Table 4.
Diaphyseal Endoprosthetic Complications by Individual Report
| Citation | Device | Overall Implant Complications | Complications By Anatomic Site (%) | Henderson Failure Types (%)a | Notes | Cemented vs Noncemented |
| Mahdal et al25Current Oncology2022 | Henderson (27) | 7/27 (26%)9 humeral18 femoral | Humerus 4/9 (44%) | I (0) | Four out of the five type II cases were in the humerus and one was in the femur | NA |
| II5/27 (18.5%) | ||||||
| Femur3/18 (17%) | III2/27 (7.4%) | |||||
| IV (0) | ||||||
| V (0) | ||||||
| Benevenia et al2 CORR 2016 | MereteCemented stems (29)Noncemented (15) | 12/44 (27%) | Humerus (0)b | I (0) | — | Cemented (21)dNoncemented (33)d |
| Femur12/21 (57%)b | II5/44 (11%); all noncementedc | Between stem and bone | ||||
| Tibia (0%)b | III6/44 (14%); all cementedc | Clamp-rod implant interface | ||||
| IV1/44 (2%) | — | |||||
| V1/44 (2%) | Required amputation | |||||
| Damron et al6,26 CORR 1996, 200 | StrykerCemented stems (32) | 14/32 (44%) | Humerus only (44%) | I 3/32 (9%) | All type I failures due to neurapraxia | All cemented |
| II 5/32 (16%) | ||||||
| III 2/32 (6%) | ||||||
| IV (0) | ||||||
| V 2/32 (6%) | ||||||
| Calvert et al3 CORR 2014 | Biomet Compress stems (n) | NAe | NA | NA | NA | Noncemented only |
| Zhao et al27 J Shoulder Elbow Surg | Grp I: Endoprosthesis alone (4)Grp II: With plate (5) | 2/9 (22%) | Humerus only (22%) | I 1/9 (11%) Grp 1 | No complications in Grp II | Cemented only |
| II 1/9 (11%) Grp I | ||||||
| III (0%) | ||||||
| IV (0%) | ||||||
| V (0%) | ||||||
| Zheng et al28 BMC Cancer 2019 | Cemented (49) with plates (24%) | 11/49 (22%) | Primary4/7 (57%)f | I5/49 (10%) | Type I: 2 radial n. palsies, 3 wound healingType V: only in primary group. | Cemented only |
| II2/49 (4%) | ||||||
| III1/49 (2%) | ||||||
| Metastatic7/42 (17%)f | IV (0%) | |||||
| V3/49 (6%) | ||||||
| Tedesco et al29 Orthopedics 2017 | Customized anchor plugs for short segment fixation with double compressive osseointegration (6) | 3/6 (50%) | NA | I (0%) | All 3 complications required revision | 5/6 cemented (no separate analysis) |
| II (0%) | ||||||
| III3/6 (50%) | ||||||
| IV (0%) | ||||||
| V (0%) | ||||||
| Abudu et al30 JBJS-Br 1996 | Custom (18) | NA | Primary only (NA) | I (NA) | Mechanical loosening, limb shortening secondary DJD “main complications” | NA |
| II (NA) | ||||||
| III (NA) | ||||||
| IV (0%) | ||||||
| V1/18 (5%) | ||||||
| Guder et al31 Arch Orthop Trauma Surg 2017 | Ultrashort tibial stem | 3/4 (75%) | Primary only3/4 (75%) | I2/4 (50%) | Both type I wound complications required revision | NA |
| II (0%) | ||||||
| III (0%) | ||||||
| IV (0%) | ||||||
| V1/4 (25%) | ||||||
| Bernthal et al32 Bone Joint J 2019 | Custom-cemented cross-pin fixation | NA | NA | NA | NA | NA |
| Huang et al8 Orthop Surg 2017 | Lap joint with single-plate fixation | 2/16 (13%) | Metastatic only (13%) | I (0%) | Revision done in type III and type IV (two-stage exchange) | Cemented only |
| II (0%) | ||||||
| III 1/16 (6%) | ||||||
| IV 1/16 (6%) | ||||||
| V 1/16 (6%) | ||||||
| Szczerba et al33 Ortop Traumatol Rehabil 2019 | Modular endoprosthesis included in group of other techniques | NA | Metastatic only (NA for endoprosthetic) | NA | NA | NA |
| Hanna et al34 JBJS-Br 2010 | NA | 9/23 (39%) | Primary only (41%) | I 1/23 (4%) | Implant 5 YSR 85%, 10 YSR 68%. | NA |
| II 1/23 (4%) | ||||||
| III 3/23 (13%) | Revision rate 22%. | |||||
| IV 1/23 (4%) | ||||||
| V 5/23 (22%) | Overall revision surgery 26% | |||||
| Hamada et al35 J Surg Case Reports 2014 | Custom K-MAX, Kyocera Medical corp., Kyoto, Japan | 1/2 (50%) | Metastatic (1)1/2 (50%) | I (0%) | Revision in single type II | NA |
| II 1/2 (50%) | ||||||
| Primary (1)1/2 (50%) | III (0%) | |||||
| IV (0%) | ||||||
| V (0%) | ||||||
| Sakellariou et al36 J Long Term Eff Med Implants 2008 | NA | 1/6 (17%) | NA | I (0%) | Revision in single type II | NA |
| II 1/6 (17%) | ||||||
| III (0%) | ||||||
| IV (0%) | ||||||
| V (0%) | ||||||
| Ruggieri et al37 J Surg Oncol 2011 | “Modular intramedullary diaphyseal segmental defect fixation system” | 8/24 (33%) | Metastatic (NA)Primary (NA) | I (0%) | Type II most common >10-cm bone resection | NA |
| II (NA) | Type III in all femoral reconstructions at prox stem | |||||
| III (NA) | ||||||
| IV (0%) | ||||||
| V (0%) | 1 LLD | |||||
| Sewell et al.38 J Bone Joint Surg Br 2011 | Custom tibial | 13/18 (72%) | NA | I (0%) | Implant 10 YSR 63%4 revisions | NA |
| II4/18 (22%) | ||||||
| III2/18 (11%) | ||||||
| IV1/18 (5%) | ||||||
| V6/18 (33%) | ||||||
| Aldlyami et al.9 Int Orthop 2005 | Custom | 16/35 (46%) | Primary only 16/35 (46%) | I (0%) | Implant 10 YSR 63% | Cemented only |
| II7/35 (20%) | ||||||
| III3/35 (9%) | ||||||
| IV1/35 (3%) | ||||||
| V5/35 (14%) | ||||||
| Spiegelberg39 JBJS-Br 2009 | Custom | 2/8 (25%) | Primary only 2/8 (25%) | I (0%) | Implant survival 75% | Proximal HA-coated plates, distal cemented stems only |
| II (0%) | ||||||
| III1/8 (13%) | ||||||
| IV (0%) | ||||||
| V1/8 (13%) | ||||||
| McGrath et al40 Acta Orthop Belg 2011 | Custom | 12/13 (92%) | Primary only 12/13 (92%) | I (0%) | Implant 10 YSR 47% | NA |
| II4/13 (31%) | ||||||
| III2/13 (15%) | ||||||
| IV (0%) | ||||||
| V6/13 (46%) | ||||||
| Schürmann et al5 CORR 2000 | Isoelastic diaphyseal prosthesis | 10/57 (18%) | Metastatic only10/57 (18%) | I3/57 (5%) | Type III (3/4) prosthesis fracture at locking screw inserted through prosthetic shaft in non-cemented technique | NA |
| II2/57 (4%) | ||||||
| III4/57 (7%) | ||||||
| IV1/57 (2%) | ||||||
| V (0%) | ||||||
| Kuo et al41 CORR 1983 | Titanium fiber metal composite | 1/17 (6%) | NA | NA | NA | NA; Bone graft supplemented prosthesis |
CORR = Clinical Orthopaedics and Related Research, N = number of patients or devices; Henderson failure types (Table 1), prox = proximal.
a
Type III included periprosthetic fracture and device failure, type V included both local progression and metastases except in primary tumors.
b
Complications by anatomic site P < 0.001.
c
Association of complication type with fixation, P = 0.0022.
d
Cemented versus noncemented, P = 0.39.
e
Complication rates for overall group of N = 50 implants at multiple sites (no separate analysis of the two femoral intercalary implants in this larger reports.
f
Complications primary versus metastatic, P = 0.036.