Ziranu A, Bocchi M B, Oliva M S, Meschini C, Messina F, Calori S, Vitiello R
Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Eur Rev Med Pharmacol Sci. 2022 Nov;26(1 Suppl):106-112. doi: 10.26355/eurrev_202211_30289.
Massive bone loss is a serious problem in the elderly. Joint replacement with modular prostheses represents the most common reconstructive technique after oncological and non-oncological resections. Megaprostheses are broadly available, adaptable and versatile and allow early mobilization and rehabilitation. Although segmental endoprosthetic implants are now widely used and despite innovations, complications remain far high. Our purpose is to establish what happens to megaprostheses of a specific anatomical site in the long term in a population with oncologic and non-oncologic indications treated at a single center solely by a few skilled surgeons.
We retrospectively reviewed our institutional database. We collected 35 patients who underwent endoprosthetic reconstruction exclusively of the proximal femur for neoplastic and non-neoplastic disease between 2008 and 2021. The minimum follow-up was 12 months. Complications were collected and classified, and also adapted to the non-oncological setting.
Taking into consideration the entire population, 94% of this survived the follow-up at 6 months, subsequently 85% at 1 year and 82% at 2 years. At follow-ups after 5 years, 79% of megaprostheses showed no mechanical failure. Analyzing prosthetic survival in the two groups, this was >50% at 24 months after surgery in both groups, with better survival for the oncological one.
Proximal femur replacement can be a valid option in treatment of oncological and non-oncological cases. Due to the high complication rate, only selected cases should undergo this kind of surgical procedure.
大量骨质流失是老年人面临的一个严重问题。使用模块化假体进行关节置换是肿瘤和非肿瘤切除术后最常见的重建技术。大型假体广泛可用、适应性强且用途广泛，可实现早期活动和康复。尽管节段性内置假体植入物目前已广泛使用，且有诸多创新，但并发症发生率仍然很高。我们的目的是确定在一个单一中心仅由少数技术熟练的外科医生治疗的有肿瘤和非肿瘤适应症的人群中，特定解剖部位的大型假体长期会出现什么情况。
我们回顾性地查阅了我们机构的数据库。我们收集了2008年至2021年间因肿瘤性和非肿瘤性疾病仅接受股骨近端假体重建的35例患者。最短随访时间为12个月。收集并分类并发症，并将其适用于非肿瘤情况。
考虑到整个人群，94%的患者在6个月随访时存活，随后1年时为85%，2年时为82%。在5年随访时，79%的大型假体未出现机械故障。分析两组的假体生存率，两组在术后24个月时均>50%，肿瘤组的生存率更高。
股骨近端置换在肿瘤和非肿瘤病例的治疗中可以是一种有效的选择。由于并发症发生率高，只有特定病例才应接受这种手术。
