Sobol Keenan Rhys, Fram Brianna R, Strony John T, Brown Scot A
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Department of Orthopedic Surgery and the Rothman Institute of Orthopedics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Bone Jt Open. 2022 Mar;3(3):173-181. doi: 10.1302/2633-1462.33.BJO-2021-0202.R1.
Endoprosthetic reconstruction with a distal femoral arthroplasty (DFA) can be used to treat distal femoral bone loss from oncological and non-oncological causes. This study reports the short-term implant survivorship, complications, and risk factors for patients who underwent DFA for non-neoplastic indications.
We performed a retrospective review of 75 patients from a single institution who underwent DFA for non-neoplastic indications, including aseptic loosening or mechanical failure of a previous prosthesis (n = 25), periprosthetic joint infection (PJI) (n = 23), and native or periprosthetic distal femur fracture or nonunion (n = 27). Patients with less than 24 months' follow-up were excluded. We collected patient demographic data, complications, and reoperations. Reoperation for implant failure was used to calculate implant survivorship.
Overall one- and five-year implant survivorship was 87% and 76%, respectively. By indication for DFA, mechanical failure had one- and five-year implant survivorship of 92% and 68%, PJI of 91% and 72%, and distal femur fracture/nonunion of 78% and 70% (p = 0.618). A total of 37 patients (49%) experienced complications and 27 patients (36%) required one or more reoperation. PJI (n = 16, 21%), aseptic loosening (n = 9, 12%), and wound complications (n = 8, 11%) were the most common complications. Component revision (n = 10, 13.3%) and single-stage exchange for PJI (n = 9, 12.0 %) were the most common reoperations. Only younger age was significantly associated with increased complications (mean 67 years (SD 9.1)) with complication vs 71 years (SD 9.9) without complication; p = 0.048).
DFA is a viable option for distal femoral bone loss from a range of non-oncological causes, demonstrating acceptable short-term survivorship but with high overall complication rates. Cite this article: 2022;3(3):173-181.
采用股骨远端置换术（DFA）进行的内置假体重建可用于治疗因肿瘤和非肿瘤原因导致的股骨远端骨缺损。本研究报告了因非肿瘤适应证接受DFA治疗的患者的短期植入物存活率、并发症及危险因素。
我们对来自单一机构的75例因非肿瘤适应证接受DFA治疗的患者进行了回顾性研究，这些适应证包括先前假体的无菌性松动或机械故障（n = 25）、假体周围关节感染（PJI）（n = 23）以及股骨远端原发性或假体周围骨折或骨不连（n = 27）。随访时间少于24个月的患者被排除。我们收集了患者的人口统计学数据、并发症及再次手术情况。因植入物失败进行的再次手术用于计算植入物存活率。
总体而言，植入物1年和5年存活率分别为87%和76%。按DFA的适应证划分，机械故障导致的植入物1年和5年存活率分别为92%和68%，PJI导致的为91%和72%，股骨远端骨折/骨不连导致的为78%和70%（p = 0.618）。共有37例患者（49%）出现并发症，27例患者（36%）需要进行一次或多次再次手术。PJI（n = 16，21%）、无菌性松动（n = 9，12%）和伤口并发症（n = 8，11%）是最常见的并发症。部件翻修（n = 10，13.3%）和PJI的一期置换（n = 9，12.0%）是最常见的再次手术。只有年龄较小与并发症增加显著相关（出现并发症者平均年龄67岁（标准差9.1），未出现并发症者平均年龄71岁（标准差9.9）；p = 0.048）。
DFA是治疗一系列非肿瘤原因导致的股骨远端骨缺损的可行选择，其短期存活率可接受，但总体并发症发生率较高。引用本文：2022；3(3):173 - 181。
