Peng Xiaoyuan, Ji Weiping, Yang Fan, Lin Yizhen, Yang Qingcheng, Zhang Zhichang
Department of Bone Oncology & Diseases Surgery, Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.
Eur J Med Res. 2025 Sep 2;30(1):834. doi: 10.1186/s40001-025-03007-2.
The rising incidence of cancer has highlighted the need for effective treatment strategies, particularly for bone tumors like distal femoral tumors. These tumors are among the most prevalent types of bone malignancies, often necessitating extensive surgical intervention to achieve optimal outcomes. Limb-salvage surgery, which involves resecting the tumor and reconstructing the limb with prosthetic devices, has become the standard approach for managing both malignant and aggressive benign tumors of the distal femur. This technique has largely replaced amputation, allowing patients to retain limb function and improve their quality of life. Despite advancements in surgical methods and prosthetic designs, complications such as aseptic loosening, periprosthetic fractures, and infections remain common, frequently requiring revision surgeries. The choice between cemented and uncemented prostheses in these revision procedures is crucial, as it significantly impacts patient outcomes and long-term functional recovery. This study aims to compare clinical outcomes between cemented and uncemented prostheses in distal femoral tumor revision surgeries, addressing existing gaps in the literature and providing guidance for clinical decision-making.
This retrospective study analyzed data from 46 patients who underwent revision surgery for distal femoral tumor prostheses at Shanghai Sixth People's Hospital from 2019 to 2024. Patients were divided into two groups: 22 in the cemented prosthesis group (control) and 24 in the uncemented prosthesis group (experimental). Inclusion criteria required patients to be aged 20-50 years, with confirmed epiphyseal closure and clinical diagnosis of aseptic loosening after distal femoral tumor prosthesis replacement. Patients with severe systemic conditions or infections were excluded to ensure a homogeneous study population. Key parameters evaluated included operation time, intraoperative blood loss, length of hospital stay, and postoperative drainage duration. Functional outcomes were assessed using the Musculoskeletal Tumor Society (MSTS) scoring system and the Karnofsky Performance Status (KPS) scale. Statistical analyses were performed using SPSS software, with significance set at a P value of ≤ 0.05, ensuring robust comparisons of clinical, radiological, and functional outcomes between the two prosthesis types.
The uncemented prosthesis group demonstrated superior clinical outcomes compared to the cemented group. Operation time was significantly shorter (124.75 ± 12.54 min vs. 162.67 ± 19.17 min, P < 0.001), and intraoperative blood loss was markedly lower (412.45 ± 32.12 mL vs. 647.56 ± 37.45 mL, P < 0.001). Postoperative recovery indicators also favored the uncemented group, with shorter hospital stays (16.64 ± 2.67 days vs. 19.78 ± 2.86 days, P = 0.004) and reduced drainage duration (9.85 ± 3.52 days vs. 13.47 ± 3.17 days, P = 0.007). Functional outcomes, measured by MSTS scores, were significantly higher in the uncemented group (70.24 ± 7.35 vs. 56.70 ± 4.98, P < 0.001), and KPS scores showed similar trends (78.32 ± 3.87 vs. 62.45 ± 4.12, P < 0.001).
In conclusion, this study demonstrates that uncemented prostheses provide superior clinical outcomes in revision surgeries for distal femoral tumors compared to cemented prostheses. The significant advantages include shorter operation times, reduced intraoperative blood loss, faster recovery, and improved functional outcomes, as indicated by higher MSTS and KPS scores. The biological fixation mechanism of uncemented prostheses promotes osseointegration, enhancing long-term stability and minimizing complications, such as aseptic loosening and infections. Although oncological outcomes, including disease-free survival and overall survival, were comparable between both groups, uncemented prostheses were particularly beneficial for younger patients with adequate bone stock. Despite limitations such as a small sample size and insufficient long-term follow-up, these findings offer valuable insights into the clinical application of uncemented prostheses and underscore the importance of personalized treatment strategies tailored to individual patient needs. Future research should involve larger, multicenter studies to validate these results and further explore the mechanisms behind the observed differences in outcomes.
癌症发病率的上升凸显了有效治疗策略的必要性，尤其是对于像股骨远端肿瘤这样的骨肿瘤。这些肿瘤是最常见的骨恶性肿瘤类型之一，通常需要广泛的手术干预以实现最佳治疗效果。保肢手术，即切除肿瘤并用假体装置重建肢体，已成为治疗股骨远端恶性和侵袭性良性肿瘤的标准方法。该技术在很大程度上取代了截肢手术，使患者能够保留肢体功能并提高生活质量。尽管手术方法和假体设计取得了进展，但无菌性松动、假体周围骨折和感染等并发症仍然很常见，常常需要进行翻修手术。在这些翻修手术中，骨水泥型假体和非骨水泥型假体的选择至关重要，因为它会显著影响患者的治疗效果和长期功能恢复。本研究旨在比较股骨远端肿瘤翻修手术中骨水泥型假体和非骨水泥型假体的临床效果，填补现有文献中的空白，并为临床决策提供指导。
这项回顾性研究分析了2019年至2024年在上海第六人民医院接受股骨远端肿瘤假体翻修手术的46例患者的数据。患者分为两组：骨水泥型假体组（对照组）22例和非骨水泥型假体组（试验组）24例。纳入标准要求患者年龄在20至50岁之间，骨骺已确认闭合，且在股骨远端肿瘤假体置换后临床诊断为无菌性松动。排除患有严重全身疾病或感染的患者，以确保研究人群的同质性。评估的关键参数包括手术时间、术中出血量、住院时间和术后引流持续时间。使用肌肉骨骼肿瘤学会（MSTS）评分系统和卡诺夫斯基功能状态（KPS）量表评估功能结果。使用SPSS软件进行统计分析，显著性设定为P值≤0.05，以确保对两种假体类型的临床、放射学和功能结果进行有力比较。
与骨水泥型假体组相比，非骨水泥型假体组显示出更好的临床效果。手术时间显著更短（124.75±12.54分钟对162.67±19.17分钟，P<0.001），术中出血量明显更低（412.45±32.12毫升对647.56±37.45毫升，P<0.001）。术后恢复指标也有利于非骨水泥型假体组，住院时间更短（16.64±2.67天对19.78±2.86天，P=0.004），引流持续时间缩短（9.85±3.52天对13.47±3.17天，P=0.007）。通过MSTS评分衡量的功能结果在非骨水泥型假体组中显著更高（70.24±7.35对56.70±4.98，P<0.001），KPS评分也显示出类似趋势（78.32±3.87对62.45±4.12，P<0.001）。
总之，本研究表明，在股骨远端肿瘤翻修手术中，非骨水泥型假体比骨水泥型假体提供更好的临床效果。显著优势包括手术时间更短、术中出血量减少、恢复更快以及功能结果改善，如更高的MSTS和KPS评分所示。非骨水泥型假体的生物固定机制促进骨整合，增强长期稳定性并减少并发症，如无菌性松动和感染。尽管两组之间的肿瘤学结果，包括无病生存率和总生存率相当，但非骨水泥型假体对骨量充足的年轻患者特别有益。尽管存在样本量小和长期随访不足等局限性，但这些发现为非骨水泥型假体的临床应用提供了有价值的见解，并强调了根据个体患者需求制定个性化治疗策略的重要性。未来的研究应涉及更大规模的多中心研究，以验证这些结果并进一步探索观察到的结果差异背后的机制。
