Comparison Between Uncemented and Cemented Fixation for the Tibial Component in Distal Femoral Replacement: a Clinical and Radiological Study

Overview

Journal Int Orthop

Specialty Orthopedics

Date 2018 Feb 26

PMID 29478210

Citations 2

Authors

Haijie Liang

Wei Guo

Rongli Yang

Xiaodong Tang

Taiqiang Yan

Affiliations

Soon will be listed here.

Abstract

Purposes: We performed a retrospective, cohort study to compare uncemented tibial fixation with cemented tibial fixation in distal femoral replacement (DFR).

Methods: Sixty-two cases with uncemented tibial fixation and 58 cases with cemented tibial fixation were included. Inter-group comparisons were performed for baseline data, oncological and prosthetic outcomes, and changes of cortical thickness of tibial diaphysis. Radiological signs of bone adaptations around the uncemented tibial stem were identified through evaluation of plain films during follow-up.

Results: Uncemented tibial fixation shortened operative duration by 26 minutes, achieved equivalent oncological and prosthetic outcomes, and helped preserve anterior cortical thickness of tibia compared with the cemented counterpart after a mean follow-up of over 40 months. Radiological signs of osseointegration and reactive line were observed in 64.3 and 17.9% cases with uncemented tibial fixation. The two signs had different patterns of distribution and no significant predisposing factors could be identified.

Conclusions: For DFR, the uncemented tibial fixation was safe and effective in functional reconstruction and in preservation of anterior cortex of tibial diaphysis. It could achieve osseointegration and might permit adaptive micromotion of the tibial stem post-operatively.

Level Of Evidence: level III Therapeutic.

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References

Lonner J, Klotz M, Levitz C, Lotke P . Changes in bone density after cemented total knee arthroplasty: influence of stem design. J Arthroplasty. 2001; 16(1):107-11. DOI: 10.1054/arth.2001.16486. View

Myers G, Abudu A, Carter S, Tillman R, Grimer R . Endoprosthetic replacement of the distal femur for bone tumours: long-term results. J Bone Joint Surg Br. 2007; 89(4):521-6. DOI: 10.1302/0301-620X.89B4.18631. View

Nakamura T, Matsumine A, Uchida A, Kawai A, Nishida Y, Kunisada T . Clinical outcomes of Kyocera Modular Limb Salvage system after resection of bone sarcoma of the distal part of the femur: the Japanese Musculoskeletal Oncology Group study. Int Orthop. 2013; 38(4):825-30. PMC: 3971272. DOI: 10.1007/s00264-013-2151-7. View

Pala E, Trovarelli G, Calabro T, Angelini A, Abati C, Ruggieri P . Survival of modern knee tumor megaprostheses: failures, functional results, and a comparative statistical analysis. Clin Orthop Relat Res. 2014; 473(3):891-9. PMC: 4317408. DOI: 10.1007/s11999-014-3699-2. View

Niimi R, Matsumine A, Hamaguchi T, Nakamura T, Uchida A, Sudo A . Prosthetic limb salvage surgery for bone and soft tissue tumors around the knee. Oncol Rep. 2012; 28(6):1984-90. DOI: 10.3892/or.2012.2021. View

Henderson E, Groundland J, Pala E, Dennis J, Wooten R, Cheong D . 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. DOI: 10.2106/JBJS.J.00834. View

Jahnke A, Engl S, Altmeyer C, Jakubowitz E, Seeger J, Rickert M . Changes of periprosthetic bone density after a cementless short hip stem: a clinical and radiological analysis. Int Orthop. 2014; 38(10):2045-50. DOI: 10.1007/s00264-014-2370-6. View

Schwartz A, Kabo J, Eilber F, Eilber F, Eckardt J . Cemented distal femoral endoprostheses for musculoskeletal tumor: improved survival of modular versus custom implants. Clin Orthop Relat Res. 2009; 468(8):2198-210. PMC: 2895832. DOI: 10.1007/s11999-009-1197-8. View

Saleh K, El Othmani M, Tzeng T, Mihalko W, Chambers M, Grupp T . Acrylic bone cement in total joint arthroplasty: A review. J Orthop Res. 2016; 34(5):737-44. DOI: 10.1002/jor.23184. View

10.

Mavrogenis A, Pala E, Angelini A, Ferraro A, Ruggieri P . Proximal tibial resections and reconstructions: clinical outcome of 225 patients. J Surg Oncol. 2012; 107(4):335-42. DOI: 10.1002/jso.23216. View

11.

Roberts P, Chan D, Grimer R, Sneath R, Scales J . Prosthetic replacement of the distal femur for primary bone tumours. J Bone Joint Surg Br. 1991; 73(5):762-9. DOI: 10.1302/0301-620X.73B5.1894662. View

12.

Chong D, Hansen U, van der Venne R, Verdonschot N, Amis A . The influence of tibial component fixation techniques on resorption of supporting bone stock after total knee replacement. J Biomech. 2011; 44(5):948-54. DOI: 10.1016/j.jbiomech.2010.11.026. View

13.

Kolisek F, Mont M, Seyler T, Marker D, Jessup N, Siddiqui J . Total knee arthroplasty using cementless keels and cemented tibial trays: 10-year results. Int Orthop. 2008; 33(1):117-21. PMC: 2899213. DOI: 10.1007/s00264-007-0502-y. View

14.

Bourne R, Finlay J . The influence of tibial component intramedullary stems and implant-cortex contact on the strain distribution of the proximal tibia following total knee arthroplasty. An in vitro study. Clin Orthop Relat Res. 1986; (208):95-9. View

15.

Kawai A, Muschler G, Lane J, Otis J, Healey J . Prosthetic knee replacement after resection of a malignant tumor of the distal part of the femur. Medium to long-term results. J Bone Joint Surg Am. 1998; 80(5):636-47. DOI: 10.2106/00004623-199805000-00004. View

16.

Ruggieri P, Mavrogenis A, Pala E, Abdel-Motaal M, Mercuri M . Long term results of fixed-hinge megaprostheses in limb salvage for malignancy. Knee. 2011; 19(5):543-9. DOI: 10.1016/j.knee.2011.08.003. View

17.

Simon M, Aschliman M, Thomas N, Mankin H . Limb-salvage treatment versus amputation for osteosarcoma of the distal end of the femur. J Bone Joint Surg Am. 1986; 68(9):1331-7. View

18.

Ewald F . The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res. 1989; (248):9-12. View

19.

Henderson E, OConnor M, Ruggieri P, Windhager R, Funovics P, Gibbons C . 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. DOI: 10.1302/0301-620X.96B11.34747. View

20.

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. 2017; 33(4):1275-1287.e3. DOI: 10.1016/j.arth.2017.10.051. View