Infection most frequent complication with megaprostheses in patients with bone tumors
Use of a megaprosthesis in patients with bone tumors has a failure rate of 25%, with infection as the most frequent complication, according to a presenter at the Virtual EFORT Congress.
Reinhard Windhager, MD, noted the infection rate was three times higher in the proximal tibia compared with the distal femur or the distal humerus, as well as five times higher in the proximal tibia compared with the proximal humerus and the proximal femur. After infection, he added the most frequent complications with use of a megaprosthesis included aseptic loosing, structural failure, recurrencies and soft tissue failure.
“Aseptic loosening was most frequently found in the distal femur, followed by the proximal tibia, proximal humerus, proximal femur and the distal humerus,” Windhager, of the department of orthopedics and trauma surgery at Medical University of Vienna in Vienna, Austria, said in the Erwin Morscher Honorary Lecture.
Windhager noted both the lower extremity and uniaxial joints had a higher failure rate compared with the upper extremity and polyaxial joint, respectively. Failures of a megaprosthesis are also significantly dependent on site, according to Windhager.
“The best outcome was found in the proximal femur reconstruction, followed by distal femur reconstruction or proximal tibia reconstruction,” Windhager said.
Windhager noted long-term outcomes have shown survival of a megaprosthesis around the knee to be between 45% to 60% at 20 years depending on the type of megaprosthesis.
The literature has also shown a satisfactory return to sports with the use of megaprosthesis, with one study showing a significant increase in sports activity up to 5 years postoperatively, according to Windhager.
“So, it is not that after 1 year postoperatively the maximum is reached, but as patients increase the activity during the following years,” Windhager said. “This is good news for the patients in decision-making.”
References:
Haijie L, et al. J Arthroplasty. 2018;doi:10.1016/j.arth.2017.10.051.
Henderson ER, et al. Bone Joint J. 2014;doi:10.1302/0301-620X.96B11.34747.
Lan NW, et al. Clin Orthop Relat Res. 2015;doi:10.1007/s11999-014-3788-2.
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Windhager R. Megaprostheses and 3D-printed implants in tumors and revision arthroplasty. Presented at: Virtual EFORT Congress; June 30 – July 2, 2021.
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