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Erschienen in: European Journal of Orthopaedic Surgery & Traumatology 4/2016

04.04.2016 | Original Article • HIP - MEGAPROSTHESIS

Reconstruction of the proximal femur with a modular resection prosthesis

verfasst von: Teresa Calabró, Rupert Van Rooyen, Ilaria Piraino, Elisa Pala, Giulia Trovarelli, Georgios N. Panagopoulos, Panayiotis D. Megaloikonomos, Andrea Angelini, Andreas F. Mavrogenis, Pietro Ruggieri

Erschienen in: European Journal of Orthopaedic Surgery & Traumatology | Ausgabe 4/2016

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Abstract

Background

Various megaprostheses are currently available for reconstruction of the proximal femur after tumor resection. This study evaluates the survival and complications of a modular megaprosthesis for reconstruction of the proximal femur.

Materials and methods

We studied the medical files of 109 tumor patients (age range 16–86 years) who underwent proximal femoral reconstruction with the MRP® megaprosthesis from 2002 to 2011. There were 70 patients with metastases, 34 patients with bone sarcomas, and five patients with hematological malignancies; 82 were primary and 27 were revision reconstructions. Mean follow-up was 2.5 years; 31 patients had a minimum five-year follow-up. We evaluated the survival and function of the patients, and the survival and complications of the megaprostheses.

Results

Survival was significantly higher for the patients with bone sarcomas compared to those with metastases and hematological malignancies. Mean MSTS functional score was similar between patients with bone sarcomas and those with hematological malignancies and metastases, and between patients with primary and those with revision reconstructions. Overall survival of the MRP® megaprostheses was 74 % at 5 and 9 years. Fourteen (13.6 %) major complications occurred at a mean period of 1.4 years (range 3 months to 4.5 years); these included infection (5.8 %), dislocation (3.9 %), local recurrence (2.9 %), and acetabular fracture (1 %).

Conclusion

MRP® megaprostheses are a valuable reconstruction option after tumor resection of the proximal femur.
Literatur
1.
Zurück zum Zitat Chandrasekar CR, Grimer RJ, Carter SR, Tillman RM, Abudu AT, Jeys LM (2011) Outcome of pathologic fractures of the proximal femur in nonosteogenic primary bone sarcoma. Eur J Surg Oncol 37(6):532–536CrossRefPubMed Chandrasekar CR, Grimer RJ, Carter SR, Tillman RM, Abudu AT, Jeys LM (2011) Outcome of pathologic fractures of the proximal femur in nonosteogenic primary bone sarcoma. Eur J Surg Oncol 37(6):532–536CrossRefPubMed
2.
Zurück zum Zitat Damron TA, Sim FH (2000) Surgical treatment for metastatic disease of the pelvis and the proximal end of the femur. Instr Course Lect 49:461–470PubMed Damron TA, Sim FH (2000) Surgical treatment for metastatic disease of the pelvis and the proximal end of the femur. Instr Course Lect 49:461–470PubMed
3.
Zurück zum Zitat Papagelopoulos PJ, Mavrogenis AF, Savvidou OD, Benetos IS, Galanis EC, Soucacos PN (2008) Pathological fractures in primary bone sarcomas. Injury 39(4):395–403CrossRefPubMed Papagelopoulos PJ, Mavrogenis AF, Savvidou OD, Benetos IS, Galanis EC, Soucacos PN (2008) Pathological fractures in primary bone sarcomas. Injury 39(4):395–403CrossRefPubMed
4.
Zurück zum Zitat Ruggieri P, Mavrogenis AF, Casadei R, Errani C, Angelini A, Calabro T, Pala E, Mercuri M (2010) Protocol of surgical treatment of long bone pathological fractures. Injury 41(11):1161–1167CrossRefPubMed Ruggieri P, Mavrogenis AF, Casadei R, Errani C, Angelini A, Calabro T, Pala E, Mercuri M (2010) Protocol of surgical treatment of long bone pathological fractures. Injury 41(11):1161–1167CrossRefPubMed
5.
Zurück zum Zitat Ahlmann ER, Menendez LR, Kermani C, Gotha H (2006) Survivorship and clinical outcome of modular endoprosthetic reconstruction for neoplastic disease of the lower limb. J Bone Joint Surg Br 88(6):790–795CrossRefPubMed Ahlmann ER, Menendez LR, Kermani C, Gotha H (2006) Survivorship and clinical outcome of modular endoprosthetic reconstruction for neoplastic disease of the lower limb. J Bone Joint Surg Br 88(6):790–795CrossRefPubMed
6.
Zurück zum Zitat Bernthal NM, Schwartz AJ, Oakes DA, Kabo JM, Eckardt JJ (2010) How long do endoprosthetic reconstructions for proximal femoral tumors last? Clin Orthop Relat Res 468(11):2867–2874CrossRefPubMedPubMedCentral Bernthal NM, Schwartz AJ, Oakes DA, Kabo JM, Eckardt JJ (2010) How long do endoprosthetic reconstructions for proximal femoral tumors last? Clin Orthop Relat Res 468(11):2867–2874CrossRefPubMedPubMedCentral
7.
Zurück zum Zitat Kabukcuoglu Y, Grimer RJ, Tillman RM, Carter SR (1999) Endoprosthetic replacement for primary malignant tumors of the proximal femur. Clin Orthop Relat Res 358:8–14PubMed Kabukcuoglu Y, Grimer RJ, Tillman RM, Carter SR (1999) Endoprosthetic replacement for primary malignant tumors of the proximal femur. Clin Orthop Relat Res 358:8–14PubMed
8.
Zurück zum Zitat Menendez LR, Ahlmann ER, Kermani C, Gotha H (2006) Endoprosthetic reconstruction for neoplasms of the proximal femur. Clin Orthop Relat Res 450:46–51CrossRefPubMed Menendez LR, Ahlmann ER, Kermani C, Gotha H (2006) Endoprosthetic reconstruction for neoplasms of the proximal femur. Clin Orthop Relat Res 450:46–51CrossRefPubMed
9.
Zurück zum Zitat Sharma S, Turcotte RE, Isler MH, Wong C (2007) Experience with cemented large segment endoprostheses for tumors. Clin Orthop Relat Res 459:54–59CrossRefPubMed Sharma S, Turcotte RE, Isler MH, Wong C (2007) Experience with cemented large segment endoprostheses for tumors. Clin Orthop Relat Res 459:54–59CrossRefPubMed
10.
Zurück zum Zitat Winkelmann W (2010) Reconstruction of the proximal femur with the MUTARS(R) system. Orthopade 39(10):942–948CrossRefPubMed Winkelmann W (2010) Reconstruction of the proximal femur with the MUTARS(R) system. Orthopade 39(10):942–948CrossRefPubMed
11.
Zurück zum Zitat Chandrasekar CR, Grimer RJ, Carter SR, Tillman RM, Abudu A, Buckley L (2009) Modular endoprosthetic replacement for tumours of the proximal femur. J Bone Joint Surg Br 91(1):108–112CrossRefPubMed Chandrasekar CR, Grimer RJ, Carter SR, Tillman RM, Abudu A, Buckley L (2009) Modular endoprosthetic replacement for tumours of the proximal femur. J Bone Joint Surg Br 91(1):108–112CrossRefPubMed
12.
Zurück zum Zitat Chandrasekar CR, Grimer RJ, Carter SR, Tillman RM, Abudu AT (2008) Modular endoprosthetic replacement for metastatic tumours of the proximal femur. J Orthop Surg Res 3:50CrossRefPubMedPubMedCentral Chandrasekar CR, Grimer RJ, Carter SR, Tillman RM, Abudu AT (2008) Modular endoprosthetic replacement for metastatic tumours of the proximal femur. J Orthop Surg Res 3:50CrossRefPubMedPubMedCentral
13.
Zurück zum Zitat Harvey N, Ahlmann ER, Allison DC, Wang L, Menendez LR (2012) Endoprostheses last longer than intramedullary devices in proximal femur metastases. Clin Orthop Relat Res 470(3):684–691CrossRefPubMedPubMedCentral Harvey N, Ahlmann ER, Allison DC, Wang L, Menendez LR (2012) Endoprostheses last longer than intramedullary devices in proximal femur metastases. Clin Orthop Relat Res 470(3):684–691CrossRefPubMedPubMedCentral
14.
Zurück zum Zitat Jacofsky DJ, Haidukewych GJ, Zhang H, Sim FH (2004) Complications and results of arthroplasty for salvage of failed treatment of malignant pathologic fractures of the hip. Clin Orthop Relat Res 427:52–56CrossRefPubMed Jacofsky DJ, Haidukewych GJ, Zhang H, Sim FH (2004) Complications and results of arthroplasty for salvage of failed treatment of malignant pathologic fractures of the hip. Clin Orthop Relat Res 427:52–56CrossRefPubMed
15.
Zurück zum Zitat Potter BK, Chow VE, Adams SC, Letson GD, Temple HT (2009) Endoprosthetic proximal femur replacement: metastatic versus primary tumors. Surg Oncol 18(4):343–349CrossRefPubMed Potter BK, Chow VE, Adams SC, Letson GD, Temple HT (2009) Endoprosthetic proximal femur replacement: metastatic versus primary tumors. Surg Oncol 18(4):343–349CrossRefPubMed
16.
Zurück zum Zitat Steensma M, Boland PJ, Morris CD, Athanasian E, Healey JH (2012) Endoprosthetic treatment is more durable for pathologic proximal femur fractures. Clin Orthop Relat Res 470(3):920–926CrossRefPubMedPubMedCentral Steensma M, Boland PJ, Morris CD, Athanasian E, Healey JH (2012) Endoprosthetic treatment is more durable for pathologic proximal femur fractures. Clin Orthop Relat Res 470(3):920–926CrossRefPubMedPubMedCentral
17.
Zurück zum Zitat Ashford RU, Hanna SA, Park DH, Pollock RC, Skinner JA, Briggs TW, Cannon SR (2010) Proximal femoral replacements for metastatic bone disease: financial implications for sarcoma units. Int Orthop 34(5):709–713CrossRefPubMedPubMedCentral Ashford RU, Hanna SA, Park DH, Pollock RC, Skinner JA, Briggs TW, Cannon SR (2010) Proximal femoral replacements for metastatic bone disease: financial implications for sarcoma units. Int Orthop 34(5):709–713CrossRefPubMedPubMedCentral
18.
Zurück zum Zitat Henderson ER, Groundland JS, Pala E, Dennis JA, Wooten R, Cheong D, Windhager R, Kotz RI, Mercuri M, Funovics PT, Hornicek FJ, Temple HT, Ruggieri P, Letson GD (2011) Failure mode classification for tumor endoprostheses: retrospective review of five institutions and a literature review. J Bone Joint Surg Am 93(5):418–429CrossRefPubMed Henderson ER, Groundland JS, Pala E, Dennis JA, Wooten R, Cheong D, Windhager R, Kotz RI, Mercuri M, Funovics PT, Hornicek FJ, Temple HT, Ruggieri P, Letson GD (2011) Failure mode classification for tumor endoprostheses: retrospective review of five institutions and a literature review. J Bone Joint Surg Am 93(5):418–429CrossRefPubMed
19.
Zurück zum Zitat Enneking WF, Spanier SS, Goodman MA (1980) A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res 153:106–120PubMed Enneking WF, Spanier SS, Goodman MA (1980) A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res 153:106–120PubMed
20.
Zurück zum Zitat Pala E, Mavrogenis AF, Angelini A, Henderson ER, Douglas Letson G, Ruggieri P (2013) Cemented versus cementless endoprostheses for lower limb salvage surgery. J BUON 18(2):496–503PubMed Pala E, Mavrogenis AF, Angelini A, Henderson ER, Douglas Letson G, Ruggieri P (2013) Cemented versus cementless endoprostheses for lower limb salvage surgery. J BUON 18(2):496–503PubMed
21.
Zurück zum Zitat 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 Relat Res 286:241–246PubMed 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 Relat Res 286:241–246PubMed
22.
Zurück zum Zitat Farid Y, Lin PP, Lewis VO, Yasko AW (2006) Endoprosthetic and allograft-prosthetic composite reconstruction of the proximal femur for bone neoplasms. Clin Orthop Relat Res 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 Relat Res 442:223–229CrossRefPubMed
23.
Zurück zum Zitat Gosheger G, Gebert C, Ahrens H, Streitbuerger A, Winkelmann W, Hardes J (2006) Endoprosthetic reconstruction in 250 patients with sarcoma. Clin Orthop Relat Res 450:164–171CrossRefPubMed Gosheger G, Gebert C, Ahrens H, Streitbuerger A, Winkelmann W, Hardes J (2006) Endoprosthetic reconstruction in 250 patients with sarcoma. Clin Orthop Relat Res 450:164–171CrossRefPubMed
24.
Zurück zum Zitat Finstein JL, King JJ, Fox EJ, Ogilvie CM, Lackman RD (2007) Bipolar proximal femoral replacement prostheses for musculoskeletal neoplasms. Clin Orthop Relat Res 459:66–75CrossRefPubMed Finstein JL, King JJ, Fox EJ, Ogilvie CM, Lackman RD (2007) Bipolar proximal femoral replacement prostheses for musculoskeletal neoplasms. Clin Orthop Relat Res 459:66–75CrossRefPubMed
25.
Zurück zum Zitat Manoso MW, Frassica DA, Lietman ES, Frassica FJ (2007) Proximal femoral replacement for metastatic bone disease. Orthopedics 30(5):384–388PubMed Manoso MW, Frassica DA, Lietman ES, Frassica FJ (2007) Proximal femoral replacement for metastatic bone disease. Orthopedics 30(5):384–388PubMed
26.
Zurück zum Zitat Mittermayer F, Krepler P, Dominkus M, Schwameis E, Sluga M, Heinzl H, Kotz R (2001) Long-term followup of uncemented tumor endoprostheses for the lower extremity. Clin Orthop Relat Res 388:167–177CrossRefPubMed Mittermayer F, Krepler P, Dominkus M, Schwameis E, Sluga M, Heinzl H, Kotz R (2001) Long-term followup of uncemented tumor endoprostheses for the lower extremity. Clin Orthop Relat Res 388:167–177CrossRefPubMed
27.
Zurück zum Zitat Zeegen EN, Aponte-Tinao LA, Hornicek FJ, Gebhardt MC, Mankin HJ (2004) Survivorship analysis of 141 modular metallic endoprostheses at early followup. Clin Orthop Relat Res 420:239–250CrossRefPubMed Zeegen EN, Aponte-Tinao LA, Hornicek FJ, Gebhardt MC, Mankin HJ (2004) Survivorship analysis of 141 modular metallic endoprostheses at early followup. Clin Orthop Relat Res 420:239–250CrossRefPubMed
28.
Zurück zum Zitat Rack H, Qazi JI (2006) Titanium alloys for biomedical applications. Mater Sci Eng C 26(8):1269–1277CrossRef Rack H, Qazi JI (2006) Titanium alloys for biomedical applications. Mater Sci Eng C 26(8):1269–1277CrossRef
29.
Zurück zum Zitat Ogilvie CM, Wunder JS, Ferguson PC, Griffin AM, Bell RS (2004) Functional outcome of endoprosthetic proximal femoral replacement. Clin Orthop Relat Res 426:44–48CrossRefPubMed Ogilvie CM, Wunder JS, Ferguson PC, Griffin AM, Bell RS (2004) Functional outcome of endoprosthetic proximal femoral replacement. Clin Orthop Relat Res 426:44–48CrossRefPubMed
30.
Zurück zum Zitat Gosheger G, Hillmann A, Lindner N, Rodl R, Hoffmann C, Burger H, Winkelmann W (2001) Soft tissue reconstruction of megaprostheses using a trevira tube. Clin Orthop Relat Res 393:264–271CrossRefPubMed Gosheger G, Hillmann A, Lindner N, Rodl R, Hoffmann C, Burger H, Winkelmann W (2001) Soft tissue reconstruction of megaprostheses using a trevira tube. Clin Orthop Relat Res 393:264–271CrossRefPubMed
31.
Zurück zum Zitat Chandrasekar CR, Grimer RJ, Carter SR, Tillman RM, Abudu A, Jeys LM (2009) Unipolar proximal femoral endoprosthetic replacement for tumour: the risk of revision in young patients. J Bone Joint Surg Br 91(3):401–404CrossRefPubMed Chandrasekar CR, Grimer RJ, Carter SR, Tillman RM, Abudu A, Jeys LM (2009) Unipolar proximal femoral endoprosthetic replacement for tumour: the risk of revision in young patients. J Bone Joint Surg Br 91(3):401–404CrossRefPubMed
32.
Zurück zum Zitat Unwin PS, Cannon SR, Grimer RJ, Kemp HB, Sneath RS, Walker PS (1996) Aseptic loosening in cemented custom-made prosthetic replacements for bone tumours of the lower limb. J Bone Joint Surg Br 78(1):5–13PubMed Unwin PS, Cannon SR, Grimer RJ, Kemp HB, Sneath RS, Walker PS (1996) Aseptic loosening in cemented custom-made prosthetic replacements for bone tumours of the lower limb. J Bone Joint Surg Br 78(1):5–13PubMed
33.
Zurück zum Zitat Mavrogenis AF, Pala E, Angelini A, Calabro T, Romagnoli C, Romantini M, Drago G, Ruggieri P (2015) Infected prostheses after lower-extremity bone tumor resection: clinical outcomes of 100 patients. Surg Infect (Larchmt) 16(3):267–275CrossRef Mavrogenis AF, Pala E, Angelini A, Calabro T, Romagnoli C, Romantini M, Drago G, Ruggieri P (2015) Infected prostheses after lower-extremity bone tumor resection: clinical outcomes of 100 patients. Surg Infect (Larchmt) 16(3):267–275CrossRef
34.
Zurück zum Zitat Mavrogenis AF, Papagelopoulos PJ, Coll-Mesa L, Pala E, Guerra G, Ruggieri P (2011) Infected tumor prostheses. Orthopedics 34(12):991–1000CrossRefPubMed Mavrogenis AF, Papagelopoulos PJ, Coll-Mesa L, Pala E, Guerra G, Ruggieri P (2011) Infected tumor prostheses. Orthopedics 34(12):991–1000CrossRefPubMed
35.
Zurück zum Zitat Mavrogenis AF, Ruggieri P, Mercuri M, Papagelopoulos PJ (2008) Megaprosthetic reconstruction for malignant bone tumors: complications and outcomes. J Long Term Eff Med Implants 18(3):239–251CrossRefPubMed Mavrogenis AF, Ruggieri P, Mercuri M, Papagelopoulos PJ (2008) Megaprosthetic reconstruction for malignant bone tumors: complications and outcomes. J Long Term Eff Med Implants 18(3):239–251CrossRefPubMed
36.
Zurück zum Zitat Mavrogenis AF, Mitsiokapa EA, Sakellariou VI, Tzanos G, Papagelopoulos PJ (2011) Functional and radiographic outcome after tumor limb salvage surgery using STANMORE megaprostheses. J BUON 16(2):353–360PubMed Mavrogenis AF, Mitsiokapa EA, Sakellariou VI, Tzanos G, Papagelopoulos PJ (2011) Functional and radiographic outcome after tumor limb salvage surgery using STANMORE megaprostheses. J BUON 16(2):353–360PubMed
Metadaten
Titel
Reconstruction of the proximal femur with a modular resection prosthesis
verfasst von
Teresa Calabró
Rupert Van Rooyen
Ilaria Piraino
Elisa Pala
Giulia Trovarelli
Georgios N. Panagopoulos
Panayiotis D. Megaloikonomos
Andrea Angelini
Andreas F. Mavrogenis
Pietro Ruggieri
Publikationsdatum
04.04.2016
Verlag
Springer Paris
Erschienen in
European Journal of Orthopaedic Surgery & Traumatology / Ausgabe 4/2016
Print ISSN: 1633-8065
Elektronische ISSN: 1432-1068
DOI
https://doi.org/10.1007/s00590-016-1764-0

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