenard
SOFCOT (The French Society of Orthopaedic and Trauma Surgery)
Publication date
01-07-2017
Publisher
Springer Berlin Heidelberg
Published in
International Orthopaedics / Issue 7/2017
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-016-3351-8

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