Survivorship, Complications, and Outcomes Following Distal Femoral Replacement for Neoplastic Indications

Overview

Journal J Orthop

Specialty Orthopedics

Date 2024 Jan 29

PMID 38283873

Authors

Daniel Hameed

Jeremy A Dubin

Carly Deter

Sandeep S Bains

Zhongming Chen

Christopher G Salib

Mallory C Moore

Matthew T Wallace

Albert J Aboulafia

Affiliations

Soon will be listed here.

Abstract

Background: Distal femoral replacements (DFRs) are excellent treatment options for limb salvage procedures in patients who have bone loss secondary to neoplasm. Multiple studies report adequate survivorship and complication rates following DFR implantation, primarily for non-neoplastic indications. However, current literature regarding neoplasm-specific reports is often limited by sample size, survivorship, and patient reported outcome measurements. Therefore, we sought to examine patients who received a DFR for a neoplastic indication at multiple tertiary academic centers. Specific outcomes analyzed included: (1) revision-free survival, (2) medical/surgical complications, and (3) Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR).

Methods: All patients who underwent a DFR for a neoplastic indication were retrospectively reviewed. A total of 29 knees were included for various neoplastic indications. Outcomes of interest included: post-operative thromboses, pneumonia, dislocations, periprosthetic joint infections (PJIs), aseptic loosening, osteolysis, emergency department visits, inpatient readmissions, and revision surgeries. Patient-reported outcome measure (PROM) collected included: Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR).

Results: Revision-free survivorship was 72.4 % at 23 months with radiographic follow-up. PJI was the most common post-operative complication, affecting 3 knees (10.3 %). The mean number of emergency department visits and inpatient readmissions averaged less than one per patient (0.63 and 0.41, respectively). KOOS JR scores improved markedly among from baseline to final follow-up (44.1-57.8).

Conclusion: The use of DFR led to satisfactory medium-term clinical outcomes with an acceptable complication rate for this challenging group of patients. The marked improvement in patient satisfaction for this patient population gives a promising outlook for patients who will undergo this procedure in the future and can guide patient-provider regarding surgical expectations.

References

Lex J, Adlan A, Tsoi K, Evans S, Stevenson J . Frequency and reason for reoperation following non-invasive expandable endoprostheses: A systematic review. J Bone Oncol. 2021; 31:100397. PMC: 8529098. DOI: 10.1016/j.jbo.2021.100397. View

ENNEKING W, Spanier S, Goodman M . A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res. 1980; (153):106-20. View

Pala E, Henderson E, Calabro T, Angelini A, Abati C, Trovarelli G . Survival of current production tumor endoprostheses: complications, functional results, and a comparative statistical analysis. J Surg Oncol. 2013; 108(6):403-8. DOI: 10.1002/jso.23414. View

Gusho C, Greenspoon J, Clayton B, Bauer J, Colman M, Gitelis S . Long-term outcomes and improved risk of revision following tumor endoprosthetic replacement of the distal femur: Single institutional results. J Orthop. 2021; 25:259-264. PMC: 8212066. DOI: 10.1016/j.jor.2021.05.027. View

Sobol K, Fram B, Strony J, Brown S . Survivorship, complications, and outcomes following distal femoral arthroplasty for non-neoplastic indications. Bone Jt Open. 2022; 3(3):173-181. PMC: 8965790. DOI: 10.1302/2633-1462.33.BJO-2021-0202.R1. View

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

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

Natarajan M, Sivaseelam A, Ayyappan S, Bose J, Sampath Kumar M . Distal femoral tumours treated by resection and custom mega-prosthetic replacement. Int Orthop. 2005; 29(5):309-13. PMC: 3456650. DOI: 10.1007/s00264-005-0677-z. View

Jeys L, Kulkarni A, Grimer R, Carter S, Tillman R, Abudu A . Endoprosthetic reconstruction for the treatment of musculoskeletal tumors of the appendicular skeleton and pelvis. J Bone Joint Surg Am. 2008; 90(6):1265-71. DOI: 10.2106/JBJS.F.01324. View

10.

Bickels J, Wittig J, Kollender Y, Henshaw R, Meller I, Malawer M . Distal femur resection with endoprosthetic reconstruction: a long-term followup study. Clin Orthop Relat Res. 2002; (400):225-35. DOI: 10.1097/00003086-200207000-00028. View

11.

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. DOI: 10.1097/01.blo.0000223978.36831.39. View

12.

Staals E, Sambri A, Campanacci D, Muratori F, Leithner A, Gilg M . Expandable distal femur megaprosthesis: A European Musculoskeletal Oncology Society study on 299 cases. J Surg Oncol. 2020; 122(4):760-765. DOI: 10.1002/jso.26060. View

13.

Kawai A, Healey J, Boland P, Athanasian E, Jeon D . A rotating-hinge knee replacement for malignant tumors of the femur and tibia. J Arthroplasty. 1999; 14(2):187-96. DOI: 10.1016/s0883-5403(99)90124-9. View

14.

Staats K, Vertesich K, Sigmund I, Sosa B, Kaider A, Funovics P . Does a Competing Risk Analysis Show Differences in the Cumulative Incidence of Revision Surgery Between Patients with Oncologic and Non-oncologic Conditions After Distal Femur Replacement?. Clin Orthop Relat Res. 2020; 478(5):1062-1073. PMC: 7170673. DOI: 10.1097/CORR.0000000000001106. View

15.

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