Survivorship, complications, and outcomes following distal femoral arthroplasty for non-neoplastic indications. (1st March 2022)

• Record Type: Journal Article
• Authors: Sobol, Keenan Rhys; Fram, Brianna R.; Strony, John T.; Brown, Scot A.
• Is Part Of: Bone & joint open. Volume 3:Number 3(2022)
• Page Start: 173
• Page End: 181
• Publication Date: 2022-03-01
• Subjects: Distal femoral replacement -- Megaprosthesis -- Distal femur -- Fracture -- Periprosthetic joint infection -- Mechanical failure -- Trauma -- Total joint -- femoral arthroplasty -- periprosthetic joint infection (PJI) -- reoperations -- mechanical failure -- femoral bone loss -- aseptic loosening -- distal femoral fractures -- nonunion -- periprosthetic distal femur fractures -- wound complications; Orthopedic surgery -- Periodicals; Musculoskeletal system -- Surgery -- Periodicals; 617.47
• DOI: 10.1302/2633-1462.33.BJO-2021-0202.R1
• Languages: English
• ISSNs: 2633-1462

Abstract

Abstract : Aims: Endoprosthetic reconstruction with a distal femoral arthroplasty (DFA) can be used to treat distal femoral bone loss from oncological and non-oncological causes. This study reports the short-term implant survivorship, complications, and risk factors for patients who underwent DFA for non-neoplastic indications. Methods: We performed a retrospective review of 75 patients from a single institution who underwent DFA for non-neoplastic indications, including aseptic loosening or mechanical failure of a previous prosthesis (n = 25), periprosthetic joint infection (PJI) (n = 23), and native or periprosthetic distal femur fracture or nonunion (n = 27). Patients with less than 24 months' follow-up were excluded. We collected patient demographic data, complications, and reoperations. Reoperation for implant failure was used to calculate implant survivorship. Results: Overall one- and five-year implant survivorship was 87% and 76%, respectively. By indication for DFA, mechanical failure had one- and five-year implant survivorship of 92% and 68%, PJI of 91% and 72%, and distal femur fracture/nonunion of 78% and 70% (p = 0.618). A total of 37 patients (49%) experienced complications and 27 patients (36%) required one or more reoperation. PJI (n = 16, 21%), aseptic loosening (n = 9, 12%), and wound complications (n = 8, 11%) were the most common complications. Component revision (n = 10, 13.3%) and single-stage exchange for PJI (n = 9, 12.0 %) were the most common reoperations. Only younger age was significantly associated with increased complications (mean 67 years (SD 9.1)) with complication vs 71 years (SD 9.9) without complication; p = 0.048). Conclusion: DFA is a viable option for distal femoral bone loss from a range of non-oncological causes, demonstrating acceptable short-term survivorship but with high overall complication rates. Cite this article: Bone Jt Open 2022;3(3):173–181.