Midterm Outcome after Mega-Prosthesis Implanted in Patients with Bony Defects in Cases of Revision Compared to Patients with Malignant Tumors

doi:10.1016/j.arth.2015.04.002

The Journal of Arthroplasty

Volume 30, Issue 9, September 2015, Pages 1592-1596

https://doi.org/10.1016/j.arth.2015.04.002 Get rights and content

Abstract

Use of mega-prostheses is a common option for the treatment of patients with malignant tumors as well as in patients with large osseous defects at the time of revision surgery. No studies have compared the two groups to determine whether there is a relative difference in clinical outcomes. We performed a midterm-outcome-study to evaluate our results in these two patient populations. Deep infection was found more often in our revision group (29.5% vs. 9.1%), however no significant differences in WOMAC-results could be found between the two groups. Surgeons should recognize the high complication rate as well as the differences in results using mega-prostheses in these two distinct groups of patients.

Section snippets

Patients

From 2005–2010 a total number of 68 patients (37 men and 31 women) with a median age of 70 years (interquartile ranges 59–77 years, minimum age 10 years and maximum age 98 years) received a mega-prosthesis. After receiving approval from the ethics committee, patients were included after giving written informed consent.

44 of these patients were “revision-patients” with large bony defects, 16 patients received the mega-prosthesis due to a malignant tumor and six patients underwent a

Theory/Calculation

The purpose of the study was to determine whether there are differences in outcome in patients receiving large implants due to a malignant tumor compared to patients getting their implant after several revisions or due to a complex periprosthetic fracture. Since the patients in the “tumor group” were younger and had less comorbidities, we expected a better patient-reported outcome in this group despite the loss of muscle tissue due to compartment-resection.

Results

The following complications were observed:

(1)
Wound disorders
(2)
Deep infections
(3)
Luxation
(4)
Breakage of prosthesis
(5)
Periprosthetic fracture
(6)
Aseptic loosening

Table 1 gives the number and percentage of patients affected by the above complications.

Deep infection was the most commonly observed complication and occurred in 15 cases at a median follow-up time of 10 months after implantation (interquartile range (IQR) 0–26 month, and at a maximum of 49 months). Bacteria-cultures from intraoperative soft

Discussion

As expected we observed a high rate of complications, especially in the revision-group, which is in accordance with the up to 41% of infections mentioned in other publications [13]. The infection rate was higher in the revision-group (29.5% compared to 9.1%). That was not surprising, since seven of the patients from the revision-group had a persistent or recurrent infection. Moreover, there might have been patients with an occult low grade infection in the revision-group. The highest rate of

Acknowledgement

This study was not funded by any grant or institution. Special thanks to Ms. Kirsten Zettersten for revising the manuscript with respect to the English language as native-speaker.

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: One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2015.04.002.

: Institutional review board approval was given (University of Frankfurt/Main) and all patients have given written informed consent.

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Midterm Outcome after Mega-Prosthesis Implanted in Patients with Bony Defects in Cases of Revision Compared to Patients with Malignant Tumors

Abstract

Section snippets

Patients

Theory/Calculation

Results

Discussion

Acknowledgement

Arch Phys Med Rehabil

Infektionsmanagement bei Megaimplantaten

Orthopaede

Salvage of infected tumor prostheses

Curr Orthop Pract

Function after amputation, arthrodesis or arthroplasty for tumors about the knee

J Bone Joint Surg Am

The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology

J Natl Cancer Inst

A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system

Clin Orthop Relat Res

Limb salvage compared with amputation for osteosarcoma of the distal end of the femur. A long-term oncological, functional and quality-of-life study

J Bone Joint Surg Am