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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2017

Open Access 01-12-2017 | Research article

Distal femoral replacement with the MML system: a single center experience with an average follow-up of 86 months

Authors: Andreas Toepfer, Norbert Harrasser, Paul-Ruben Schwarz, Florian Pohlig, Ulrich Lenze, Heinrich M. L. Mühlhofer, Ludger Gerdesmeyer, Ruediger von Eisenhart-Rothe, Christian Suren

Published in: BMC Musculoskeletal Disorders | Issue 1/2017

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Abstract

Background

The aim of this study was to compare the functional outcomes and complication rates after distal femoral replacement (DFR) performed with the modular Munich-Luebeck (MML) modular prosthesis (ESKA/Orthodynamics, Luebeck, Germany) in patients being treated for malignant disease or failed total knee arthroplasty.

Methods

A retrospective review of patient charts and a functional investigation (involving Musculoskeletal Tumor Society Score [MSTS], American Knee Society Score [AKSS], Oxford Knee Score [OKS], Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], Toronto Extremity Salvage Score [TESS], the 12-Item Short-Form [SF-12] Health Survey, and a failure classification system developed by Henderson et al.) of DFR cases from 2002 to 2015 were conducted. The indications for DFR were malignant tumor resection in the femur (n = 20, group A) or failure of revision total knee arthroplasty without a history of malignant disease (n = 16, group B).

Results

One-hundred and twenty-nine patients were treated during the study period. Of these, 82 were analyzed for complications and implant-survival. Further, 36 patients were available for functional assessment after a mean follow-up of 86 months (range: 24–154). There were 75 complications in total. The overall failure rate for DFR was 64.6% (53/82 patients). The most common failure mechanisms were type III (mechanical failure), followed by type I (soft tissue) and type II (aseptic loosening). The mean MSTS score (out of 30) was 17 for group A and 12 for group B. All the clinical outcome scores revealed an age-dependent deterioration of function.

Conclusion

DFR is an established procedure to restore distal femoral integrity. However, complication rates are high. Post-procedure functionality depends mainly on the patient’s age at initial reconstruction.
Literature
1.
Lombardi Jr AV, Berend KR. The shattered femur: radical solution options. J Arthroplasty. 2006;21(4 Suppl 1):107–11.CrossRefPubMed
2.
Pennekamp PH, Wirtz DC, Durr HR. [Proximal and total femur replacement]. Oper Orthop Traumatol. 2012;24(3):215–26.CrossRefPubMed
3.
Schwartz AJ, Kabo JM, Eilber FC, Eilber FR, Eckardt JJ. Cemented distal femoral endoprostheses for musculoskeletal tumor: improved survival of modular versus custom implants. Clin Orthop Relat Res. 2010;468(8):2198–210.CrossRefPubMed
4.
Ruggieri P, Mavrogenis AF, Pala E, Abdel-Mota’al M, Mercuri M. Long term results of fixed-hinge megaprostheses in limb salvage for malignancy. Knee. 2012;19(5):543–9.CrossRefPubMed
5.
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
6.
Myers GJ, Abudu AT, Carter SR, Tillman RM, Grimer RJ. Endoprosthetic replacement of the distal femur for bone tumours: long-term results. J Bone Joint Surg (Br). 2007;89(4):521–6.CrossRef
7.
Morgan HD, Cizik AM, Leopold SS, Hawkins DS, Conrad 3rd EU. Survival of tumor megaprostheses replacements about the knee. Clin Orthop Relat Res. 2006;450:39–45.CrossRefPubMed
8.
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
9.
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;438:71–9.CrossRefPubMed
10.
Coathup MJ, Batta V, Pollock RC, Aston WJ, Cannon SR, Skinner JA, Briggs TW, Unwin PS, Blunn GW. Long-term survival of cemented distal femoral endoprostheses with a hydroxyapatite-coated collar: a histological study and a radiographic follow-up. J Bone Joint Surg Am. 2013;95(17):1569–75.CrossRefPubMed
11.
Bus MP, van de Sande MA, Fiocco M, Schaap GR, Bramer JA, Dijkstra PD. Erratum to: what Are the long-term results of MUTARS(R) modular endoprostheses for reconstruction of tumor resection of the distal femur and proximal tibia? Clin Orthop Relat Res. 2017;475(3):922.CrossRefPubMed
12.
Bickels J, Wittig JC, Kollender Y, Henshaw RM, Kellar-Graney KL, Meller I, Malawer MM. Distal femur resection with endoprosthetic reconstruction: a long-term followup study. Clin Orthop Relat Res. 2002;400:225–35.CrossRef
13.
Biau D, Faure F, Katsahian S, Jeanrot C, Tomeno B, Anract P. Survival of total knee replacement with a megaprosthesis after bone tumor resection. J Bone Joint Surg Am. 2006;88(6):1285–93.PubMed
14.
Batta V, Coathup MJ, Parratt MT, Pollock RC, Aston WJ, Cannon SR, Skinner JA, Briggs TW, Blunn GW. Uncemented, custom-made, hydroxyapatite-coated collared distal femoral endoprostheses: up to 18 years’ follow-up. Bone Joint J. 2014;96-B(2):263–9.CrossRefPubMed
15.
Plotz W, Rechl H, Burgkart R, Messmer C, Schelter R, Hipp E, Gradinger R. Limb salvage with tumor endoprostheses for malignant tumors of the knee. Clin Orthop Relat Res. 2002;405:207–15.CrossRef
16.
Gerdesmeyer L, Topfer A, Kircher J, Grundei H, Diehl P. [The modular MML revision system in knee revision and tumor arthroplasty]. Orthopade. 2006;35(9):975–81.CrossRefPubMed
17.
Henderson ER, O’Connor MI, Ruggieri P, Windhager R, Funovics PT, Gibbons CL, Guo W, Hornicek FJ, Temple HT, Letson GD. Classification of failure of limb salvage after reconstructive surgery for bone tumours : a modified system Including biological and expandable reconstructions. Bone Joint J. 2014;96-B(11):1436–40.CrossRefPubMed
18.
Ahlmann ER, Menendez LR, Kermani C, Gotha H. Survivorship and clinical outcome of modular endoprosthetic reconstruction for neoplastic disease of the lower limb. J Bone Joint Surg (Br). 2006;88(6):790–5.CrossRef
19.
Guo W, Ji T, Yang R, Tang X, Yang Y. Endoprosthetic replacement for primary tumours around the knee: experience from Peking University. J Bone Joint Surg (Br). 2008;90(8):1084–9.CrossRef
20.
Shehadeh A, Noveau J, Malawer M, Henshaw R. Late complications and survival of endoprosthetic reconstruction after resection of bone tumors. Clin Orthop Relat Res. 2010;468(11):2885–95.CrossRefPubMedPubMedCentral
21.
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;450:52–9.CrossRefPubMed
22.
Gosheger G, Gebert C, Ahrens H, Streitbuerger A, Winkelmann W, Hardes J. Endoprosthetic reconstruction in 250 patients with sarcoma. Clin Orthop Relat Res. 2006;450:164–71.CrossRefPubMed
23.
Healey JH, Morris CD, Athanasian EA, Boland PJ. Compress knee arthroplasty has 80% 10-year survivorship and novel forms of bone failure. Clin Orthop Relat Res. 2013;471(3):774–83.CrossRefPubMed
24.
Pala E, Henderson ER, Calabro T, Angelini A, Abati CN, Trovarelli G, Ruggieri P. Survival of current production tumor endoprostheses: complications, functional results, and a comparative statistical analysis. J Surg Oncol. 2013;108(6):403–8.CrossRefPubMed
25.
Bus MP, van de Sande MA, Fiocco M, Schaap GR, Bramer JA, Dijkstra PD. What Are the Longterm Results of MUTARS® Modular Endoprostheses for Reconstruction of Tumor Resection of the Distal Femur and Proximal Tibia? Clin Orthop Relat Res. 2015. doi:10.​1007/​s11999-015-4644-8.
26.
Back DL, David L, Hilton A, Blunn G, Briggs TW, Cannon SR. The SMILES prosthesis in salvage revision knee surgery. Knee. 2008;15(1):40–4.CrossRefPubMed
27.
Barrack RL, Lyons TR, Ingraham RQ, Johnson JC. The use of a modular rotating hinge component in salvage revision total knee arthroplasty. J Arthroplasty. 2000;15(7):858–66.CrossRefPubMed
28.
Barrack RL. Evolution of the rotating hinge for complex total knee arthroplasty. Clin Orthop Relat Res. 2001;(392):292–9.CrossRef
29.
Berend KR, Lombardi AV, Jr. Distal femoral replacement in nontumor cases with severe bone loss and instability. Clin Orthop Relat Res. 2009;467(2):485–92.CrossRefPubMed
30.
Jones RE, Barrack RL, Skedros J. Modular, mobile-bearing hinge total knee arthroplasty. Clin Orthop Relat Res. 2001;(392):306–14.CrossRef
31.
Jones RE, Skedros JG, Chan AJ, Beauchamp DH, Harkins PC. Total knee arthroplasty using the S-ROM mobile-bearing hinge prosthesis. J Arthroplasty. 2001;16(3):279–87.CrossRefPubMed
32.
Lombardi AV, Jr., Mallory TH, Eberle RW, Adams JB. Rotating hinge prosthesis in revision total knee arthroplasty: indications and results. Surg Technol Int. 1997;6:379–82.PubMed
33.
Petrou G, Petrou H, Tilkeridis C, Stavrakis T, Kapetsis T, Kremmidas N, Gavras M. Medium-term results with a primary cemented rotating-hinge total knee replacement. A 7- to 15-year follow-up. J Bone Joint Surg Br. 2004;86(6):813–7.CrossRefPubMed
34.
Pour AE, Parvizi J, Slenker N, Purtill JJ, Sharkey PF. Rotating hinged total knee replacement: use with caution. J Bone Joint Surg Am. 2007;89(8):1735–41.PubMed
35.
Pradhan NR, Bale L, Kay P, Porter ML. Salvage revision total knee replacement using the Endo-Model rotating hinge prosthesis. Knee. 2004;11(6):469–73.CrossRefPubMed
36.
Rand JA, Chao EY, Stauffer RN. Kinematic rotating-hinge total knee arthroplasty. J Bone Joint Surg Am. 1987;69(4):489–97.CrossRefPubMed
37.
Springer BD, Hanssen AD, Sim FH, Lewallen DG. The kinematic rotating hinge prosthesis for complex knee arthroplasty. Clin Orthop Relat Res. 2001;(392):283–91.CrossRef
38.
Springer BD, Sim FH, Hanssen AD, Lewallen DG: The modular segmental kinematic rotating hinge for nonneoplastic limb salvage. Clin Orthop Relat Res. 2004;(421):181–7.CrossRef
39.
Utting MR, Newman JH. Customised hinged knee replacements as a salvage procedure for failed total knee arthroplasty. Knee. 2004;11(6):475–9.CrossRefPubMed
40.
Westrich GH, Mollano AV, Sculco TP, Buly RL, Laskin RS, Windsor R. Rotating hinge total knee arthroplasty in severly affected knees. Clin Orthop Relat Res. 2000;(379):195–208.CrossRef
Metadata
Title
Distal femoral replacement with the MML system: a single center experience with an average follow-up of 86 months
Authors
Andreas Toepfer
Norbert Harrasser
Paul-Ruben Schwarz
Florian Pohlig
Ulrich Lenze
Heinrich M. L. Mühlhofer
Ludger Gerdesmeyer
Ruediger von Eisenhart-Rothe
Christian Suren
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2017
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-017-1570-9

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