학술논문
Cemented and Press-fit Femoral Stems for the Management of Oncologic Femoral Tumors.
Document Type
Academic Journal
Author
Su MW; From the Department of Orthopaedic Surgery, Massachusetts General Hospital, Musculoskeletal Oncology Service, Harvard Medical School, Boston, MA (Su, Groot, Werenski, Sodhi, Merchan, and Lozano-Calderon), Department of Orthopaedic Surgery, Musculoskeletal Oncology Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (Merchan, Anderson, Heincelman, Chang), Department of Orthopaedic Surgery, Musculoskeletal Oncology Service (Dr. Merchan, Dr. Anderson, Dr. Heincelman), Boston Children's Hospital, Harvard Medical School, Boston, MA (Dr. Merchan, Dr. Anderson, Dr. Heincelman).; Groot OQ; Werenski JO; Sodhi A; Merchan N; Anderson ME; Heincelman C; Chang CY; Lozano-Calderon SA
Source
Publisher: Wolters Kluwer Country of Publication: United States NLM ID: 9417468 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1940-5480 (Electronic) Linking ISSN: 1067151X NLM ISO Abbreviation: J Am Acad Orthop Surg Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Stem fixation in reconstruction after resection of femoral tumors is debated. Cemented stems offer immediate stability but risk aseptic loosening, while press-fit stems allow bone ingrowth but risk stress shielding and subsidence. Our retrospective review aimed to determine implant failure rates and their associated factors, as well as the rates of infection, debridement, and mortality for both fixation groups (cemented or press-fit stems) used in patients undergoing resection of femoral tumor disease and subsequent arthroplasty.
Methods: We retrospectively studied 252 patients who underwent resection of femoral tumors and subsequent arthroplasty using cemented (n = 173; 69%) or press-fit (noncemented) (n = 79; 31%) stems between 1999 and 2020. Implant failure was the primary outcome, with secondary outcomes including rates of implant infection, debridement, and mortality. Multivariable regression was done to assess risk factors for implant failures.
Results: The study found implant failure rates of 11% and 18% for cemented stems and press-fit stems, respectively. Lower stem to diaphyseal ratios (P = 0.024) and younger patients (P = 0.008) were associated with a higher risk of implant failure in cemented stems. The infection rates were 14% and 10% for cemented and press-fit stems, respectively. Debridement rates were 16% and 13% for cemented and press-fit stems, respectively, while the 1-year mortality rate was 16% for cemented stems and 1.5% for press-fit stems.
Conclusions: This study is the largest of its kind, providing patient characteristics and outcomes in both cemented and press-fit stems in the setting of reconstruction for femoral tumors. Both methods can be effective, with outcomes dependent on patient-specific factors, such as life expectancy, activity level, and body habitus, as well as proper implant fit. Additional studies of both implants and longer follow-up are required to elucidate the optimal fixation method for each individual patient.
Level of Evidence: Level III, retrospective noncomparative study.
(Copyright © 2024 by the American Academy of Orthopaedic Surgeons.)
Methods: We retrospectively studied 252 patients who underwent resection of femoral tumors and subsequent arthroplasty using cemented (n = 173; 69%) or press-fit (noncemented) (n = 79; 31%) stems between 1999 and 2020. Implant failure was the primary outcome, with secondary outcomes including rates of implant infection, debridement, and mortality. Multivariable regression was done to assess risk factors for implant failures.
Results: The study found implant failure rates of 11% and 18% for cemented stems and press-fit stems, respectively. Lower stem to diaphyseal ratios (P = 0.024) and younger patients (P = 0.008) were associated with a higher risk of implant failure in cemented stems. The infection rates were 14% and 10% for cemented and press-fit stems, respectively. Debridement rates were 16% and 13% for cemented and press-fit stems, respectively, while the 1-year mortality rate was 16% for cemented stems and 1.5% for press-fit stems.
Conclusions: This study is the largest of its kind, providing patient characteristics and outcomes in both cemented and press-fit stems in the setting of reconstruction for femoral tumors. Both methods can be effective, with outcomes dependent on patient-specific factors, such as life expectancy, activity level, and body habitus, as well as proper implant fit. Additional studies of both implants and longer follow-up are required to elucidate the optimal fixation method for each individual patient.
Level of Evidence: Level III, retrospective noncomparative study.
(Copyright © 2024 by the American Academy of Orthopaedic Surgeons.)