Pala Elisa, Trovarelli Giulia, Ippolito Vincenzo, Berizzi Antonio, Ruggieri Pietro
Department of Orthopedics and Ortopedic Oncology, University of Padova, Via Giustiniani 3, 35128, Padua, Italy.
Eur J Trauma Emerg Surg. 2022 Jun;48(3):2483-2491. doi: 10.1007/s00068-021-01809-7. Epub 2021 Nov 2.
Modular megaprostheses have widely replaced allografts, as a reconstructive option; however, failures of these devices remain high. Aim of this study was to analyze outcomes, survival of the implants, incidence and types of complications with Mutars modular endoprostheses at long term.
Between 2000 and 2019, 187 Mutars prostheses were implanted in two dedicated centers: 72 upper limbs and 115 lower limbs reconstructions. Diagnoses included 107 primary malignant bone or soft tissue tumors, 65 metastases, 8 benign bone tumors and 7 non-oncologic cases. Silver-coated prostheses were used in 118/187 (63%) cases.
At last follow-up, 76.5% of patients had retained their implant. The overall failure rate was 23.5% at a mean of 1.7 years. There were 22 mechanical failures and 22 non-mechanical failures. The overall implant survival to all types of failure was 68% and 52% at 5 and 10 years, respectively. Infection was the most common mode of failure with an incidence of 6.9%. Implant survival to infection was better for silver-coated implants than for standard implants even if with no significant difference (p = 0.56). Functional results were satisfactory in 97% of patients.
The overall implant survival at long term was satisfactory with Mutars prostheses. The incidence of complications with Mutars prosthesis is in line with the incidence reported in the literature with other types of tumor prosthesis. The most frequent cause of failure was infection with a lower incidence in silver-coated prostheses; silver coating seems to prevent infection in distal femur and proximal tibia. The silver coating seems to be particularly useful in two-stage revisions with a lower incidence of secondary amputation. In higher risk patients, silver-coated prostheses are the preferable choice for the reduction of the reinfection rate. The functional results of Mutars prostheses were excellent or good in most of cases. The current paper is design to enhance the literature on megaprosthesis in tumor surgery, proven that this system is one of the most used all over the word and one of the best performing.
模块化大假体作为一种重建选择已广泛取代同种异体移植；然而，这些装置的失败率仍然很高。本研究的目的是长期分析Mutars模块化内置假体的治疗结果、植入物存活率、并发症的发生率和类型。
2000年至2019年期间，在两个专门的中心植入了187个Mutars假体：72例上肢重建和115例下肢重建。诊断包括107例原发性恶性骨或软组织肿瘤、65例转移瘤、8例良性骨肿瘤和7例非肿瘤病例。118/187（63%）例使用了镀银假体。
在最后一次随访时，76.5%的患者保留了植入物。平均1.7年时的总失败率为23.5%。有22例机械性失败和22例非机械性失败。所有类型失败的植入物总存活率在5年和10年时分别为68%和52%。感染是最常见的失败模式，发生率为6.9%。镀银植入物对感染的植入物存活率优于标准植入物，即使无显著差异（p = 0.56）。97%的患者功能结果令人满意。
Mutars假体的长期植入物总存活率令人满意。Mutars假体的并发症发生率与文献报道的其他类型肿瘤假体的发生率一致。最常见的失败原因是感染，镀银假体的感染发生率较低；镀银似乎可预防股骨远端和胫骨近端的感染。镀银在二期翻修中似乎特别有用，二次截肢发生率较低。在高风险患者中，镀银假体是降低再感染率的首选。Mutars假体的功能结果在大多数情况下为优或良。本文旨在丰富肿瘤手术中大假体的文献资料，证明该系统是全球使用最广泛且性能最佳的系统之一。
