Abstract:
BACKGROUND:Compressive osseointegration is a promising modality for limb salvage in distal femoral oncologic tumors. However, few studies have explored short-term survival rates in a large patient cohort of distal femur compressive endoprostheses or highlighted the risk factors for spindle failures. QUESTIONS/PURPOSES:We asked: (1) What is the frequency of compressive osseointegration spindle failure in distal femoral reconstructions? (2) What are the characteristics of rotational failure cases with distal femur compressive osseointegration endoprostheses? (3) What are the risk factors for mechanical and rotational failure of distal femur compressive osseointegration implantation? (4) What are other modalities of failure or causes of revision surgery, which affect patients undergoing distal femur compressive osseointegration implantation for oncologic reconstruction? METHODS:Between 1996 and 2013, 127 distal femoral reconstructions with the Compress(®) prosthesis were performed in 121 patients. During that time, 116 Compress(®) prostheses were implanted for aggressive primary tumors of the distal femur and/or failure of previous oncologic reconstruction. This approach represented approximately 91% of the distal femoral reconstructions performed during that time. Of the patients with prostheses implanted, four patients (four of 116, 3%) had died, and 37 (37 of 116, 32%) were lost to followup before 24 months. The median followup was 84 months (range, 24-198 months), and 71 patients (66% of all patients) were seen within the last 3 years. A retrospective chart review was performed to determine failure modality as defined by radiographs, clinical history, and intraoperative findings. Risk factors including age, sex, BMI, resection length, and perioperative chemotherapy were analyzed to determine effect on spindle and rotational failure rates. Survival analysis was determined using the Kaplan-Meier estimator. Differences in survival between groups were analyzed using the log rank test. Risk factors were determined using Cox proportional hazard modeling. RESULTS:Spindle survival at 5 and 10 years was 91% (95% CI, 82%-95%). Survival rates from rotational failure at 5 and 10 years were 92% (95% CI, 83%-96%); the majority of failures occurred within the first 2 years postoperatively and were the result of a twisting mechanism of injury. With the numbers available, none of the potential risk factors examined were associated with mechanical failure. The 5-year and 10-year all-cause revision-free survival rates were 57% (95% CI, 44%-67%) and 50% (95% CI, 36%-61%), respectively. CONCLUSIONS:Distal femur compressive osseointegration is a viable method for endoprosthetic reconstruction. Rotational failure is rare with the majority occurring early. No variables were found to correlate with increased risk of mechanical failure. More research is needed to evaluate methods of preventing mechanical and rotational failures in addition to other common causes of revision such as infection in these massive endoprosthetic reconstructions. LEVEL OF EVIDENCE:Level IV, therapeutic study.
journal_name
Clin Orthop Relat Resjournal_title
Clinical orthopaedics and related researchauthors
Goldman LH,Morse LJ,O'Donnell RJ,Wustrack RLdoi
10.1007/s11999-016-4839-7subject
Has Abstractpub_date
2016-07-01 00:00:00pages
1714-23issue
7eissn
0009-921Xissn
1528-1132pii
10.1007/s11999-016-4839-7journal_volume
474pub_type
杂志文章abstract::Stress fracture of the patella can occur with significant frequency following patellar replacement with the duopatellar knee prosthesis. In the first 372 knees with patellar resurfacing, the incidence was 0.7% in rheumatoid arthritis (2 fractures in 286 knees) and 3.5% in osteoarthritis (3 fractures in 86 knees). The ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1982-10-01 00:00:00
abstract::Orthopaedic residency has undergone continual evolution since the early 1900s. Training has evolved from a preceptorship to a highly evolved and structured educational system which largely standardizes training throughout the United States. Approval and accreditation of training programs, as well as content, is now ov...
journal_title:Clinical orthopaedics and related research
pub_type: 历史文章,杂志文章
doi:10.1097/01.blo.0000224022.11282.71
更新日期:2006-08-01 00:00:00
abstract::Peripheral nerve injury occasionally results from long bone fractures, but bony entrapment of a peripheral nerve occurs infrequently. Bony entrapment of a peripheral nerve is usually associated with upper extremity fractures. In a 34-year-old man bony entrapment of the superficial peroneal nerve occurred in a healed m...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1984-05-01 00:00:00
abstract::Pain in the anterior knee has become synonymous with patella chondromalacia. However, pain also is the first sign of a tumor of the patella. Tumors of the patella are rare, but they often are mistaken for other benign lesions. Benign tumors of the patella are more frequent than malignant tumors (73% versus 27%). The m...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-200108000-00007
更新日期:2001-08-01 00:00:00
abstract:UNLABELLED:To augment cement-bone bonding, we interposed hydroxyapatite granules at the cement-bone interface (bioactive bone cement technique). Hydroxyapatite granules (2-3 g) were smeared on the bone surface of the acetabulum and femur just before cementing. We used porous hydroxyapatite granules 300 to 500 microm in...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-007-0057-7
更新日期:2008-02-01 00:00:00
abstract::Cases of longstanding (median, 60 months) tarsal tunnel syndrome were decompressed surgically in 14 female and four male patients. Patients reported intermittent dysesthesia, paresthesia, or anesthesia at the medial plantar aspect of the foot. Symptoms were aggravated by physical activities. Previous trauma was noted ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-016-5011-0
更新日期:2017-04-01 00:00:00
abstract::Evidence from studies on migration raises serious doubts regarding the part played by fatigue failure of acrylic bone cement in the genesis of aseptic loosening of the components of total hip arthroplasties. Moreover, the viscoelastic properties of cement raise serious doubts concerning the relevance of conventional l...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:10.1097/00003086-199810000-00026
更新日期:1998-10-01 00:00:00
abstract::One hundred eighty five consecutive patients underwent anterior decompression, stabilization, and/or fusion procedures of the thoracolumbar spine. At 1 year or more followup, the incidence of complications was analyzed. There were no iatrogenic spinal neurologic deficits and no deep wound infections. The most common c...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1994-09-01 00:00:00
abstract::Vascular injury is one of the drastic complications that can arise from internal fixation of acetabular fractures. A 29-year-old, obese man sustained multiple trauma, including a displaced transverse acetabular fracture. Extreme obesity made adequate exposure to the posterior acetabular area difficult, causing placeme...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1987-04-01 00:00:00
abstract::Operative treatment of inadequately or imperfectly treated fractures of the distal radius can improve wrist and hand function substantially, but rarely restores the limb to normal. Patients with malunion of the distal radius present either with poor radiographic alignment before complete healing of the fracture (nasce...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:10.1097/01.blo.0000152442.66083.ff
更新日期:2005-02-01 00:00:00
abstract::A prospective study ascertained the effect of lateral retinacular release and/or excision of the infrapatellar fat pad on patellar vascularity after total knee arthroplasty. Fifty patients (70 knees) had postoperative technetium bone scans, which revealed a higher incidence of vascular compromise of the patella after ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1990-11-01 00:00:00
abstract::A quantitative three-dimensional measurement method, radiographic stereophotogrammetry (SPG), was employed to assess the relation between early subsidence of the femoral prosthesis after total hip arthroplasty (THA) and subsequent clinical course. The SPG technique and the authors' error control mechanisms are describ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1985-12-01 00:00:00
abstract::Marlex mesh is a synthetic material which has been used clinically to replace ligamentous structures. It serves as a scaffold for infiltration of the fibroblasts eventually becoming mature fibrocytes. In dogs, almost totally mature fibrocytes appear within the framework of the Marlex mesh prosthesis by the end of 3 mo...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1978-11-01 00:00:00
abstract::The goal of this study was to determine if obesity is a risk factor for total joint arthroplasty. This was a retrospective review of 130 patients treated with either primary total hip arthroplasty or primary total knee arthroplasty during a two-year period (154 consecutive arthroplasties). The patients were placed in ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1993-04-01 00:00:00
abstract::The anatomic abnormalities and the effects of serial release of soft tissue are described in seven stillborn fetal clubfeet. The essential anatomic abnormality is a dislocation of the talocalcaneonavicular joint, with dysplastic changes in the talus and less severe changes in the adjacent bones. By gradually releasing...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1983-04-01 00:00:00
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-015-4232-y
更新日期:2015-07-01 00:00:00
abstract::What percent of abstracts presented at the American Academy of Orthopaedic Surgeons annual meeting are submitted, survive peer review, and eventually are published? The answer to this fundamental question is important because many national meeting attendees use the unscrutinized information that is presented to alter ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-199902000-00028
更新日期:1999-02-01 00:00:00
abstract::Two hundred and twenty-one consecutive arthroscopic examinations of the knee are reviewed to establish diagnostic accuracy based on subsequent arthrotomy and the clinical course in the absence of arthrotomy. One hundred and nine knees showed an arthroscopic accuracy of 89.9 per cent at subsequent arthrotomy. Ninety-fi...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1976-11-01 00:00:00
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1978-09-01 00:00:00
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,meta分析,评审
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更新日期:2012-02-01 00:00:00
abstract::A 19-year-old man with a fracture of the distal humerus avulsed the anterior interosseous nerve. Avulsion of this nerve may be more common than previously believed. As shown by a cadaver study, the mechanism of injury is related to traction on the median nerve. Complete clinical assessment requires an accurate neurolo...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1983-12-01 00:00:00
abstract::Malleolar fractures are one of the most common fractures faced in orthopaedic surgery. The results from a consecutive series of 144 malleolar fractures during a 10-year period that were classified and treated according to the AO system are presented. Assessment of outcome was done using the scoring system of Baird and...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1997-08-01 00:00:00
abstract::Detailed, long-term studies of cemented total hip arthroplasties clearly show that failure of fixation of the acetabular component is a major problem, with a rising incidence and an unusual complexity. By finite element analysis the stress distribution in the human acetabulum before and after total hip arthroplasty wa...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1984-03-01 00:00:00
abstract::A study of the injury fatality rate in an adult population was done in the Moscow region. Investigators determined that side by side with the severity of injury, the direct causes of death were erroneous diagnosis, ungrounded delay of surgical interventions, and lack of and insufficient use of necessary medical care. ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1995-11-01 00:00:00
abstract::A small amount of partially purified, water-soluble murine osteosarcoma-derived bone morphogenetic protein (BMP) was implanted into the dorsal muscles of mice in combination with calf skin gelatin or collagen as carriers. Changes in the ribs adjacent to the implants were then chronologically observed. On implantation ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1989-02-01 00:00:00
abstract::The purpose of this study was to quantify precisely aging-induced changes in skeletal perfusion and bone mechanical properties in a small rodent model. Blood flow was measured in conscious juvenile (2 months old), adult (6 months old), and aged (24 months old) male Fischer-344 rats using radiolabeled microspheres. The...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
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更新日期:2002-03-01 00:00:00
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/01.blo.0000136836.78049.45
更新日期:2004-08-01 00:00:00