Fixed-hinge cemented modular implants: An effective reconstruction technique following primary distal femoral bone tumor resection. A 136-case multicenter series.
BACKGROUND
Reconstruction by endoprosthesis is widespread after bone tumor resection. The design and type of fixation and of hinge remain a matter of debate. The aim of the present study was to assess survival, complications and functional results in a homogeneous series of adult patients undergoing bone defect reconstruction following distal femoral tumor resection, using a single model of fixed-hinge cemented endoprosthesis, at a minimum 5 years' follow-up.


HYPOTHESIS
The study hypotheses were that loosening and infection are the main causes of failure, and that this type of reconstruction is reliable following distal femoral resection.


PATIENTS AND METHODS
All patients aged over 17 years undergoing reconstruction using the Stanmore Mets® fixed-hinge cemented modular endoprosthesis following distal femoral resection for primary bone tumor in 4 French reference centers between 2004 and 2013 were included. Epidemiological data, MSTS functional score, clinical and radiological examination results, complications and survival with types of failure according to the Henderson classification were assessed.


RESULTS
One hundred and thirty-six patients (68 male, 68 female; mean age, 41.2 years [range, 17-77 years]) were included. Mean follow-up was 81 months [range, 61-134 months]. Thirty-two patients (38%) experienced a total 67 complications requiring surgical revision: mainly infection (n=28) or mechanical failure (n=26). Overall implant survival was 78% at 5 years. There were 30 implant failures on the Henderson classification. Mean MSTS score was 82%.


DISCUSSION
The present results are comparable to those of the literature and for other types of reconstruction. Recent meta-analyses suggest that type of hinge and of stem fixation have little effect on implant survival. International comparative studies are needed to determine the exact role of each type of reconstruction according to the patient profile.


LEVEL OF EVIDENCE
IV, multicenter retrospective series.
['Mattei|Jean Camille|JC|', 'Chapat|Benjamin|B|', 'Ferembach|Benjamin|B|', 'Le Nail|Louis-Romée|LR|', 'Crenn|Vincent|V|', 'Bizzozero|Paul|P|', 'Venton|Geoffroy|G|', 'Kerzoncuf|Marjorie|M|', 'Loundnou|Anderson|A|', 'Backstein|David|D|', 'Alshaygy|Ibrahim|I|', 'Griffin|Antony|A|', 'Wunder|Jay|J|', 'Biau|David|D|', 'Gouin|François|F|', 'Rosset|Philippe|P|', 'Rochwerger|Alexandre|A|']
D000328:Adult D000368:Aged D001859:Bone Neoplasms D005260:Female D006801:Humans D008297:Male D011475:Prosthesis Failure D012086:Reoperation D012189:Retrospective Studies D016896:Treatment Outcome
Fixed-hinge Cemented Primary bone tumor Distal femur Endoprosthetic replacement