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World Journal of Surgical Oncology
Published in: World Journal of Surgical Oncology 1/2023

Open Access 01-12-2023 | giant cell tumor | Research

Aseptic loosening of tumor prostheses in distal femur after revision surgery: a retrospective study

Authors: Ziming Li, Xiuchun Yu, Ming Xu, Kai Zheng, Ziwei Hou, Zukang Miao, Yanshun Sun

Published in: World Journal of Surgical Oncology | Issue 1/2023

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Abstract

Background

Tumor prostheses of the distal femur after revision surgery is associated with high rates of aseptic loosening, which has introduced great challenges to the survival of patients, but only a few studies have evaluated their X-ray imaging. The purpose of this study was to analyze the risk factors for recurrence of aseptic loosening and make recommendations to reduce the incidence of aseptic loosening after revision surgery of tumor prostheses in the distal femur.

Method

A retrospective analysis was performed on 23 patients who had revision surgery for distal femur prostheses due to aseptic loosening between June 2002 and June 2021. They were divided into two groups based on the condition of the prostheses after revision surgery: loosening group (9 patients) and control group (14 patients). Following the initial replacement, the length and diameter of the prosthetic intramedullary stem were measured through the standard full-length anteroposterior X-ray imaging of both lower limbs. The osteotomy length, femoral length and diameter, femoral intramedullary stem diameter, hip-knee-ankle angle (HKAA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and so on were measured as well. Following that, statistical analysis was performed.

Results

Patients in the loosening group had statistically significant differences in the ratio of prostheses length to femur length (71.89 ± 6.62) and the ratio of intramedullary stem diameter to femoral diameter (25.50 ± 6.90) (P < 0.05), when compared to the control group. The HKAA (175.58 ± 2.78), mLDFA (94.42 ± 2.57), and the deviation angle between the lower limb alignment and the tibial prostheses force line (2.23 ± 1.09) in the loosening group were significantly different from those in the control group (P < 0.05) on postoperative radiographs of the entire length of the lower limbs. The lowest score in intramedullary manubrium I indicated less osteolysis, while the highest score in intramedullary manubrium III indicated the most serious osteolysis, and the difference was statistically significant (P < 0.05).

Conclusions

Our study suggests that the use of longer and thicker intramedullary stems can effectively decrease the occurrence of aseptic loosening. Additionally, it is important to avoid using the original prostheses and reconstruct the standard line of lower limb force to further reduce the incidence of aseptic loosening. It is crucial to closely monitor the distal segment of the intramedullary stem for osteolysis after surgery.
Literature
1.
Pala E, Trovarelli G, Calabro T, Angelini A, Abati CN, Ruggieri P. Survival of modern knee tumor megaprostheses: failures, functional results, and a comparative statistical analysis. Clin Orthop Relat Res. 2015;473(3):891–9.CrossRefPubMed
2.
Li JJ, Tian DM, Yang L, Zhang JY, Hu YC. Influence of a metaphyseal sleeve on the stress-strain state of a bone-tumor implant system in the distal femur: an experimental and finite element analysis. J Orthop Surg Res. 2020;15(1):589.CrossRefPubMedPubMedCentral
3.
Baptista PP, Bannwart CL, Batista FA, Bellan DG. Proximal tibial reconstruction with auto transplantation of the fibular growth plate: two case reports, describing the surgical technique. Springerplus. 2016;5:490.CrossRefPubMedPubMedCentral
4.
Kamal AF, Muhamad A. Outcomes of en bloc resection followed by reconstruction of giant cell tumor around knee and distal radius. A case series. Ann Med Surg (Lond). 2020;49:61–6.CrossRefPubMed
5.
Hindiskere S, Staals E, Donati DM, Manfrini M. What is the survival of the telescope allograft technique to augment a short proximal femur segment in children after resection and distal femur endoprosthesis reconstruction for a bone sarcoma? Clin Orthop Relat Res. 2021;479(8):1780–90.CrossRefPubMedPubMedCentral
6.
Sundfeldt M, Carlsson LV, Johansson CB, Thomsen P, Gretzer C. Aseptic loosening, not only a question of wear: a review of different theories. Acta Orthop. 2006;77(2):177–97.CrossRefPubMed
7.
Kinkel S, Lehner B, Kleinhans JA, Jakubowitz E, Ewerbeck V, Heisel C. Medium to long-term results after reconstruction of bone defects at the knee with tumor endoprostheses. J Surg Oncol. 2010;101(2):166–9.PubMed
8.
Henderson ER, Groundland JS, Pala E, Dennis JA, Wooten R, Cheong D, et al. Failure mode classification for tumor endoprostheses: retrospective review of five institutions and a literature review. J Bone Joint Surg Am. 2011;93(5):418–29.CrossRefPubMed
9.
Zhang C, Hu J, Zhu K, Cai T, Ma X. Survival, complications and functional outcomes of cemented megaprostheses for high-grade osteosarcoma around the knee. Int Orthop. 2018;42(4):927–38.CrossRefPubMed
10.
Staats K, Vertesich K, Sigmund IK, Sosa B, Kaider A, Funovics PT, et al. Does a competing risk analysis show differences in the cumulative incidence of revision surgery between patients with oncologic and non-oncologic conditions after distal femur replacement? Clin Orthop Relat Res. 2020;478(5):1062–73.CrossRefPubMed
11.
El Ghoneimy AM, Shehab AM, Farid N. What is the cumulative incidence of revision surgery and what are the complications associated with stemmed cementless nonextendable endoprostheses in patients 18 years or younger with primary bone sarcomas about the knee. Clin Orthop Relat Res. 2022;480(7):1329–38.CrossRefPubMed
12.
Theil C, Roder J, Gosheger G, Deventer N, Dieckmann R, Schorn D, et al. What is the likelihood that tumor endoprostheses will experience a second complication after first revision in patients with primary malignant bone tumors and what are potential risk factors? Clin Orthop Relat Res. 2019;477(12):2705–14.CrossRefPubMedPubMedCentral
13.
Zan P, Wang H, Cai Z, Shen J, Sun W. Revision surgeries for tumor endoprostheses around the knee joint: a mid-long-term follow-up of 20 cases. World J Surg Oncol. 2022;20(1):76.CrossRefPubMedPubMedCentral
14.
Haijie L, Dasen L, Tao J, Yi Y, Xiaodong T, Wei G. Implant survival and complication profiles of endoprostheses for treating tumor around the knee in adults: a systematic review of the literature over the past 30 years. J Arthroplasty. 2018;33(4):1275-87 e3.CrossRefPubMed
15.
Innocenti M, Muratori F, Foschi L, et al. Salvage of limb salvage in oncological reconstructions of the lower limb with megaprosthesis: how much to push the boundaries? Arch Orthop Trauma Surg. 2023;143(2):763–71.CrossRefPubMed
16.
Pala E, Henderson ER, Calabro T, Angelini A, Abati CN, Trovarelli G, et al. Survival of current production tumor endoprostheses: complications, functional results, and a comparative statistical analysis. J Surg Oncol. 2013;108(6):403–8.CrossRefPubMed
17.
Yu XC, Xu M, Song RX, Fu ZH, Liu XP. Long-term outcome of giant cell tumors of bone around the knee treated by en bloc resection of tumor and reconstruction with prosthesis. Orthop Surg. 2010;2(3):211–7.CrossRefPubMedPubMedCentral
18.
Zhang HR, Zhang JY, Yang XG, Qiao RQ, Li JK, Ren ZP, et al. The effects of length of femoral stem on aseptic loosening following cemented distal femoral endoprosthetic replacement in tumour surgery. Int Orthop. 2020;44(7):1427–33.CrossRefPubMed
19.
Geiger EJ, Arnold MT, Hart CM, Greig D, Trikha R, Sekimura T, et al. What is the long-term survivorship of primary and revision cemented distal femoral replacements for limb salvage of patients with sarcoma? Clin Orthop Relat Res. 2023;481(3):460–71.CrossRefPubMed
20.
Piakong P, Kiatisevi P, Yau R, Trovarelli G, Lam YL, Joyce D, et al. What is the 10-year survivorship of cemented distal femoral endoprostheses for tumor reconstructions and what radiographic features are associated with survival? Clin Orthop Relat Res. 2020;478(11):2573–81.CrossRefPubMedPubMedCentral
21.
Hou ZW, Xu M, Zheng K, Yu XC. Classification and reconstruction of femoral bone defect in the revision of aseptic loosening of distal femoral endoprostheses: a 10-year multicenter retrospective analysis. BMC Musculoskelet Disord. 2022;23(1):935.CrossRefPubMedPubMedCentral
22.
23.
Marmotti A, Messina D, Cykowska A, Beltramo C, Bellato E, Colombero D, et al. Periprosthetic osteolysis: a narrative review. J Biol Regul Homeost Agents. 2020;34(4 Suppl. 3):405–17. Congress of the Italian Orthopaedic Research Society.PubMed
24.
Willert HG, Bertram H, Buchhorn GH. Osteolysis in alloarthroplasty of the hip. The role of ultra-high molecular weight polyethylene wear particles. Clin Orthop Relat Res. 1990;258:95–107.CrossRef
25.
Heyberger C, Auberger G, Babinet A, Anract P, Biau DJ. Patients with revision modern megaprostheses of the distal femur have improved disease-specific and health-related outcomes compared to those with primary replacements. J Knee Surg. 2018;31(9):822–6.CrossRefPubMed
26.
Avedian RS, Goldsby RE, Kramer MJ, O’Donnell RJ. Effect of chemotherapy on initial compressive osseointegration of tumor endoprostheses. Clin Orthop Relat Res. 2007;459:48–53.CrossRefPubMed
27.
Pugh LR, Clarkson PW, Phillips AE, Biau DJ, Masri BA. Tumor endoprosthesis revision rates increase with peri-operative chemotherapy but are reduced with the use of cemented implant fixation. J Arthroplasty. 2014;29(7):1418–22.CrossRefPubMed
28.
Bergin PF, Noveau JB, Jelinek JS, Henshaw RM. Aseptic loosening rates in distal femoral endoprostheses: does stem size matter? Clin Orthop Relat Res. 2012;470(3):743–50.CrossRefPubMed
29.
Schulze C, Lochner K, Jonitz A, Lenz R, Duettmann O, Hansmann D, et al. Cell viability, collagen synthesis and cytokine expression in human osteoblasts following incubation with generated wear particles using different bone cements. Int J Mol Med. 2013;32(1):227–34.CrossRefPubMed
30.
Gallo J, Havranek V, Zapletalova J, Lostak J. Male gender, Charnley class C, and severity of bone defects predict the risk for aseptic loosening in the cup of ABG I hip arthroplasty. BMC Musculoskelet Disord. 2010;11:243.CrossRefPubMedPubMedCentral
31.
Tang W, Xiao L, Ge G, Zhong M, Zhu J, Qin J, et al. Puerarin inhibits titanium particle-induced osteolysis and RANKL-induced osteoclastogenesis via suppression of the NF-kappaB signaling pathway. J Cell Mol Med. 2020;24(20):11972–83.CrossRefPubMedPubMedCentral
32.
Unwin PS, Cobb JP, Walker PS. Distal femoral arthroplasty using custom-made prostheses. The first 218 cases. J Arthroplasty. 1993;8(3):259–68.CrossRefPubMed
33.
Stevenson JD, Wigley C, Burton H, Ghezelayagh S, Morris G, Evans S, et al. Minimising aseptic loosening in extreme bone resections: custom-made tumour endoprostheses with short medullary stems and extra-cortical plates. Bone Joint J. 2017;99-B(12):1689–95.CrossRefPubMed
34.
Ozger H, Alpan B, Salduz A, Gurkan V, Sungur M, Valiyev N, et al. Mid-term implant survival, functional and radiological results and mechanical complications of mega-prosthetic reconstruction around the knee with the PENTA(R) system. Arch Orthop Trauma Surg. 2022;142(9):2323–33.CrossRefPubMed
35.
Ihle M, Mai S, Pfluger D, Siebert W. The results of the titanium-coated RM acetabular component at 20 years: a long-term follow-up of an uncemented primary total hip replacement. J Bone Joint Surg Br. 2008;90(10):1284–90.CrossRefPubMed
36.
Vijayvargiya M, Shetty V, Makwana K, Suri HS. Mid-term results of an uncemented tapered femoral stem and various factors affecting survivorship. J Clin Orthop Trauma. 2019;10(2):368–73.CrossRefPubMed
37.
Whelan JS, Jinks RC, McTiernan A, Sydes MR, Hook JM, Trani L, et al. Survival from high-grade localised extremity osteosarcoma: combined results and prognostic factors from three European Osteosarcoma Intergroup randomised controlled trials. Ann Oncol. 2012;23(6):1607–16.CrossRefPubMed
38.
Hirose S, Otsuka H, Morishima T, Sato K. Outcomes of Charnley total hip arthroplasty using improved cementing with so-called second- and third-generation techniques. J Orthop Sci. 2012;17(2):118–23.CrossRefPubMed
39.
Sasaki K, Pinitlertsakun J, Nualnim P, Guerra G, Sansook Y, Kaewdoung S, et al. The reversible adjustable coupling: a lightweight and low-cost alignment component for the lower limb prosthesis. J Rehabil Assist Technol Eng. 2017;4:2055668317706427.PubMedPubMedCentral
Metadata
Title
Aseptic loosening of tumor prostheses in distal femur after revision surgery: a retrospective study
Authors
Ziming Li
Xiuchun Yu
Ming Xu
Kai Zheng
Ziwei Hou
Zukang Miao
Yanshun Sun
Publication date
01-12-2023
Publisher
BioMed Central
Published in
World Journal of Surgical Oncology / Issue 1/2023
Electronic ISSN: 1477-7819
DOI
https://doi.org/10.1186/s12957-023-03047-0

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