Skip to main content
SpringerLink
Log in

Clinical Outcome of Total Knee Megaprosthesis Replacement for Bone Tumors

  • Chapter
Total Knee Arthroplasty

Abstract

Malignant bone tumors frequently develop around the knee. In the past, amputation was the most common type of treatment. However, advances in medical therapy over the last three decades have resulted in improved overall survival and limb salvage is feasible in the majority of patients. Reconstruction of resected bone and knee joints with megaprosthesis implantation restores a stable and functional extremity. Initial designs demonstrated a high number of complications; aseptic loosening, breakage of stem prosthesis, wear of polyethylene parts and infection. A hinge rotating mechanism, porous coated and hydroxyapatite collars and local rotational muscular flaps for wound coverage are surgical advances that have helped to reduce complication rates. The functional results of distal femur reconstructions are best compared to the proximal tibia. Currently the survival of megaprostheses from aseptic loosening around the knee is reported to exceed 90 % at 5 years. Infection and local tumor recurrence are the leading causes for late amputation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. National comprehensive cancer network. Bone cancer. J Natl Compr Canc Netw. 2013;11:688–723.

    Google Scholar 

  2. Simon MA, Springfield D, editors. Surgery for bone and soft-tissue tumors. Philadelphia: Lippincott-Raven; 1998. Chap 24a.

    Google Scholar 

  3. Abudu A, Grimer R, Tillman R, Carter S. The use of prostheses in skeletally immature patients. Orthop Clin North Am. 2006;37:75–84.

    Article  PubMed  Google Scholar 

  4. Marcove RC. En bloc resection of osteogenic sarcoma. Can J Surg. 1977;20:521–8.

    CAS  PubMed  Google Scholar 

  5. Rosen G, Marcove RC, Caparros B, Nirenberg A, Kosloff C, Huvos AG. Primary osteogenic sarcoma: the rationale for preoperative chemotherapy and delayed surgery. Cancer. 1979;43:2163–77.

    Article  CAS  PubMed  Google Scholar 

  6. Hillmann A, Hoffmann C, Gosheger G, Krakau H, Winkelmann W. Malignant tumor of the distal part of the femur or the proximal part of the tibia: endoprosthetic replacement or rotationplasty: functional outcome and quality-of-life measurements. J Bone Joint Surg Am. 1999;81A:462–8.

    Google Scholar 

  7. Capanna R, Scoccianti G, Campanacci DA, Beltrami G, De Biase P. Surgical technique: extraarticular knee resection with prosthesis-proximal tibia-extensor apparatus allograft for tumors invading the knee. Clin Orthop. 2011;469:2905–14.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Hardes J, Henrichs MP, Gosheger G, Gebert C, Höll S, Dieckmann R, Hauschild G, Streitbürger A. Endoprosthetic replacement after extra-articular resection of bone and soft-tissue tumours around the knee. Bone Joint J. 2013;95:1425–31.

    Article  PubMed  Google Scholar 

  9. Unwin PS, Cannon SR, Grimer RJ, Kemp HB, Sneath RS, Walker PS. Aseptic loosening in cemented custom-made prosthetic replacements for bone tumours of the lower limb. J Bone Joint Surg Br. 1996;78B:5–13.

    Google Scholar 

  10. Myers GJ, Abudu AT, Carter SR, Tillman RM, Grimer RJ. The long-term results of endoprosthetic replacement of the proximal tibia for bone tumours. J Bone Joint Surg Br. 2007;89:1632–7.

    Article  CAS  PubMed  Google Scholar 

  11. Malo M, Davis AM, Wunder J, Masri BA, Bell RS, Isler MH, Turcotte RE. Functional evaluation in distal femoral endoprosthetic replacement for bone sarcoma. Clin Orthop. 2001;389:173–80.

    Article  PubMed  Google Scholar 

  12. Schwartz AJ, Kabo JM, Eilber FC, Eilber FR, Eckardt JJ. Cemented endoprosthetic reconstruction of the proximal tibia: how long do they last? Clin Orthop. 2010;468:2875–84.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Simon MA, Aschiliman MA, Thomas N, Mankin HJ. Limb-salvage treatment versus amputation for osteosarcoma of the distal end of the femur. J Bone Joint Surg Am. 1986;68A:1331–7.

    Google Scholar 

  14. Rougraff BT, Simon MA, Kneisl JS, Greenberg DB, Mankin HJ. Limb salvage compared with amputation for osteosarcomamof the distal end of the femur: a long-term oncological, functional, and quality-of-life study. J Bone Joint Surg Am. 1994;76A:649–56.

    Google Scholar 

  15. Bernthal NM, Greenberg M, Heberer K, Eckardt JJ, Fowler EG. What are the functional outcomes of endoprosthestic reconstructions after tumor resection? Clin Orthop. 2014.

    Google Scholar 

  16. Unwin PS, Cobb JP, Walker PS. Distal femoral arthroplasty using custom made prostheses: the first 218 cases. J Arthroplasty. 1993;8:259–68.

    Article  CAS  PubMed  Google Scholar 

  17. Henderson ER, Groundland JS, Pala E, Dennis JA, Wooten R, Cheong D, Windhager R, Kotz RI, Mercuri M, Funovics PT, Hornicek FJ, Temple HT, Ruggieri P, Letson GD. Failure mode classification for tumor endoprostheses: retrospective review of five institutions and a literature review. J Bone Joint Surg Am. 2011;93A:418–29.

    Article  Google Scholar 

  18. Kramer MJ, Tanner BJ, Horvai AE, O’Donnell RJ. Compressive osseointegration promotes viable bone at the endoprosthetic interface: retrieval study of compress implants. Int Orthop. 2008;32:567–71.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Bini SA, Johnston JO, Martin DL. Compliant prestress fixation in tumor prostheses: interface retrieval data. Orthopedics. 2000;23:707–11.

    CAS  PubMed  Google Scholar 

  20. Torbert JT, Fox EJ, Hosalkar HS, Ogilvie CM, Lackman RD. Endoprosthetic reconstructions: results of long-term followup of 139 patients. Clin Orthop. 2005;438:51–9.

    Article  PubMed  Google Scholar 

  21. Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop. 1980;153:106–20.

    PubMed  Google Scholar 

  22. Malawer M. Distal femoral resection with endoprosthetic reconstruction. In: Malawer MM, Sugarbaker PH, editors. Musculoskeletal cancer surgery, Chapter 30. Dordrecht, The Netherlands: Kluwer Academic Publishers; p. 459.

    Google Scholar 

  23. Kawai A, Lin PP, Boland PJ, Athanasian EA, Healey JH. Relationship between magnitude of resection, complication, and prosthetic survival after prosthetic knee reconstructions for distal femoral tumors. J Surg Oncol. 1999;70:109–15.

    Article  CAS  PubMed  Google Scholar 

  24. Myers GJ, Abudu AT, Carter SR, Tillman RM, Grimer RJ. Endoprosthetic replacement of the distal femur for bone tumours: long-term results. J Bone Joint Surg Br. 2007;89:521–6.

    Article  CAS  PubMed  Google Scholar 

  25. Bergin PF, Noveau JB, Jelinek JS, Henshaw RM. Aseptic loosening rates in distal femoral endoprostheses: does stem size matter? Clin Orthop. 2012;470:743–50.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Batta V, Coathup MJ, Parratt MT, Pollock RC, Aston WJ, Cannon SR, Skinner JA, Briggs TW, Blunn GW. Uncemented, custom-made, hydroxyapatite-coated collared distal femoral endoprostheses: up to 18 years follow-up. Bone Joint J. 2014;96:263–9.

    Article  PubMed  Google Scholar 

  27. Capanna R, Morris HG, Campanacci D, Del Ben M, Campanacci M. Modular uncemented prosthetic reconstruction after resection of tumours of the distal femur. J Bone Joint Surg Br. 1994;76B:178–86.

    Google Scholar 

  28. Lan F, Wunder JS, Griffin AM, Davis AM, Bell RS, White LM, Ichise M, Cole W. Periprosthetic bone remodelling around a prosthesis for distal femoral tumours. Measurement by dual-energy X-ray absorptiometry (DEXA). J Bone Joint Surg Br. 2000;82B:120–5.

    Article  Google Scholar 

  29. Mittermayer F, Windhager R, Dominkus M, Krepler P, Schwameis E, Sluga M, Kotz R, Strasser G. Revision of the Kotz type of tumour endoprosthesis for the lower limb. J Bone Joint Surg Br. 2002;84B:401–6.

    Article  Google Scholar 

  30. Griffin AM, Parsons JA, Davis AM, Bell RS, Wunder JS. Uncemented tumor endoprostheses at the knee: root causes of failure. Clin Orthop. 2005;438:71–9.

    Article  PubMed  Google Scholar 

  31. Colangeli M, Donati D, Benedetti MG, Catani F, Gozzi E, Montanari E, Giannini S. Total knee replacement versus osteochondral allograft in proximal tibia bone tumours. Int Orthop. 2007;31:823–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  32. Dubousset J, Missenard G, Kalifa C. Management of osteogenic sarcoma in children and adolescents. Clin Orthop. 1991;270:52–9.

    PubMed  Google Scholar 

  33. Malawer MM, Price WM. Gastrocnemius transposition flap in conjunction with limbsparing surgery for primary sarcomas around the knee. Plast Reconstr Surg. 1984;73:741–9.

    Article  CAS  PubMed  Google Scholar 

  34. Gosheger G, Hillmann A, Lindner N, Rödl R, Hoffmann C, Bürger H, Winkelmann W. Soft tissue reconstruction of megaprostheses using a trevira tube. Clin Orthop. 2001;393:264–71.

    Article  PubMed  Google Scholar 

  35. Hardes J, Ahrens H, Nottrott M, Dieckmann R, Gosheger G, Henrichs MP, Streitbürger A. Attachment tube for soft tissue reconstruction after implantation of a mega-endoprosthesis. Oper Orthop Traumatol. 2012;24:227–34.

    Article  CAS  PubMed  Google Scholar 

  36. Ward WG, Johnson KS, Dorey FJ, Eckardt JJ. Extramedullary porous coating to prevent diaphyseal osteolysis and radiolucent lines around proximal tibial replacements. J Bone Joint Surg Am. 1993;75A:976–87.

    Google Scholar 

  37. Flint MN, Griffin AM, Bell RS, Ferguson PC, Wunder JS. Aseptic loosening is uncommon with uncemented proximal tibia tumor prostheses. Clin Orthop. 2006;450:52–9.

    Article  PubMed  Google Scholar 

  38. Mavrogenis AF, Pala E, Angelini A, Ferraro A, Ruggieri P. Proximal tibial resections and reconstructions: clinical outcome of 225 patients. J Surg Oncol. 2013;107:335–42.

    Article  PubMed  Google Scholar 

  39. Bickels J, Wittig JC, Kollender Y, Henshaw RM, Kellar-Graney KL, Meller I, Malawer MM. Distal femur resection with endoprosthetic reconstruction: a long-term follow up study. Clin Orthop. 2002;400:225–35.

    Article  PubMed  Google Scholar 

  40. Horowitz SM, Lane JM, Otis JC, Healey JH. Prosthetic arthroplasty of the knee after resection of a sarcoma in the proximal end of the tibia: a report of sixteen cases. J Bone Joint Surg Am. 1991;73A:286–93.

    Google Scholar 

  41. Malawer MM, Chou LB. Prosthetic survival and clinical results with use of large-segment replacements in the treatment of high-grade bone sarcomas. J Bone Joint Surg Am. 1995;77A:1154–65.

    Google Scholar 

  42. Wu CC, Henshaw RM, Pritsch T, Squires MH, Malawer MM. Implant design and resection length affect cemented endoprosthesis survival in proximal tibial reconstruction. J Arthroplasty. 2008;23:886–93.

    Article  PubMed  Google Scholar 

  43. Jeys L, Grimer R. The long-term risks of infection and amputation with limb salvage surgery using endoprostheses. Recent Results Cancer Res. 2009;179:75–84.

    PubMed  Google Scholar 

  44. Morii T, Morioka H, Ueda T, Araki N, Hashimoto N, Kawai A, Mochizuki K, Ichimura S. Deep infection in tumor endoprosthesis around the knee: a multi-institutional study by the Japanese musculoskeletal oncology group. BMC Musculoskelet Disord. 2013;14:51.

    Article  PubMed Central  PubMed  Google Scholar 

  45. Robert RS, Ottaviani G, Huh WW, Palla S, Jaffe N. Psychosocial and functional outcomes in long-term survivors of osteosarcoma: a comparison of limb-salvage surgery and amputation. Pediatr Blood Cancer. 2010;54:990–9.

    PubMed Central  PubMed  Google Scholar 

  46. Hardes J, Gebert C, Schwappach A, Ahrens H, Streitburger A, Winkelmann W, Gosheger G. Characteristics and outcome of infections associated with tumor endoprostheses. Arch Orthop Trauma Surg. 2006;126:289–96.

    Article  CAS  PubMed  Google Scholar 

  47. Grimer RJ, Belthur M, Chandrasekar C, Carter SR, Tillman RM. Two-stage revision for infected endoprostheses used in tumor surgery. Clin Orthop. 2002;395:193–203.

    Article  PubMed  Google Scholar 

  48. Flint MN, Griffin AM, Bell RS, Wunder JS, Ferguson PC. Two-stage revision of infected uncemented lower extremity tumor endoprostheses. J Arthroplasty. 2007;22:859–65.

    Article  PubMed  Google Scholar 

  49. Racano A, Pazionis T, Farrokhyar F, Deheshi B, Ghert M. High infection rate outcomes in long-bone tumor surgery with endoprosthetic reconstruction in adults: a systematic review. Clin Orthop. 2013;47:2017–27.

    Article  Google Scholar 

  50. Hussmann B, Johann I, Kauther MD, Landgraeber S, Jäger M, Lendemans S. Measurement of the silver ion concentration in wound fluids after implantation of silver-coated megaprostheses: correlation with the clinical outcome. Biomed Res Int. 2013;2013:763096.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  51. Glehr M, Leithner A, Friesenbichler J, Goessler W, Avian A, Andreou D, Maurer-Ertl W, Windhager R, Tunn PU. Argyria following the use of silver-coated megaprostheses: no association between the development of local argyria and elevated silver levels. Bone Joint J. 2013;95:988–92.

    Article  PubMed  Google Scholar 

  52. Gosheger G, Hardes J, Ahrens H, Streitburger A, Buerger H, Erren M, Gunsel A, Kemper FH, Winkelmann W, Von Eiff C. Silver-coated megaendoprostheses in a rabbit model – an analysis of the infection rate and toxicological side effects. Biomaterials. 2004;25:5547–56.

    Article  CAS  PubMed  Google Scholar 

  53. Hardes J, von Eiff C, Streitbuerger A, Balke M, Budny T, Henrichs MP, Hauschild G, Ahrens H. Reduction of periprosthetic infection with silver-coated megaprostheses in patients with bone sarcoma. J Surg Oncol. 2010;101:389–95.

    PubMed  Google Scholar 

  54. Shirai T, Tsuchiya H, Nishida H, Yamamoto N, Watanabe K, Nakase J, Terauchi R, Arai Y, Fujiwara H, Kubo T. Antimicrobial megaprostheses supported with iodine. J Biomater. 2014.

    Google Scholar 

  55. Gebhardt MC, Flugstad DI, Springfield DS, Mankin HJ. The use of bone allografts for limb salvage in high-grade extremity osteosarcoma. Clin Orthop. 1991;270:181–96.

    PubMed  Google Scholar 

  56. Brigman BE, Hornicek FJ, Gebhardt MC, Mankin HJ. Allografts about the knee in young patients with high-grade sarcoma. Clin Orthop. 2004;421:232–9.

    Article  PubMed  Google Scholar 

  57. Friesenbichler J, Maurer-Ertl W, Sadoghi P, Lovse T, Windhager R, Leithner A. Serum metal ion levels after rotating-hinge knee arthroplasty: comparison between a standard device and a megaprosthesis. Int Orthop. 2012;36:539–44.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, ATTIKON University General Hospital, Athens, Hellenic Republic, Greece

    Vasileios A. Kontogeorgakos MD, DSc

  2. Medical School, University of Athens, Athens, Hellenic Republic, Greece

    Vasileios A. Kontogeorgakos MD, DSc

Authors
  1. Vasileios A. Kontogeorgakos MD, DSc
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vasileios A. Kontogeorgakos MD, DSc .

Editor information

Editors and Affiliations

  1. Orthopaedic Department, University of Thessalia, Larissa, Greece

    Theofilos Karachalios

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag London

About this chapter

Cite this chapter

Kontogeorgakos, V.A. (2015). Clinical Outcome of Total Knee Megaprosthesis Replacement for Bone Tumors. In: Karachalios, T. (eds) Total Knee Arthroplasty. Springer, London. https://doi.org/10.1007/978-1-4471-6660-3_20

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-6660-3_20

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-6659-7

  • Online ISBN: 978-1-4471-6660-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation