Osseointegration reduces aseptic loosening of primary distal femoral implants in pediatric and adolescent osteosarcoma patients: a retrospective clinical and radiographic study.

Autor: Welsh C; College of Medicine, University of Central Florida, Orlando, FL, USA., Hull P; College of Medicine, University of Central Florida, Orlando, FL, USA., Meckmongkol T; College of Medicine, University of Central Florida, Orlando, FL, USA.; Department of General Surgery, Nemours Children's Hospital, Orlando, FL, USA.; Department of Internal Medicine, College of Medicine, Biionix (Bionic Materials, Implants & Interfaces) Cluster, University of Central Florida, Orlando, FL, USA., Mumith A; College of Medicine, University of Central Florida, Orlando, FL, USA.; Department of Internal Medicine, College of Medicine, Biionix (Bionic Materials, Implants & Interfaces) Cluster, University of Central Florida, Orlando, FL, USA.; Sunnybrook Holland Orthopaedic Centre, Toronto, Canada., Lovejoy J; College of Medicine, University of Central Florida, Orlando, FL, USA.; Department of Orthopaedics, Sports Medicine and Physical Medicine and Rehabilitation, Nemours Children's Hospital, Orlando, FL, USA., Giangarra C; Department of Orthopaedic Surgery, Marshall University, Huntington, WV, USA., Coathup M; College of Medicine, University of Central Florida, Orlando, FL, USA. Melanie.coathup@ucf.edu.; Department of Internal Medicine, College of Medicine, Biionix (Bionic Materials, Implants & Interfaces) Cluster, University of Central Florida, Orlando, FL, USA. Melanie.coathup@ucf.edu.
Jazyk: angličtina
Zdroj: European journal of orthopaedic surgery & traumatology : orthopedie traumatologie [Eur J Orthop Surg Traumatol] 2023 Dec; Vol. 33 (8), pp. 3585-3596. Date of Electronic Publication: 2023 May 29.
DOI: 10.1007/s00590-023-03590-2
Abstrakt: Aim: The challenge of distal femoral replacement (DFR) longevity remains a priority for orthopaedic oncologists as the overall survival and activity level of young patients with osteosarcoma continues to improve. This study hypothesized that increased extracortical osseointegration at the bone-implant shoulder (i.e., where the metal implant shaft abuts the femur) will improve stress transfer adjacent to the implant, as evidenced by reduced cortical bone loss, radiolucent line progression and implant failure in young patients (< 20 years) following DFR surgery.
Methods: Twenty-nine patients of mean age 13.09 ± 0.56 years received a primary DFR. The clinical outcome of 11 CPS®, 10 GMRS®, 5 Stanmore® and 3 Repiphysis® implants was evaluated over a mean follow-up period of 4.25 ± 0.55 years. The osseous response to a bone-implant shoulder composed of either a hydroxyapatite-coated grooved ingrowth collar (Stanmore®), a porous metal coating (GMRS®) or a polished metal surface (Repiphysis®) was quantified radiographically.
Results: All (100.0%) of the Stanmore® implants, 90.0% of GMRS®, 81.8% of CPS® and 33.3% of the Repiphysis® implants survived. Significantly increased extracortical bone and osseointegration were measured adjacent to the Stanmore® bone-implant shoulder when compared with the GMRS® and Repiphysis® implants (p < 0.0001 in both cases). Significantly decreased cortical loss was identified in the Stanmore® group (p = 0.005, GMRS® and p < 0.0001, Repiphysis®) and at 3 years, the progression of radiolucent lines adjacent to the intramedullarly stem was reduced when compared with the GMRS® and Repiphysis® implants (p = 0.012 and 0.026, respectively).
Conclusions: Implants designed to augment osseointegration at the bone-implant shoulder may be critical in reducing short- (≤ 2 years) to mid- (≤ 5 years) term aseptic loosening in this vulnerable DFR patient group. Further longer-term studies are required to confirm these preliminary findings.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)
Databáze: MEDLINE
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