Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534
Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534
Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534
Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534
Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534
Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534
Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534
Deprecated: Implicit conversion from float 245.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534
Deprecated: Implicit conversion from float 245.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534
Deprecated: Implicit conversion from float 245.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534
Warning: imagejpeg(C:\Inetpub\vhosts\kidney.de\httpdocs\phplern\24664193
.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Clin+Orthop+Relat+Res
2015 ; 473
(3
): 831-8
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
Frequent complications and severe bone loss associated with the repiphysis
expandable distal femoral prosthesis
#MMPMID24664193
Cipriano CA
; Gruzinova IS
; Frank RM
; Gitelis S
; Virkus WW
Clin Orthop Relat Res
2015[Mar]; 473
(3
): 831-8
PMID24664193
show ga
BACKGROUND: The treatment of choice for distal femur malignancies in skeletally
immature patients remains controversial. An expandable endoprosthesis device
(Repiphysis Limb Salvage System; Wright Medical Technology, Arlington, TN, USA)
allows for limb preservation and noninvasive lengthening but has been associated
with significant complications; however, the extent and implications of bone loss
associated with this implant have not been reported. QUESTIONS/PURPOSES: Our
goals were to report (1) the 2-year minimum clinical outcomes after placement of
the Repiphysis expandable prosthesis for pediatric distal femur malignancies; (2)
the complications associated with this prosthesis; (3) the failure rate of this
prosthesis; and (4) the revision alternatives available for salvage procedures.
METHODS: Between 2002 and 2010, one surgeon (SG) treated all skeletally immature
patients (mean age, 10.1 years; range, 4.7-13.6 years) with distal femoral
osteosarcoma using a Repiphysis expandable prosthesis. Of the 12 patients who met
these criteria, two were excluded for death from disease before 2 years, and mean
followup for the remaining 10 was 72 months (range, 26-119 months). Medical
records were retrospectively reviewed for complications and clinical outcomes, as
assessed by the Musculoskeletal Tumor Society (MSTS) scoring system. Radiographs
at final followup were reviewed for bone loss and analyzed by the two senior
authors (SG, WWV) to determine reconstruction options available for future
revisions. RESULTS: MSTS scores averaged 67%, and we observed 37 implant-related
complications requiring a total of 15 reoperations. Six patients underwent
implant revisions with aseptic loosening being the predominant mode of failure;
ultimately, four of these were converted to adult modular oncology prostheses,
and two underwent total femoral replacements. Bone loss in this series was severe
in terms of femoral length, cortical thinning, and metadiaphyseal compromise, and
most patients will not have sufficient bone stock to permit future revision using
standard stem fixation. CONCLUSIONS: The bone loss around the stem of this
prosthesis limits subsequent revision options, often resulting in a total femoral
prosthesis. Although the decision to use the Repiphysis device must be made on an
individual basis, surgeons should recognize the potential for significant bone
compromise limiting revision options and consider other options. LEVEL OF
EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete
description of levels of evidence.