Arnaud Dubory1,2, Eric Mascard3, Méryl Dahan4, Philippe Anract4, Charles Court5,6, Stéphane Boisgard7, Brice Viard5,6, Gilles Missenard5,6. 1. Orthopaedic Department, Tumor and Spine Unit, Bicêtre University Hospital, AP-HP Paris, 78 rue du Général Leclerc, Le Kremlin-Bicêtre, France, F-94270. arnauddubory@hotmail.fr. 2. JE 2494 Univ Paris-Sud Orsay, F-01405, Orsay, France. arnauddubory@hotmail.fr. 3. Clinique Arago, 187 rue Raymond Losserand, Paris, France, 75014. 4. Orthopaedic Department, Cochin University Hospital, AP-HP Paris, 27 rue du Faubourg Saint-Jacques, Paris, France, 75014. 5. Orthopaedic Department, Tumor and Spine Unit, Bicêtre University Hospital, AP-HP Paris, 78 rue du Général Leclerc, Le Kremlin-Bicêtre, France, F-94270. 6. JE 2494 Univ Paris-Sud Orsay, F-01405, Orsay, France. 7. Orthopaedic Department, University Hospital-Medical School Clermont-Ferrand, CHU Gabriel-Montpied, 58 rue Montalembert, Clermont-Ferrand, France, 63000.
Abstract
PURPOSE: Allograft hip composite prosthesis (APC) is a type of reconstruction after resection of the proximal femur. This study aimed to assess long-term outcomes after an APC reconstruction. MATERIALS AND METHODS: Forty-six patients were retrospectively included (14 revision total hip replacements, 30 primary malignant bone tumors, two metastasis). RESULTS: The mean length of femoral bone resection was 16.4 cm (7 to 27). With a mean follow-up of 14.7 years (6.3 to 32.6), Postel-Merle d'Aubigné score was 15.7 (8 to 21), Musculoskeletal Tumor Society score at 23.1 or 77% (15 to 29), and abductor strength at 3.4 (2 to 5). Allograft resorption was minor for 20 patients (44.4%), moderate for 13 patients (28.9%), and severe for 12 patients (26.7%). Host-allograft shaft bone fusion was achieved in 37 cases (84.1%). Trochanteric fracture occurred in 26 cases (59.1%). Length of femoral resection, allograft bone resorption, and trochanteric fracture did not have an effect on functional outcomes. At ten years follow-up, overall revision-free and femoral stem survivals were 54.1 ± 0.8% and 81.4 ± 0.6% respectively. No parameter evaluated influenced the survivorship. CONCLUSION: APC is a reliable reconstruction adapted for huge proximal femoral bone resections. Trochanteric fracture and allograft bone resorption do not seem to influence functional results. LEVEL OF EVIDENCE: Level IV.
PURPOSE: Allograft hip composite prosthesis (APC) is a type of reconstruction after resection of the proximal femur. This study aimed to assess long-term outcomes after an APC reconstruction. MATERIALS AND METHODS: Forty-six patients were retrospectively included (14 revision total hip replacements, 30 primary malignant bone tumors, two metastasis). RESULTS: The mean length of femoral bone resection was 16.4 cm (7 to 27). With a mean follow-up of 14.7 years (6.3 to 32.6), Postel-Merle d'Aubigné score was 15.7 (8 to 21), Musculoskeletal Tumor Society score at 23.1 or 77% (15 to 29), and abductor strength at 3.4 (2 to 5). Allograft resorption was minor for 20 patients (44.4%), moderate for 13 patients (28.9%), and severe for 12 patients (26.7%). Host-allograft shaft bone fusion was achieved in 37 cases (84.1%). Trochanteric fracture occurred in 26 cases (59.1%). Length of femoral resection, allograft bone resorption, and trochanteric fracture did not have an effect on functional outcomes. At ten years follow-up, overall revision-free and femoral stem survivals were 54.1 ± 0.8% and 81.4 ± 0.6% respectively. No parameter evaluated influenced the survivorship. CONCLUSION: APC is a reliable reconstruction adapted for huge proximal femoral bone resections. Trochanteric fracture and allograft bone resorption do not seem to influence functional results. LEVEL OF EVIDENCE: Level IV.
Entities:
Keywords:
Abductor strength; Allograft hip prosthesis; Allograft resorption; Primary malignant bone tumor; Trochanteric fracture
Authors: J D'Antonio; J C McCarthy; W L Bargar; L S Borden; W N Cappelo; D K Collis; M E Steinberg; J H Wedge Journal: Clin Orthop Relat Res Date: 1993-11 Impact factor: 4.176
Authors: Joseph L Finstein; Joseph J King; Edward J Fox; Christian M Ogilvie; Richard D Lackman Journal: Clin Orthop Relat Res Date: 2007-06 Impact factor: 4.176
Authors: Cai Liu; Li Min; Yong Zhou; Yi Luo; Fan Tang; Minxun Lu; Hong Duan; Wenli Zhang; Xinzhu Yu; Chongqi Tu Journal: BMC Musculoskelet Disord Date: 2021-02-01 Impact factor: 2.362