Royal Orthopaedic Hospital, Birmingham, UK.
Instituto Nacional de Cancerología, Bogotá, Colombia.
Bone Joint J. 2019 May;101-B(5):522-528. doi: 10.1302/0301-620X.101B5.BJJ-2018-1106.R1.
The aim of this study was to evaluate the prosthesis characteristics and associated conditions that may modify the survival of total femoral endoprosthetic replacements (TFEPR).
In all, 81 patients treated with TFEPR from 1976 to 2017 were retrospectively evaluated and failures were categorized according to the Henderson classification. There were 38 female patients (47%) and 43 male patients (53%) with a mean age at diagnosis of 43 years (12 to 86). The mean follow-up time was 10.3 years (0 to 31.7). A survival analysis was performed followed by univariate and multivariate Cox regression to identify independent implant survival factors.
The revision-free survival of the implant was 71% at five years and 63.3% at ten years. Three prostheses reached 15 years without revision. The mean Musculoskeletal Tumor Society score in the group was 26 (23 to 28). The mechanisms of failure were infection in 18%, structural failures in 6%, tumour progression in 5%, aseptic loosening in 2%, and soft-tissue failures in 1%. Prostheses used for primary reconstruction after oncological resections had lower infection rates than revision implants (8% 25%; p = 0.001). The rates of infection in silver-coated and non-silver-coated prosthesis were similar (17.4% 19.%; p = 0.869). The incidence of hip dislocation was 10%. Rotating hinge prosthesis had a lower failure rate than fixed hinge prosthesis (5.3% 11%). After Cox regression, the independent factors associated with failures were the history of previous operations (hazard ratio (HR) 3.7; p = 0.041), and the associated arthroplasty of the proximal tibia (HR 3.8; p = 0.034). At last follow-up, 11 patients (13%) required amputation.
TFEPR offers a reliable reconstruction option for massive bone loss of the femur, with a good survival when the prosthesis is used as a primary implant. The use of a rotating hinge at the knee and dual mobility bearing at the hip may be adequate to reduce the risk of mechanical and soft-tissue failures. Infection remains the main concern and there is insufficient evidence to support the routine use of silver-coated endoprosthesis. Cite this article: 2019;101-B:522-528.
本研究旨在评估假体特征和相关条件，这些特征和条件可能会改变全股骨假体置换术（TFEPR）的生存率。
回顾性评估了 1976 年至 2017 年间接受 TFEPR 治疗的 81 例患者，根据 Henderson 分类对假体失败进行分类。其中 38 例为女性（47%），43 例为男性（53%），平均诊断年龄为 43 岁（12 岁至 86 岁）。平均随访时间为 10.3 年（0 至 31.7 年）。进行生存分析，然后进行单变量和多变量 Cox 回归分析，以确定独立的假体生存因素。
假体的无翻修生存率在 5 年时为 71%，在 10 年时为 63.3%。有 3 个假体在没有翻修的情况下达到了 15 年。该组肌肉骨骼肿瘤学会评分的平均值为 26（23 至 28）。失败的机制为感染 18%，结构性失败 6%，肿瘤进展 5%，无菌性松动 2%，软组织失败 1%。用于肿瘤切除后初次重建的假体的感染率低于翻修假体（8% 25%；p = 0.001）。银涂层和非银涂层假体的感染率相似（17.4% 19%；p = 0.869）。髋关节脱位的发生率为 10%。旋转铰链假体的失败率低于固定铰链假体（5.3% 11%）。经 Cox 回归分析，与失败相关的独立因素为既往手术史（风险比（HR）3.7；p = 0.041）和近端胫骨的相关关节成形术（HR 3.8；p = 0.034）。末次随访时，11 例（13%）患者需要截肢。
TFEPR 为股骨大量骨缺损提供了一种可靠的重建选择，当假体作为初次植入物使用时，具有良好的生存率。在膝关节使用旋转铰链和髋关节使用双动关节轴承可能足以降低机械和软组织失败的风险。感染仍然是主要关注点，没有足够的证据支持常规使用银涂层假体。 引用本文： 2019;101-B：522-528.
