Table 3.
Summary of the data from the recent studies on the use of megaprosthesis for the management of massive skeletal defects in proximal femur.
| Authors | Diagnosis | No of patients | Average age (years) | Average Follow up | Clinical outcome | Radiological Outcome | Complications | Result | Survival |
|---|---|---|---|---|---|---|---|---|---|
| Natarajan et al.17 | Multiple Myeloma | 6 (3 PF; 3 SF) | 47.7 | 88.2 m | 2 Excellent | One loosening | 1 skin necrosis | 2 deaths from disease | 66.7% at 5 years |
| 2 Good | 1 periprosthetic fracture | ||||||||
| 2 Fair | |||||||||
| Khan et a.18 | Giant cell tumor | 12 | 36 | 4.8 y | Mean clinical score of 28.3 (25–30) | No loosening No dislocation | 2 superficial infections | All alive at latest follow up | – |
| Ilyas et a.19 | Malignant tumors | 15 | 37 | 6.7 y | MSTS = 19 | One aseptic loosening | 3 dislocations | 3 revisions | – |
| 2 infections | 2 deaths from disease | ||||||||
| Bruns et al.20 | Malignant tumors (23) & Non–neoplastic (22) | 25 (7 PF) | 40.1 | 2.5 y | MSTS = 24.9 | 11 stem stress shielding | 2 extensor mechanism rupture | 2 deaths from disease | 87% at 7 years |
| KI = 82% | 1 DVT | 1 revision | |||||||
| 1 Septic loosening | |||||||||
| 1 dislocation of hip | |||||||||
| Donati et al.21 | Tumors | 25 Malignant tumors (22), GCT (2), Osteoblastoma (1) | 34 | 12.25 y | 7 | 17 stem stress shielding | 1 infection | 4 revisions | – |
| 10 Good | 1 dislocation | ||||||||
| 7 Fair | 1 stiff knee | ||||||||
| 1 Poor | 1 recurrence of disease | ||||||||
| Bernthal et al.22 | Sarcomas | 24 (7 PF, 9 DF, 8 PT) | 37 | 13.2 y | MSTS = 25.9 | – | – | All walking without aids | – |
| Shih et al.23 | Failed THA with massive bone loss | 12 | 59 | 5.7 y | HHS = 83 | 1 HO | 5 dislocations | 2 revisions 3 Girdle stone arthroplasty | – |
| 3 GT displacement | 4 infections | ||||||||
| 1 aseptic loosening | |||||||||
| Donati et al.24 | Primary or metastatic tumors | 68 (38 SC, 30 UC) | 61.6 | 46.5 m | – | – | 4 | 14 re-surgeries | – |
| 8 infections | |||||||||
| 2 relapse | |||||||||
| Ahlmann et al.25 | Bone neoplasia | 211 (96PF, 78 DF, PT 30, TF 7) | 50 | 37.3 m | MSTS = 22.25 | 5 Aseptic loosening | 9 Fatigue failure | 29 revisions, 5amputations | 60% at 10 years |
| PF = 22 | 11 Infections | ||||||||
| DF = 22.9 | DF 4 | 6 recurrence (PF 3, DF 2, PT 1) | |||||||
| PT = 22.25 | PT 1 | 10 dislocations | 97.6% limb survival at 10 years | PF 82% | |||||
| TF = 19.5 | 1 Fracture | DF 58% | |||||||
| PT 82% | |||||||||
| TF 100% | |||||||||
| Bertani et a.26 | Tumors and Non-neoplastic conditions | 23 (13 Tumors, 8 Failed THA, 2 Trauma) | 65 ± 17.2 | 5.4 y | MSTS = 16.2 | 1 Aseptic loosening | 2 infections | 5 revisions | 81.5% at 10 years |
| 1 tumor extension | |||||||||
| 1 stem fatigue fracture | |||||||||
| Calabro et al.27 | Malignant Tumors (7 failed previous prosthesis) | 109 95 cemented 14 cementless | 60 | 2.5 y | MSTS = 21 | – | 5.8%infection | 6 deaths from disease | 74% at 9 years |
| 3.9%dislocation | |||||||||
| 2.9%recurrence | |||||||||
| 1%acetabular fracture | |||||||||
| Calori et al.28 | Non-union, Complex Fractures and Failed THAs | 32 (11 PF, 13 DF, 2 PT, 6 TF) | 64 | 18 m | – | – | 1 dislocation | – | – |
| 1 fracture (DF) | |||||||||
| Curtin et al.29 | Periprosthetic fractures | 16 | 75 | 19.2 m | OHS = 39 | – | 2 dislocations | – | – |
| Hardes et al.30 | Sarcomas | 125 | 37 | 19 m 54 m | – | – | Infection | Revisions | – |
| 5.9% | |||||||||
| 55 PF | 22 SC + 23 UC | 17.6% | |||||||
| 70 PT | SC + 41 UC | PF: 4.5 vs 18.2% | 9 vs 9 % | ||||||
| PT: 6.9 vs 17.1% | 3 vs 32 % | ||||||||
| Ji et al.31 | Tumors | 7 (3 PF, 1 DF, 2 PT, 1 Patella) | 28 | 27 m | MSTS93 = 81% | – | 1 local recurrence | 1 revision | – |
| Korim et al.32 | Non-neoplastic conditions | 356 14 studies | 3.8 y (0–14) | – | 2.5 % loosening | 83% implant retention | |||
| 7.6% infection | 12 % mortality | ||||||||
| 0.5% prosthesis fracture | |||||||||
| 1 % periprosthetic fracture | |||||||||
| Lundh et al.33 | 17 | 77 | 44 m | – | – | 3 infections | 9 deaths at latest follow up | 94% at 44 months | |
| 2 CF Knee | 5 PF | 2 dislocations | |||||||
| 10 PPF Knee | 8 DF | ||||||||
| 5 PPF Hip | 2 TF | ||||||||
| 2 Primary prosthesis | |||||||||
| Hattori et al.34 | Metastasis | 61.8 | 2.5–86 m | MSTS = 62.3% | 2 dislocations | 1 revision | 86.4 % at 6 months | ||
| 19 PF | |||||||||
| 2 IC | |||||||||
| 1 TKA | |||||||||
| Gosal et a.35 | GCT | 11 | 32 | 10.6 y | MSTS = 26.8 | – | – | – | 100% |
| Parvizi et al.36 | Non- Neoplastic conditions | 48 | 73.8 | 36.5 m | HHS = 64.9 | 2 radiolucencies >2 mm | 8 dislocations | 10 revisions | 87% at 1 year |
| 1 infection | 73% at 5 years | ||||||||
| 4 acetabular failure | |||||||||
| Ruggieri et al.37 | Sarcomas | 23 | 21 | 148 m | MSTS = 66% | – | 1 Leg ischemia | 5 revisions | 38% disease free at 16 years |
| 1 infection | 13 deaths from disease | ||||||||
| 1 prosthetic disconnection | |||||||||
| 1 poly wear | |||||||||
| 1 PPF | |||||||||
| Mazurkiewicz et al.38 | Primary neoplasms and metastasis | 49 | – | – | 28% excellent | – | 3 dislocation | 2 deaths from disease | |
| 60% good | 1 infection | ||||||||
| 12 primary | 1 recurrence | ||||||||
| 37 metastasis | |||||||||
| Ueda et al.39 | Periacetabular tumors | 25 | 44 | 163 m | MSTS = 55% | 2 aseptic loosening | 8 infections | 5 revisions | 47% at 5 years as well as at 10 years |
| 4 dislocations | 13 deaths from disease | ||||||||
| 7 local recurrence | 1 hemipelvectomy | ||||||||
| 3 implant removal | |||||||||
| Tan et al.40 | Tumors | 17 (4 PF, 7 DF, 6 PT) | – | MSTS = 78.3% ± 16.6% | – | 7 infections | 75.6 months implant survival | ||
| 2 dislocations | |||||||||
| 1 CPN palsy |
Abbreviation: PF = Proximal Femur, SF = Shaft of Femur, DF = Distal femur, TF = Total Femur, PT = Proximal tibia, MSTS = Musculoskeletal Tumor Society Score, KI = Karnofsky Index, DVT = Deep Vein Thrombosis, GCT = Giant Cell Tumor, THA = Total Hip Arthroplasty, HHS = Harris Hip Score, HO = Heterotopic Ossification, SC = Silver Coated, UC = Uncoated, OHS = Oxford Hip Score, m = months, y = years, CF = Comminuted Fracture, PPF = Periprosthetic Fracture, IC = Intercalary, TKA = Total Knee Arthroplasty, CPN = Common Peroneal Nerve.