Long term outcomes of cemented endoprosthetic reconstruction for periarticular XXXX of the distal femur.

@entity5 @entity1 @entity421 @entity179
BACKGROUND: In order to achieve an oncological margin during limb salvage surgery for @entity5 of the distal femur, part or the entire knee joint is frequently sacrificed. Endoprosthetics make limb salvage possible through restoration of a functional extremity. Currently there remains a paucity of data concerning their long-term outcomes and associated risk factors for failure. METHODS: We identified 152 @entity1 who underwent an endoprosthetic reconstruction for an oncological process of the distal femur between 1972 and 2013. The mean follow-up was 10years. Mean age and body mass index (BMI) were 39years and 25.8 respectively. The most common pathology was @entity421 (n=78, 48%). Outcomes were compared to a control group of 20,643 @entity1 undergoing total knee arthroplasty (TKA) for @entity179 ( @entity179 ) during the same time period. RESULTS: The mean five-, 10-, 15-, 20-, and 25-year revision-free survival for an endoprosthesis was 76%, 63%, 51%, 36%, and 28%. Compared to the five-, 10-, 15-, 20-, and 25-year survival of 95%, 90%, 82%, 74%, and 67% for control TKAs (p<0.0001 at all-time points). Overall limb survival was 93%, with 11 @entity1 undergoing amputation. There was no difference in implant survival comparing modular and custom endoprostheses. CONCLUSION: The results of this study show that given the complexity of these operations, the rate of revision surgery following endoprosthetic replacement is high. Nevertheless, the use of these modular reconstructions leads to a high rate of limb salvage (93%) over a 25-year period at our institution. LEVEL OF EVIDENCE: Level III.
