Mumith Aadil, Coathup Melanie, Edwards Thomas C, Gikas Panos, Aston Will, Blunn Gordon
Institute of Orthopaedics and Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, London, UK; University of Central Florida, College of Medicine, Orlando, Florida, USA.
Institute of Orthopaedics and Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, London, UK.
Bone Joint Res. 2020 Jul 8;9(7):333-340. doi: 10.1302/2046-3758.97.BJR-2019-0122.R1. eCollection 2020 Jul.
Limb salvage in bone tumour patients replaces the bone with massive segmental prostheses where achieving bone integration at the shoulder of the implant through extracortical bone growth has been shown to prevent loosening. This study investigates the effect of multidrug chemotherapy on extracortical bone growth and early radiological signs of aseptic loosening in patients with massive distal femoral prostheses.
A retrospective radiological analysis was performed on adult patients with distal femoral arthroplasties. In all, 16 patients were included in the chemotherapy group with 18 patients in the non-chemotherapy control group. Annual radiographs were analyzed for three years postoperatively. Dimensions of the bony pedicle, osseointegration of the hydroxyapatite (HA) collar surface, bone resorption at the implant shoulder, and radiolucent line (RLL) formation around the cemented component were analyzed.
A greater RLL score (p = 0.041) was observed at three years postoperatively, with those receiving chemotherapy showing greater radiological loosening compared with those not receiving chemotherapy. Chemotherapy patients experience osteolysis at the shoulder of the ingrowth collar over time (p < 0.001) compared with non-chemotherapy patients where osteolysis was not observed. A greater median percentage integration of the collar surface was observed in the non-chemotherapy group (8.6%, interquartile range (IQR) 0.0% to 37.9%; p = 0.021) at three years. Bone growth around the collar was observed in both groups, and no statistical difference in amount of extracortical bony bridging was seen.
Multidrug chemotherapy affects the osseointegration of ingrowth collars and accelerates signs of radiological loosening. This may increase the risk of aseptic loosening in patients with massive segmental implants used to treat bone cancer.Cite this article: 2020;9(7):333-340.
骨肿瘤患者的保肢手术采用大块节段性假体替代骨骼，通过皮质外骨生长在假体肩部实现骨整合已被证明可预防松动。本研究调查多药化疗对接受大块股骨远端假体患者的皮质外骨生长及无菌性松动早期影像学征象的影响。
对成年股骨远端关节置换患者进行回顾性影像学分析。化疗组纳入16例患者，非化疗对照组纳入18例患者。术后三年每年分析X线片。分析骨蒂尺寸、羟基磷灰石（HA）领圈表面的骨整合、假体肩部的骨吸收以及骨水泥固定部件周围的透亮线（RLL）形成情况。
术后三年观察到化疗组的RLL评分更高（p = 0.041），接受化疗的患者与未接受化疗的患者相比，影像学显示松动更明显。随着时间推移，化疗患者的长入型领圈肩部出现骨质溶解（p < 0.001），而未观察到非化疗患者出现骨质溶解。三年时，非化疗组领圈表面的中位整合百分比更高（8.6%，四分位间距（IQR）0.0%至37.9%；p = 0.021）。两组均观察到领圈周围有骨生长，皮质外骨桥接量无统计学差异。
多药化疗影响长入型领圈的骨整合并加速影像学松动征象。这可能增加用于治疗骨癌的大块节段性植入物患者无菌性松动的风险。引用本文：2020;9(7):333 - 340。
