Use of Endoprosthesis for the Treatment of Non-Neoplastic Pathologies of the Knee
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Published:
Oct 17, 2023
Keywords:
Endoprosthesis, knee, infection, complications
Main Article Content
Abstract
Introduction: Endoprosthesis is the gold standard for reconstruction after oncological resections. The advances regarding its materials and designs allowed for the expansion of the indications to non-neoplastic pathologies. Its simple and fast intraoperative assembly and its immediate mechanical stability allow for early rehabilitation and functional recovery. However, the failure rate is high, although it is different from oncological pathologies. The predominant causes are varied. Objectives: To analyze our experiencein the use of knee endoprosthesis and compare it with the literature, evaluating functional outcomes, radiographic outcomes, implant survival and causes of eventual failure. Materials and Methods: Patients with complex non-neoplastic knee pathology that required reconstruction with endoprosthesis were selected. Clinical history, anamnesis, physical examination, and radiographs were reviewed. For clinical examination and functional evaluation, the MusculoSkeletal Tumor Society Score (MSTS Score) was used. For implant failures, the modified Henderson et al. classification was used. Results: 12 endoprostheses were studied, with an average follow-up of 3.8 years. Failures were recorded in 2 (18%), with a mean time to failure of 47.5 months. One type 2 failure (aseptic loosening) and one type 4 failure (infection) were recorded. No other complications were noted. For the functional evaluation, the mean final score was 76.6%. Conclusion: Our results support the use of endoprostheses for complex non-neoplastic knee diseases in carefully selected patients, despite being a complex surgical procedure with many complications.
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Jorge, F. D., Varaona, J. M., Prado , L., Tálamo , F., & Pérez Cortés, P. (2023). Use of Endoprosthesis for the Treatment of Non-Neoplastic Pathologies of the Knee. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(5), 466-477. https://doi.org/10.15417/issn.1852-7434.2023.88.5.1678
Section
Clinical Research
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References
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https://doi.org/10.1007/s00264-015-2991-4
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12. Pala E, Henderson ER, Calabrò T, Angelini A, Abati CN, Trovarelli G, et al. Survival of current production
tumor endoprostheses: complications, functional results, and a comparative statistical analysis. J Surg Oncol
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https://doi.org/10.1093/jac/dku247
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18. Morii T, Yabe H, Morioka H, Beppu Y, Chuman H, Kawai A, et al. Postoperative deep infection in tumor
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19. Mavrogenis AF, Pala E, Angelini A, Calabro T, Romagnoli C, Romantini M, et al. Infected prostheses after lowerextremity bone tumor resection: clinical outcomes of 100 patients. Surg Infect (Larchmt) 2015;16(3):267-75.
https://doi.org/10.1089/sur.2014.085
20. Racano A, Pazionis T, Farrokhyar F, Deheshi B, Ghert M. High infection rate outcomes in long-bone tumor surgery with endoprosthetic reconstruction in adults: a systematic review. Clin Orthop Relat Res 2013;471(6):2017-27. https://doi.org/10.1007/s11999-013-2842-9
21. Pala E, Mavrogenis AF, Angelini A, Hendreson ER, Letson DG, Ruggieri P. Cemented versus cementless
endoprostheses for lower limb salvage surgery. J BUON 2013;18(2):496-503. PMID: 23818368
22. Taylor SJ, Walker PS, Perry JS, Cannon SR, Woledge R. The forces in the distal femur and the knee during walking and other activities measured by telemetry. J Arthroplasty 1998;13(4):428-37. https://doi.org/10.1016/s0883-5403(98)90009-2
23. Pala E, Trovarelli G, Angelini A, Maraldi M, Berizzi A, Ruggieri P. Megaprosthesis of the knee in tumor and
revision surgery. Acta Biomed 2017;88(2S):129-38. https://doi.org/10.23750/abm.v88i2-S.6523
24. Al-Taki MM, Masri BA, Duncan CP, Garbuz DS. Quality of life following proximal femoral replacement using a
modular system in revision THA. Clin Orthop Relat Res 2011;469(2):470-5. https://doi.org/10.1007/s11999-010-1522-2
25. Tunn PU, Pomraenke D, Goerling U, Hohenberger P. Functional outcome after endoprosthetic limb-salvage therapy of primary bone tumours—a comparative analysis using the MSTS score, the TESS and the RNL index. Int Orthop 2008;32:619-25. https://doi.org/10.1007/s00264-007-0388-8
https://doi.org/10.1007/s11999-014-3736-1
2. Pala E, Trovarelli G, Calabrò T, Angelini A, Abati CN, Ruggieri P. Survival of modern knee tumor megaprostheses: Failures, functional results, and a comparative statistical analysis. Clin Orthop Relat Res 2015;473(3):891-9. https://doi.org/10.1007/s11999-014-3699-2
3. Ahlmann ER, Menendez LR, Kermani C, Gotha H. Survivorship and clinical outcome of modular endoprosthetic
reconstruction for neoplastic disease of the lower limb. J Bone Joint Surg Br 2006;88:790-5. https://doi.org/10.1302/0301-620X.88B6.17519
4. Windhager R, Schreiner M, Staats K, Apprich S. Megaprostheses in the treatment of periprosthetic fractures of the knee joint: indication, technique, results and review of literature. Int Orthop 2016;40(5):935-43.
https://doi.org/10.1007/s00264-015-2991-4
5. Calori GM, Colombo M, Malagoli E, Mazzola S, Bucci M, Mazza E. Megaprosthesis in post-traumatic and
periprosthetic large bone defects: issues to consider. Injury 2014;45(6):S105-S110. https://doi.org/10.1016/j.injury.2014.10.032
6. Korim MT, Esler CNA, Reddy VRM, Ashford RU. A systematic review of endoprosthetic replacement for nontumour indications around the knee joint. Knee 2013;20(6):367-75. https://doi.org/10.1016/j.knee.2013.09.001
7. Berend KR, Lombardi Jr AV. Distal femoral replacement in nontumor cases with severe bone loss and instability. Clin Orthop Relat Res 2009;467(2):485-92. https://doi.org/10.1007/s11999-008-0329-x
8. Houdek MT, Wagner ER, Wilke BK, Wyles CC, Taunton MJ, Sim FH. Long term outcomes of cemented
endoprosthetic reconstruction for periarticular tumors of the distal femur. Knee 2016;23(1):167-72.
https://doi.org/10.1016/j.knee.2015.08.010
9. Hardes J, Gebert C, Schwappach A, Ahrens H, Streitburger A, Winkelmann W, et al. Characteristics and outcome of infections associated with tumor endoprostheses. Arch Orthop Trauma Surg 2006;126(5):289-96.
https://doi.org/10.1007/s00402-005-0009-1
10. Henderson ER, Groundland JS, Pala E, Dennis JA, Wooten R, Cheong D, et al. Failure mode classification for
tumor endoprostheses: retrospective review of five institutions and a literature review. J Bone Joint Surg Am
2011;93(5):418-29. https://doi.org/10.2106/JBJS.J.00834
11. Jeys LM, Grimer RJ, Carter SR, Tillman RM. Periprosthetic infection in patients treated for an oncological
orthopaedic condition. J Bone Joint Surg Am 2005;87(4):842-9. https://doi.org/10.2106/JBJS.C.01222
12. Pala E, Henderson ER, Calabrò T, Angelini A, Abati CN, Trovarelli G, et al. Survival of current production
tumor endoprostheses: complications, functional results, and a comparative statistical analysis. J Surg Oncol
2013;108(6):403-08. https://doi.org/10.1002/jso.23414
13. Saebye CKP, Keller J, Baad-Hansen T. Validation of the Danish version of the musculoskeletal tumour
society score questionnaire. World J Orthop 2019;10(1):23-32. https://doi.org/10.5312/wjo.v10.i1.23
14. De Gori M, Scoccianti G, Frenos F, Bettini L, Familiari F, Gasparini G, et al. Modular endoprostheses for
nonneoplastic conditions: Midterm complications and survival. BioMed Res Int 2016;2016:2606521.
https://doi.org/10.1155/2016/2606521
15. Willis-Owen CA, Konyves A, Martin DK. Factors affecting the incidence of infection in hip and knee replacement: an analysis of 5277 cases. J Bone Joint Surg Br 2010;92(8):1128-33. https://doi.org/10.1302/0301-620X.92B8.24333
16. Lamagni T. Epidemiology and burden of prosthetic joint infections. J Antimicrob Chemother 2014;69(1):i5-i10.
https://doi.org/10.1093/jac/dku247
17. Pilge H, Gradl G, von Eisenhart-Rothe R, Gollwitzer H. Incidence and outcome after infection of megaprostheses. Hip Int 2012;22(Suppl 8):S83-S90. https://doi.org/10.5301/HIP.2012.9576
18. Morii T, Yabe H, Morioka H, Beppu Y, Chuman H, Kawai A, et al. Postoperative deep infection in tumor
endoprosthesis reconstruction around the knee. J Orthop Sci 2010;15(3):331-9. https://doi.org/10.1007/s00776-010-1467-z
19. Mavrogenis AF, Pala E, Angelini A, Calabro T, Romagnoli C, Romantini M, et al. Infected prostheses after lowerextremity bone tumor resection: clinical outcomes of 100 patients. Surg Infect (Larchmt) 2015;16(3):267-75.
https://doi.org/10.1089/sur.2014.085
20. Racano A, Pazionis T, Farrokhyar F, Deheshi B, Ghert M. High infection rate outcomes in long-bone tumor surgery with endoprosthetic reconstruction in adults: a systematic review. Clin Orthop Relat Res 2013;471(6):2017-27. https://doi.org/10.1007/s11999-013-2842-9
21. Pala E, Mavrogenis AF, Angelini A, Hendreson ER, Letson DG, Ruggieri P. Cemented versus cementless
endoprostheses for lower limb salvage surgery. J BUON 2013;18(2):496-503. PMID: 23818368
22. Taylor SJ, Walker PS, Perry JS, Cannon SR, Woledge R. The forces in the distal femur and the knee during walking and other activities measured by telemetry. J Arthroplasty 1998;13(4):428-37. https://doi.org/10.1016/s0883-5403(98)90009-2
23. Pala E, Trovarelli G, Angelini A, Maraldi M, Berizzi A, Ruggieri P. Megaprosthesis of the knee in tumor and
revision surgery. Acta Biomed 2017;88(2S):129-38. https://doi.org/10.23750/abm.v88i2-S.6523
24. Al-Taki MM, Masri BA, Duncan CP, Garbuz DS. Quality of life following proximal femoral replacement using a
modular system in revision THA. Clin Orthop Relat Res 2011;469(2):470-5. https://doi.org/10.1007/s11999-010-1522-2
25. Tunn PU, Pomraenke D, Goerling U, Hohenberger P. Functional outcome after endoprosthetic limb-salvage therapy of primary bone tumours—a comparative analysis using the MSTS score, the TESS and the RNL index. Int Orthop 2008;32:619-25. https://doi.org/10.1007/s00264-007-0388-8