Nahhas, M., Turcotte, R.E. and Isler, M. RADIOLOGICAL FOLLOW-UP OF DISTAL FEMORAL ENDOPROSTHESES FOR TUMOR RESECTION Nahhas, M., Turcotte, R.E. and Isler, M.

Radiological Follow-up of Distal Femoral Endoprostheses Choice of the reconstruction method depends on many variables function complications longevity of the implant (rate of revision) radiological follow-up

Radiological follow-up of distal femoral endoprostheses complications of massive oncological endoprosthetic implants (infection) recurrence aseptic loosening fracture bushing wear

Radiological follow-up of distal femoral endoprostheses Turner et al, OCNA #13, 1982 analyzed complications of early rotating hinge implants fractures of tibial bearing component 5/200 misalignment or lack of tibial support stress concentration corrected by design changes

Radiological follow-up of distal femoral endoprostheses Rotating hinge vs fixed hinge decreased constraints to decrease loosening bushing failure generation of metallic debris Polyethylene bearing surfaces increased debris?

Radiological follow-up of distal femoral endoprostheses GOAL to determine the rate of complications consequences longevity inform the surgeon and patient regarding choice of reconstruction options

Radiological follow-up of distal femoral endoprostheses Material and Methods: prospective orthopedic oncology database 32 patients had received a distal femoral massive endoprosthesis years 1990 to 2004

Radiological follow-up of distal femoral endoprostheses Material and Methods: identical implant (KMRS) identical technique (cemented) Average follow-up 3.8 years (46m) MSTS (ISOLS) method of radiologic evaluation

Radiological follow-up of distal femoral endoprostheses MSTS (ISOLS) method aseptic loosening (bone remodelling) aseptic loosening (interface) anchorage (loosening or fracture) implant body problems implant articulation problems (wear) extra-cortical bone bridging

Radiological follow-up of distal femoral endoprostheses

Radiological follow-up of distal femoral endoprostheses stress shielding

Radiological follow-up of distal femoral endoprostheses Results (N = 32) excellent bone remodeling in 31 no change from immediate postop excellent interface in 32 no radio-lucent line excellent anchorage in 31 adequate cement mantle, no change

Radiological follow-up of distal femoral endoprostheses Results (N=32) implant body problems: none Implant Articulation excellent in 30 (no change) good in 2 patients (<2mm decrease)

Radiological follow-up of distal femoral endoprostheses Results N=32 Extracortical bone bridging excellent in 6 patients, good in 4, fair in 11 and poor in 11 *beaded surface at interface

Radiological follow-up of distal femoral endoprostheses Turner et al, 1982 analyzed complications of early rotating hinge implants fractures of tibial bearing component 5/200 none in our series no significant signs of polyethylene wear being associated with loosening

Radiological follow-up of distal femoral endoprostheses Eckardt et al, 1997 N=24, F-up median 5.8y stress shielding proximal osteolysis osteolysis at the proximal junction as early sign of loosening (54%) at 42 m 17% radiological loosening 8% revision

Radiological follow-up of distal femoral endoprostheses Malawer, 2002 median f-up 7.8y revised for aseptic loosening 5.4% hardware failure 5.4% (polyethylene)

Radiological follow-up of distal femoral endoprostheses Chao et al 1996 N=30, F-up median 3.5y 1981-1993 similar results to ours, same implant extracortical bone bridging > 25% in 18 (60%)

Radiological follow-up of distal femoral endoprostheses Our study 3.8y follow-up no revisions done or planned bone bridging > 25% in 65% excellent radiological results

Radiological follow-up of distal femoral endoprostheses Discussion descriptive study of radiological complications in a prospective series using a uniform reconstruction method certain conclusions can be drawn regarding medium and long term outcome

Radiological follow-up of distal femoral endoprostheses Conclusion : Overall results in this series suggests a low rate of complications can be expected from the radiological standpoint when using massive endoprostheses for the reconstruction of the distal femur after oncological resection

Radiological follow-up of distal femoral endoprostheses this study adds to the existing evidence scientific data regarding the outcome for an implant allows the surgeon to make an evidence based choice

Radiological follow-up of distal femoral endoprostheses Thank you for your attention