Aseptic loosening rates in distal femoral endoprostheses: does stem size matter?.

MedStar author(s):
Citation: Clinical Orthopaedics & Related Research. 470(3):743-50, 2012 Mar.PMID: 21968899Institution: MedStar Washington Hospital Center | Washington Cancer InstituteDepartment: Orthopedic Oncology | RadiologyForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Chondrosarcoma/su [Surgery] | *Femoral Neoplasms/su [Surgery] | *Giant Cell Tumor of Bone/su [Surgery] | *Osteosarcoma/su [Surgery] | Adult | Female | Humans | Male | Multivariate Analysis | Prosthesis Design | Retrospective StudiesLocal holdings: Available online through MWHC library: 2008 - present, Available in print through MWHC library: 1999 - 2003ISSN:
  • 0009-921X
Name of journal: Clinical orthopaedics and related researchAbstract: BACKGROUND: Long-term survival of distal femoral endoprosthetic replacements is largely affected by aseptic loosening. It is unclear whether and to what degree surgical technique and component selection influence the risk of loosening.CONCLUSIONS: Our data suggest durability relates to selecting stems that fill the canal.LEVEL OF EVIDENCE: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.METHODS: We retrospectively reviewed the charts of all 93 patients in whom 104 distal femoral replacements had been performed from 1985 to 2008. We extracted the following data: age, need for revision surgeries, tumor diagnosis, adjunct treatment, and implant characteristics. We reviewed radiographs and determined stem size, bone diaphyseal width, and resection percentage of the femur. Kaplan-Meier survivorship was calculated for all implant failures and failures resulting from aseptic loosening. We evaluated radiolucent lines in patients with radiographic followup over 5years. We identified independent risk factors for loosening. The minimum followup for radiographic evaluation was 5years (mean, 12.7years; range, 5.4-23.5years).QUESTIONS/PURPOSES: We (1) established the overall failure and aseptic loosening rates in a tumor population and asked (2) whether stem diameter and specifically the diaphysis-to-stem ratio predicts loosening, and (3) whether resection percentage correlates with failure.RESULTS: Overall implant survival for 104 stems in 93 patients was 73.3% at 10years, 62.8% at 15years, and 46.1% at 20years. Survival from aseptic loosening was 94.6% at 10 and 15years and 86.5% at 20years. Of the variables analyzed, only bone:stem ratio independently predicted aseptic failure. Patients with stable implants had larger stem sizes and lower bone:stem ratios than those with loose implants (14.5mm versus 10.7mm and 2.02 versus 2.81, respectively).All authors: Bergin PF, Henshaw RM, Jelinek JS, Noveau JBDigital Object Identifier: Date added to catalog: 2013-09-17
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article Available 21968899

Available online through MWHC library: 2008 - present, Available in print through MWHC library: 1999 - 2003

BACKGROUND: Long-term survival of distal femoral endoprosthetic replacements is largely affected by aseptic loosening. It is unclear whether and to what degree surgical technique and component selection influence the risk of loosening.

CONCLUSIONS: Our data suggest durability relates to selecting stems that fill the canal.

LEVEL OF EVIDENCE: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

METHODS: We retrospectively reviewed the charts of all 93 patients in whom 104 distal femoral replacements had been performed from 1985 to 2008. We extracted the following data: age, need for revision surgeries, tumor diagnosis, adjunct treatment, and implant characteristics. We reviewed radiographs and determined stem size, bone diaphyseal width, and resection percentage of the femur. Kaplan-Meier survivorship was calculated for all implant failures and failures resulting from aseptic loosening. We evaluated radiolucent lines in patients with radiographic followup over 5years. We identified independent risk factors for loosening. The minimum followup for radiographic evaluation was 5years (mean, 12.7years; range, 5.4-23.5years).

QUESTIONS/PURPOSES: We (1) established the overall failure and aseptic loosening rates in a tumor population and asked (2) whether stem diameter and specifically the diaphysis-to-stem ratio predicts loosening, and (3) whether resection percentage correlates with failure.

RESULTS: Overall implant survival for 104 stems in 93 patients was 73.3% at 10years, 62.8% at 15years, and 46.1% at 20years. Survival from aseptic loosening was 94.6% at 10 and 15years and 86.5% at 20years. Of the variables analyzed, only bone:stem ratio independently predicted aseptic failure. Patients with stable implants had larger stem sizes and lower bone:stem ratios than those with loose implants (14.5mm versus 10.7mm and 2.02 versus 2.81, respectively).

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