The Journal of Bone and Joint Surgery 80:636-47 (1998)
© 1998 The Journal of Bone and Joint Surgery, Inc.
Prosthetic Knee Replacement after Resection of a Malignant Tumor of the Distal Part of the Femur. Medium to Long-Term Results*
AKIRA KAWAI, M.D. ,
GEORGE F. MUSCHLER, M.D. ,
JOSEPH M. LANE, M.D. ,
JAMES C. OTIS, PH.D. and
JOHN H. HEALEY, M.D., NEW YORK, N.Y.
Investigation performed at the Orthopaedic Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York City
We evaluated the medium to long-term results of treatment with a custom prosthetic knee replacement after wide resection of a primary malignant tumor of the distal part of the femur in forty consecutive patients. The duration of follow-up ranged from five to seventeen years (median, eight years). At the time of the latest follow-up, thirty-five (88 per cent) of the forty patients were free of disease and five (13 per cent) were alive with metastatic disease. No local recurrence was observed. Twenty early complications occurred in eighteen patients (45 per cent). Aseptic loosening of the femoral component, which necessitated a revision in eleven patients at an average of fifty-one months, was the most frequent mode of failure. The rate of prosthetic survival, as estimated with use of the Kaplan-Meier method, was 85, 67, and 48 per cent at three, five, and ten years. Univariate analysis demonstrated that the rate of prosthetic survival was significantly worse for male patients, for those in whom at least 40 per cent of the femur had been resected, for those who had had total resection of the quadriceps muscles or subtotal resection (preservation of only the rectus femoris muscle), and for those in whom a straight femoral stem had been used (p < 0.05 for all comparisons). Multivariate analysis showed that the independent adverse prognostic factors for prosthetic survival were male gender, resection of at least 40 per cent of the femur, and fixation of the femoral stem with cement. The rate of limb salvage was calculated, with use of the Kaplan-Meier method, to be 93 per cent at three years and 90 per cent at five and ten years.
At the latest follow-up examination, the functional scores according to the classification system of the Musculoskeletal Tumor Society ranged from 14 to 29 points; the mean was 24 points, which represents function that is 80 per cent that of normal. The mean scores in the categories of walking supports and gait were better for the patients in whom the quadriceps muscles had been preserved than for those who had had total or subtotal resection of those muscles.
Although advances in imaging and local therapy narrow the indications for an extra-articular resection of a tumor, the implant that was used in the present study continues to be used in approximately 15 per cent of patients who have a fracture or an intra-articular extension of the tumor that necessitates extensive extra-articular resection.
 CiteULike  Connotea  Del.icio.us  Technorati What's this?
This article has been cited by other articles:
|
|
|
|
 
D. L. Muscolo, M. A. Ayerza, L. A. Aponte-Tinao, E. Abalo, and G. Farfalli
Unicondylar Osteoarticular Allografts of the Knee
J. Bone Joint Surg. Am.,
October 1, 2007;
89(10):
2137 - 2142.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Futani, T. Minamizaki, Y. Nishimoto, S. Abe, H. Yabe, and T. Ueda
Long-Term Follow-up After Limb Salvage in Skeletally Immature Children with a Primary Malignant Tumor of the Distal End of the Femur
J. Bone Joint Surg. Am.,
March 1, 2006;
88(3):
595 - 603.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. S. Weisstein, R. E. Goldsby, and R. J. O'Donnell
Oncologic Approaches to Pediatric Limb Preservation
J. Am. Acad. Ortho. Surg.,
December 1, 2005;
13(8):
544 - 554.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. L. Muscolo, M. A. Ayerza, L. A. Aponte-Tinao, and M. Ranalletta
Use of Distal Femoral Osteoarticular Allografts in Limb Salvage Surgery
J. Bone Joint Surg. Am.,
November 1, 2005;
87(11):
2449 - 2455.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W.-C. Li, R.-S. Yang, and J.-Y. Tsauo
Knee Proprioception in Patients with Osteosarcoma Around the Knee After Modular Endoprosthetic Reconstruction
J. Bone Joint Surg. Am.,
April 1, 2005;
87(4):
850 - 856.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Tsuchiya, S. L. Wan, K. Sakayama, N. Yamamoto, H. Nishida, and K. Tomita
Reconstruction using an autograft containing tumour treated by liquid nitrogen
J Bone Joint Surg Br,
February 1, 2005;
87-B(2):
218 - 225.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. A. Paluska
Persistent Knee Pain in a Recreational Runner
J Am Board Fam Med,
September 1, 2003;
16(5):
435 - 442.
[Full Text]
|
|
|
|
|
|
|
M. R. DiCaprio and G. E. Friedlaender
Malignant Bone Tumors: Limb Sparing Versus Amputation
J. Am. Acad. Ortho. Surg.,
January 1, 2003;
11(1):
25 - 37.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. C. Gebhardt
What's New in Musculoskeletal Oncology
J. Bone Joint Surg. Am.,
April 1, 2002;
84(4):
694 - 701.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Kawai, T. Miyakawa, M. Senda, H. Endo, N. Naito, M. Umeda, and H. Inoue
Gait Characteristics After Limb-Sparing Surgery with Sciatic Nerve Resection : A Report of Two Cases
J. Bone Joint Surg. Am.,
February 1, 2002;
84(2):
264 - 268.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. HILLMANN, D. ROSENBAUM, J. SCHRÖTER, G. GOSHEGER, C. HOFFMANN, and W. WINKELMANN
Electromyographic and Gait Analysis of Forty-three Patients After Rotationplasty
J. Bone Joint Surg. Am.,
February 1, 2000;
82(2):
187 - 96.
[Abstract]
[Full Text]
|
|
|
|
