Use of rotating-hinge knee prosthesis after distal femoral resection had durable outcomes
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Use of a rotating-hinge knee prosthesis after distal femoral resection had durable long-term outcomes with a gradual rate of implant removal or revision after 10 years, according to published results.
Researchers retrospectively studied data of 214 patients who received a Finn/Orthopaedic Salvage System knee prosthesis (Zimmer Biomet) after distal femoral resection of a malignant or aggressive benign tumor from 1991 to 2017. Researchers considered postoperative complications requiring surgery as the study endpoint. Researchers classified reoperations as major when there was removal or exchange of the metal-body femoral component, the tibial component or the bone-implant fixation, or amputation. To estimate the cumulative incidence of implant removal or revision or amputation, researchers used competing risk analysis.
Results showed 312 reoperations were performed in 113 patients, with 8% of patients requiring five or more additional operations and 10% of patients requiring more than one major reoperation. Researchers found major and minor reoperations continuously accrued after 10 years despite a decrease in the number of reoperations over time. Patients had a cumulative incidence of implant removal or revision for any reason of 22.6% at 5 years, 30.1% at 10 years, 34.3% at 15 years and 42.5% at 20 years, according to results. Although most implant removals or revisions occurred in the first 10 years, researchers noted the risk persisted at a mean of 1.24% per year mainly due to deep infection.
“While the long-term follow-up schedule is individualized, we recommend lifetime evaluation by a surgeon familiar with, and able to treat, late problems that continue to occur with the specific implant. Notably, design changes make it imperative that appropriate sizes with which to exchange older components are available,” the authors wrote. “Our results may help clinicians plan the surveillance schedule and explain the exact long-term burden of reoperations to patients who remain disease free.”
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