Puttock Darren R, Howard Daniel P, Eastley Nicholas C, Ashford Robert U
Leicester Orthopaedics, University Hospitals of Leicester, Leicester, UK.
Arthroplasty. 2022 Dec 1;4(1):50. doi: 10.1186/s42836-022-00150-7.
Megaprosthetic replacement (MPR) of the femur is typically reserved for salvage or oncological reconstruction. Presently little is known about the provision of femoral MPRs performed nationally, the trends in indications for their use, and their outcomes beyond published unit-level data. Although the National Joint Registry (NJR) collects data as part of a mandatory arthroplasty audit process, MPR data entry on this platform is thought to be inconsistent. The aim of this study is to determine current trends for femoral MPR procedures as submitted to the NJR.
Data for all procedures submitted to the NJR using the following implants were extracted: METS (Stanmore/Stryker), MUTARS (Implantcast), Segmental (Zimmer), GMRS (Stryker) and MEGA C (LINK). Pseudoanonymized data were analyzed through the NJR's research Data Access Portal and are reported using descriptive statistics.
A total of 1781 procedures were identified. Submitted cases increased for primary and revision hip and knee categories over the study period, although they plateaued in recent years. MPR implants were most commonly used in revision hip arthroplasty procedures. MPR use for the management of peri-prosthetic fractures has increased and now represents the most commonly reported indication for MPR use in both hip and knee revision categories. Few centers submitted large MPR case volumes (which were noted to be lower than published unit case series, indicating NJR under-reporting), and the vast majority of centers submitting MPR cases did so in low volume.
Due to the limitations identified, reported case volumes must be interpreted with caution. An MPR-specific NJR data entry form has been developed to allow more accurate and tailored reporting of MPR procedures, to support specialist service provision, and to provide meaningful data for future research.
股骨的大假体置换（MPR）通常用于挽救性治疗或肿瘤重建。目前，对于全国范围内进行的股骨MPR的情况、其使用指征的趋势以及已发表的单位层面数据之外的结果了解甚少。尽管国家关节注册中心（NJR）在强制性关节置换审计过程中收集数据，但据认为该平台上MPR数据的录入并不一致。本研究的目的是确定提交给NJR的股骨MPR手术的当前趋势。
提取使用以下植入物提交给NJR的所有手术的数据：METS（斯坦莫尔/史赛克）、MUTARS（英普拉斯）、节段型（ Zimmer）、GMRS（史赛克）和MEGA C（LINK）。通过NJR的研究数据访问门户对去识别化数据进行分析，并使用描述性统计进行报告。
共识别出1781例手术。在研究期间，初次和翻修髋关节及膝关节类别的提交病例有所增加，尽管近年来趋于平稳。MPR植入物最常用于翻修髋关节置换手术。MPR用于治疗假体周围骨折的情况有所增加，现在是髋关节和膝关节翻修类别中MPR使用最常报告的指征。很少有中心提交大量MPR病例（注意到这些病例数低于已发表的单位病例系列，表明NJR报告不足），提交MPR病例的绝大多数中心提交的病例数较少。
由于存在已识别的局限性，对报告的病例数必须谨慎解读。已开发了一份特定于MPR的NJR数据录入表格，以允许更准确和有针对性地报告MPR手术，支持专科服务的提供，并为未来研究提供有意义的数据。
