ANALYSIS OF IMPLANT-RELATED COMPLICATIONS AFTER HINGE KNEE REPLACEMENT FOR TUMORS AROUND THE KNEE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIDong , MAHuanzhi , ZHANGWei ,  SUNChengliang , LUXiaoyong , GAOYutong , ZHOUDongsheng

Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan Shandong, 250021, P.R.China;

Corresponding author：

SUNChengliang, Email: sunchl200@126.com

Keywords：

Bone tumor; Limb salvage; Hinge knee prosthesis; Complication

DOI：

10.7507/1002-1892.20150202

Video：

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Objective To investigate the reasons and managements of implant-related complications after hinge knee replacement for tumors around the knee. Methods A retrospective analysis was made on the clinical data of 96 patients undergoing hinge knee replacement between January 2000 and December 2012. There were 64 males and 32 females with the mean age of 31.0 years (range, 15-72 years). The most common tumor type was osteosarcoma (72 cases), and the second was giant cell tumor (15 cases). The tumor located at the distal femurs in 52 cases and at the proximal tibias in 44 cases. Fifteen hinge and 81 rotating hinge prostheses were used. The recurrence, metastasis, and survival were recorded. The implant-related complications were observed. Results The median follow-up time was 43.5 months (range, 10-156 months). Complications were observed in 21 patients (25 implant-related complications);13 complications located at the femur and 12 complications at the tibia. The complications included aseptic loosening (8 cases), deep infection (7 cases), prosthetic breakage (4 cases), peri-prosthetic fracture (2 cases), and dislocation (4 cases). Most deep infection occurred within 12 months after operation (6/7), and most aseptic loosening after 40 months of operation (6/8). The rate of limb salvage was 90.6% (87/96) and the amputation rate was 9.4% (9/96). The overall survival rate of the prosthesis was 76.7% (5-year) and 47.2% (10-year). The 5-year survival rate was 82.9% for femoral prosthesis and 71.0% for tibial prosthesis, showing no significant difference (P=0.954). Conclusion Hinge knee prosthesis still has a high rate of complications. Deep infection is main reason to decrease short-term prosthetic survival rate, and aseptic loosening shortens the long-short prosthetic survival time.

Citation： LIDong, MAHuanzhi, ZHANGWei, SUNChengliang, LUXiaoyong, GAOYutong, ZHOUDongsheng. ANALYSIS OF IMPLANT-RELATED COMPLICATIONS AFTER HINGE KNEE REPLACEMENT FOR TUMORS AROUND THE KNEE. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(8): 936-940. doi: 10.7507/1002-1892.20150202 Copy

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2.	汤小东,郭卫,杨荣利,等.膝关节定制型肿瘤假体的翻修.中国修复重建外科杂志,2010,24(1):5-10.
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5.	Mittermayer F,Krepler P,Dominkus M,et al.Long-term followup of uncemented tumor endoprostheses for the lower extremity.Clin Orthop Relat Res,2001,388:167-177.
6.	杨志平,田永昊,杨强,等.定制肿瘤型铰链膝关节假体置换术后假体生存率及并发症分析.中华骨科杂志,2011,31(6):617-622.
7.	Tan PX,Yong BC,Wang J,et al.Analysis of the efficacy and prognosis of limb-salvage surgery for osteosarcoma around the knee.Eur J Surg Oncol,2012,38(12):1171-1177.
8.	Ferrari S,Palmerini E,Staals EL,et al.The treatment of nonmetastatic high grade osteosarcoma of the extremity:review of the Italian Rizzoli experience.Impact on the future.Cancer Treat Res,2009,152:275-287.
9.	Ayerza MA,Farfalli GL,Aponte-Tinao L,et al.Does increased rate of limb-sparing surgery affect survival in osteosarcoma? Clin Orthop Relat Res,2010,468(11):2854-2859.
10.	Wu CC,Henshaw RM,Pritsch T,et al.Implant design and resection length affect cemented endoprosthesis survival in proximal tibial reconstruction.J Arthroplasty,2008,23(6):886-893.
11.	Petrou G,Petrou H,Tilkeridis C,et al.Medium-term results with a primary cemented rotating-hinge total knee replacement.A 7-to 15-year follow-up.J Bone Joint Surg (Br),2004,86(6):813-817.
12.	Guenoun B,Latargez L,Freslon M,et al.Complications following rotating hinge Endo-Modell (Link) knee arthroplasty.Orthop Traumatol Surg Res,2009,95(7):529-536.
13.	Springer BD,Hanssen AD,Sim FH,et al.The kinematic rotating hinge prosthesis for complex knee arthroplasty.Clin Orthop Relat Res,2001,(392):283-291.
14.	Natarajan MV,Sivaseelam A,Rajkumar G,et al.Custom megaprosthetic replacement for proximal tibial tumors.Int Orthop,2003,27(6):334-337.
15.	Gaur AH,Liu T,Knapp KM,et al.Infections in children and young adults with bone malignancies undergoing limb-sparing surgery.Cancer,2005,104(3):602-610.
16.	Kaste SC,Neel MN,Rao BN,et al.Complications of limb-sparing procedures using endoprosthetic replacements about the knee for pediatric skeletal sarcomas.Pediatr Radiol,2001,31(2):62-71.
17.	Slone RM,Heare MM,Vander Griend RA,et al.Orthopedic fixation devices.Radiographics,1991,11(5):823-847.
18.	Utting MR,Newman JH.Customised hinged knee replacements as a salvage procedure for failed total knee arthroplasty.Knee,2004,11(6):475-479.
19.	Kinkel S,Lehner B,Kleinhans JA,et al.Medium to long-term results after reconstruction of bone defects at the knee with tumor endoprostheses.J Surg Oncol,2010,101(2):166-169.
20.	Fukuroku J,Inoue N,Rafiee B,et al.Extracortical bone-bridging fixation with use of cortical allograft and recombinant human osteogenic protein-1.J Bone Joint Surg (Am),2007,89(7):1486-1496.
21.	Wang CJ,Wang HE.Early catastrophic failure of rotating hinge total knee prosthesis.J Arthroplasty,2000,15(3):387-391.

1. Balke M,Ahrens H,Streitbüerger A,et al.Modular endoprosthetic reconstruction in malignant bone tumors:indications and limits.Recent Results Cancer Res,2009,179:39-50.
2. 汤小东,郭卫,杨荣利,等.膝关节定制型肿瘤假体的翻修.中国修复重建外科杂志,2010,24(1):5-10.
3. Biau D,Faure F,Katsahian S,et al.Survival of total knee replacement with a megaprosthesis after bone tumor resection.J Bone Joint Surg (Am),2006,88(6):1285-1293.
4. Guo W,Ji T,Yang R,et al.Endoprosthetic replacement for primary tumours around the knee:experience from Peking University.J Bone Joint Surg (Br),2008,90(8):1084-1089.
5. Mittermayer F,Krepler P,Dominkus M,et al.Long-term followup of uncemented tumor endoprostheses for the lower extremity.Clin Orthop Relat Res,2001,388:167-177.
6. 杨志平,田永昊,杨强,等.定制肿瘤型铰链膝关节假体置换术后假体生存率及并发症分析.中华骨科杂志,2011,31(6):617-622.
7. Tan PX,Yong BC,Wang J,et al.Analysis of the efficacy and prognosis of limb-salvage surgery for osteosarcoma around the knee.Eur J Surg Oncol,2012,38(12):1171-1177.
8. Ferrari S,Palmerini E,Staals EL,et al.The treatment of nonmetastatic high grade osteosarcoma of the extremity:review of the Italian Rizzoli experience.Impact on the future.Cancer Treat Res,2009,152:275-287.
9. Ayerza MA,Farfalli GL,Aponte-Tinao L,et al.Does increased rate of limb-sparing surgery affect survival in osteosarcoma? Clin Orthop Relat Res,2010,468(11):2854-2859.
10. Wu CC,Henshaw RM,Pritsch T,et al.Implant design and resection length affect cemented endoprosthesis survival in proximal tibial reconstruction.J Arthroplasty,2008,23(6):886-893.
11. Petrou G,Petrou H,Tilkeridis C,et al.Medium-term results with a primary cemented rotating-hinge total knee replacement.A 7-to 15-year follow-up.J Bone Joint Surg (Br),2004,86(6):813-817.
12. Guenoun B,Latargez L,Freslon M,et al.Complications following rotating hinge Endo-Modell (Link) knee arthroplasty.Orthop Traumatol Surg Res,2009,95(7):529-536.
13. Springer BD,Hanssen AD,Sim FH,et al.The kinematic rotating hinge prosthesis for complex knee arthroplasty.Clin Orthop Relat Res,2001,(392):283-291.
14. Natarajan MV,Sivaseelam A,Rajkumar G,et al.Custom megaprosthetic replacement for proximal tibial tumors.Int Orthop,2003,27(6):334-337.
15. Gaur AH,Liu T,Knapp KM,et al.Infections in children and young adults with bone malignancies undergoing limb-sparing surgery.Cancer,2005,104(3):602-610.
16. Kaste SC,Neel MN,Rao BN,et al.Complications of limb-sparing procedures using endoprosthetic replacements about the knee for pediatric skeletal sarcomas.Pediatr Radiol,2001,31(2):62-71.
17. Slone RM,Heare MM,Vander Griend RA,et al.Orthopedic fixation devices.Radiographics,1991,11(5):823-847.
18. Utting MR,Newman JH.Customised hinged knee replacements as a salvage procedure for failed total knee arthroplasty.Knee,2004,11(6):475-479.
19. Kinkel S,Lehner B,Kleinhans JA,et al.Medium to long-term results after reconstruction of bone defects at the knee with tumor endoprostheses.J Surg Oncol,2010,101(2):166-169.
20. Fukuroku J,Inoue N,Rafiee B,et al.Extracortical bone-bridging fixation with use of cortical allograft and recombinant human osteogenic protein-1.J Bone Joint Surg (Am),2007,89(7):1486-1496.
21. Wang CJ,Wang HE.Early catastrophic failure of rotating hinge total knee prosthesis.J Arthroplasty,2000,15(3):387-391.

Chinese Journal of Reparative and Reconstructive Surgery

ANALYSIS OF IMPLANT-RELATED COMPLICATIONS AFTER HINGE KNEE REPLACEMENT FOR TUMORS AROUND THE KNEE

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