Table 4.
Summary of the data from the recent studies on the use of megaprosthesis for the management of massive skeletal defects in distal femu.
| Authors | Diagnosis | No of patients | Average age (years) | Mean Follow up | Clinical outcome | Radiological Outcome | Complications | Result | Survival |
|---|---|---|---|---|---|---|---|---|---|
| Agarwal et al.43 | Osteosarcoma | 135 (92 megaprosthesis) | 32.4 m | EFS | 3 loosening | 8 infections | 5 revisions | 61% disease free survival at latest follow up | |
| 49 DF, 22 PT, 14 PH, 3 PF, 3 TH, 1 DH) | 1 limb ischemia | 3 amputations | |||||||
| LE = 85% | 4 PPF | 1 hip disarticulation | |||||||
| UE = 66% | 3 implant breakage | 2 implant removal | |||||||
| 2 recurrences | |||||||||
| 2 CPN palsy | |||||||||
| 1 RNP | |||||||||
| Bruns et al.44 | Malignant tumors (23) & Non-neoplastic (22) | 25 (13 PF, 5PT, 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 | |||||||||
| Ilyas et al.45 | Tumors | 48 | 24 | 5.6 y | MSTS = 21 | 2 aseptic loosening | 6 infections | 1 amputation | 65% at 10 years |
| 2 SNP | 1 recurrence | ||||||||
| CPN palsy | 7 deaths from disease | ||||||||
| 21 limb ischemia | |||||||||
| 1 prosthetic fracture | |||||||||
| 1 prosthetic fracture | |||||||||
| 1 PPF | |||||||||
| Pala et al.46 | Tumors | 247 (187 DF, 60 PT) | 32 | 2 y | MSTS = 81% | 14 aseptic loosening (5.7%) | 23 infection (9.3%) | 24 deaths from disease | 70 % at 4 years, 58 % at 8 years |
| 14 recurrence (5.7%) | |||||||||
| Toepfer et.47 | Tumors & | 129(82 reviewed) | 15 aseptic loosening (20%) | 17 soft tissue failure (22.7%) | 47 deaths from disease | 81.8 ± 7.3 months implant survival | |||
| Failed Revision TKA | 36 available | 86m | 28 structural failure (37.3%) | 64.6% overall failure | |||||
| 20 Tumors | 13 infections (17.3%) | ||||||||
| 16 Failed rTKA | 46.2 ± 22.1 | MSTS = 17 | 2 recurrences | ||||||
| 71,0 ± 13,3 | MSTS = 12 | ||||||||
| Biau et al.48 | Tumors | 91 (58 MP, 33 APC) | 27 | 62 m | – | 18 aseptic loosening (20%) | 10 failures 8 failures | 23 deaths | |
| 56 DF | 21 revisions | 130 m | |||||||
| 35 PT | 15 revisions | 117 m | |||||||
| Ahlmann et al.49 | Diaphyseal tumors | 6 ICEP | 42 | 21.6 | MSTS = 90% | 1 loosening of humeral prosthesis | 1 humeral revision | All doing well | 100% at one year 83% at 2 years |
| 3 Tibia | |||||||||
| 2 Femur | |||||||||
| 1 Humerus | |||||||||
| Cannon50 | PPF of Distal Femur | 27 | – | 6 m | KSS = 88 | – | 1 infection | 8 deaths unrelated to disease | – |
| 1 delayed wound healing | |||||||||
| Chim et a.51 | Tumors | 10 (5 DF & 5 PT) | 31 | 32 m | – | – | 1 infection | 3 metastases and deaths | – |
| 1 superficial skin necrosis | |||||||||
| 1 cellulitis (All resolved) | |||||||||
| 4 recurrence | |||||||||
| Evans et al.52 | Trauma | 10 | 70.2 | 3 y | TESS = 62.5 | No loosening | All doing well | 1 death unrelated to surgery | – |
| Gosheger et al.53 | Sarcomas | 250 | 30.7 | 45 m | EFS: | 20 aseptic loosening (8%) 2 | 30 infections (12%) | 47 deaths due to disease | Prosthetic survival |
| 39 PH | cranial subluxation of humeral prostheses | 4 prosthetic fracture (1.6%) | 60.4% at 5 years | ||||||
| 5 DH | 3 femoral dislocations | 42.3 % at 10 years | |||||||
| 7 TH | PH = 21 | 8 poly wear | |||||||
| 41 PF | DH = 23 | 1 Patellar tendon avulsion | |||||||
| 103 DF | TH = 19 | ||||||||
| 12 TF | PF = 21 | ||||||||
| 42 PT | DF = 24 | ||||||||
| 1 TT | TF = 20 | ||||||||
| PT = 25 | |||||||||
| Holl et al.54 | Failed TKA | 20 (21 Knees) | 73 | 34 m | KSS = 68 | 2 aseptic loosening | 6 infections | 2 revisions 1 non-salvage | – |
| 15 DF | 2 PPF | 2 deaths due to infection | |||||||
| 4PT | |||||||||
| 2 Both DF & PT | |||||||||
| Hu et al.55 | Neoplasm and non-neoplastic conditions | 40.3 | 89 m | MSTS = 25.2 | 5 loose cemented stems | 5 prosthetic fracture | 13 deaths from disease | 91% at 2 years 83% at 5 years 68 % at 10 years | |
| 3 asymptomatic radiolucencies | 7 uncontrolled infections | 17 deaths unrelated to surgery | |||||||
| 3 tumor progressions | 10 amputations | ||||||||
| Kinekl et al.56 | Tumors | 77 (49 DF, 28 PT) | 38 | 46 m | EFS = 73% | 13 aseptic loosening | 15 locking mechanism failure | 58% revision rate | 57% at 5 years |
| 11 infections | 8 implant removal | ||||||||
| 4 recurrence | 5 amputations | ||||||||
| 3 PPF1 patellar tendon rupture | |||||||||
| 5 joint stiffness | |||||||||
| 10 wound problem | |||||||||
| Pala et al.57 | Tumor | 687 | 34 | 7.9 y | MSTS = 23.3 (77.6%) | 33 aseptic loosening | 41 soft tissue failure | Over all 27 % failure rate 206 deaths from disease | 70% at 10 years 50% at 20 years |
| 26 structural failure (fixed prostheses only) | |||||||||
| 57 infections | |||||||||
| 28 recurrence | |||||||||
| Staals et.58 | Malignant tumors of distal femur | 15 (Expandable prosthesis) | 8 | 104 m | MSTS = 81% | 1 loosening | 8 breakage | 9 revisions & deaths | – |
| 2 recurrence | 2 amputations | ||||||||
| 1 infection | 2 deaths due to metastasis | ||||||||
| No longer use by authors | |||||||||
| Vincent et al.59 | – | 196 (DF & PT) | – | – | – | – | Cemented (29): | 45 revisions | – |
| 109 cemented | 62% loosening | ||||||||
| 87 press fit | 24% infection | ||||||||
| 13% fracture | |||||||||
| Press fit (16): | |||||||||
| 43% loosening | |||||||||
| 31% infection | |||||||||
| 6% fracture | |||||||||
| 6% LLD | |||||||||
| 6% recurrence | |||||||||
| 6% malrotation | |||||||||
| Torner et al.60 | Tumors | 7 (6 DF, 1 PF) (Expandable prosthesis) | 9.8 | 65.3 m | MSTS = 26.3 | – | 1 pelvic metastasis | 2 deaths from disease | 71.5% success rate (5 out of 7 functioning well at latest follow up) |
| 1 implant failure due to MRI done for leg trauma | |||||||||
| Vaishya et al.61 | Resistant non-unions of DF fractures | 10 | 74 | 4 y | KSS (pain) = 84 KSS | – | 3 wound problems | – | – |
| (function) = 88 | 1 PPF | ||||||||
| Zimel et al.62 | Failed distal femoral prosthesis | 27 Compliant Pre-stress Implant | 30 | 90 m | MSTS = 27 | – | 3 mechanical failure | 2 revised to CPC | – |
| 1 revised to APC | |||||||||
| 3 amputation | |||||||||
| 4 infections | 1 fusion | ||||||||
| Windhager et al.63 | PPF | 144 (seven studies) | 68.4–81 | 6–58.6 | – | – | 20 mechanical failures | 0–55% revisions | – |
| 23 non-mechanical failures | 6.6–45% mortality |
Abbreviations: PH = Proximal Humerus, TH = Total Humerus, DH = Distal Humerus, PF = Proximal Femur, DF = Distal Femur, TF = Total Femur, PT = Proximal Tibia, TT = Total Tibia, EFS = Enneking Functional Score, LE = Lower Extremity, UE = Upper Extremity, m = months, PPF = Periprosthetic fracture, CPN = Common Peroneal Nerve. RNP = Radial Nerve Palsy, MSTS = Musculoskeletal Tumor Society score, KI = Karnofsky index, SNP = Sciatic Nerve Palsy, TKA = Total Knee Arthroplasty, rTKA = Revision Total Knee Arthroplasty, MP Megaprosthesis, APC = Allograft Prosthesis Composite, EMF = Extensor Mechanism Failure, ICEP = Intercalary Endoprosthesis, KSS = Knee Society Score, TESS = Toronto Extremity Salvage Score, MRI = Magnetic Resonance Imaging