Endoprosthetic replacement of the distal femur for bone tumours - Long-term results
Endoprosthetic replacement of the distal femur for bone tumours - Long-term results
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DOI：
10.1302/0301-620x.89b4.18631
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发表时间：
2007-04-01
影响因子：
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通讯作者：
Grimer, R. J.
中科院分区：
文献类型：
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作者：
Myers, G. J. C.;Abudu, A. T.;Grimer, R. J.
我们调查了设计的改进是否改变了肿瘤切除后接受股骨远端假体内置换术的患者的结局。使用预期数据库、植入物设计审查和病例记录记录了植入物的存活率和‘维修’程序。总共有335名患者接受了股骨远端置换，162名患者接受了固定铰链设计，173名患者接受了旋转铰链设计。患者的中位年龄为24岁(四分位数范围为17至48岁)。共有192名患者存活，平均随访12年(5至30年)。由于任何原因进行修订的风险在5年时为17%，10年时为33%，20年时为58%。无菌性松动是固定铰链膝翻修的主要原因，而旋转铰链式假体最常见的原因是感染和柄骨折。10年后，固定铰链膝无菌松动的翻修风险为35%，然而，带羟基磷灰石项圈的旋转铰链膝已经取代了固定铰链膝。使用旋转铰链假体后，因任何原因翻修的总风险降低了52%。股骨远端假体设计的改进显著减少了翻修手术的需要，但感染仍然是一个严重的问题。我们认为骨水泥型旋转铰链假体和羟基磷灰石项圈提供了假体长期存活的最好机会。
We investigated whether improvements in design have altered the outcome for patients undergoing endoprosthetic replacement of the distal femur after resection of a tumour. Survival of the implant and 'servicing' procedures have been documented using a prospective database, review of the design of the implant and case records. In total, 335 patients underwent a distal femoral replacement, 162 having a fixed-hinge design and 173 a rotating-hinge. The median age of the patients was 24 years (interquartile range 17 to 48).A total of 192 patients remained alive with a mean follow-up of 12 years (5 to 30). The risk of revision for any reason was 17% at five years, 33% at ten years and 58% at 20 years. Aseptic loosening was the main reason for revision of the fixed-hinge knees while infection and fracture of the stem were the most common for the rotating-hinge implant. The risk of revision for aseptic loosening was 35% at ten years with the fixed-hinge knee, which has, however, been replaced by the rotating-hinge knee with a hydroxyapatite collar. The overall risk of revision for any reason fell by 52% when the rotating-hinge implant was used.Improvements in the design of distal femoral endoprostheses have significantly decreased the need for revision operations, but infection remains a serious problem. We believe that a cemented, rotating-hinge prosthesis with a hydroxyapatite collar offers the best chance of long-term survival of the prosthesis.