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Case Reports
. 2020 Apr;44(4):677-684.
doi: 10.1007/s00264-019-04383-1. Epub 2019 Aug 7.

Megaprosthesis in distal femur nonunions in elderly patients-experience from twenty four cases

Raja Bhaskara Rajasekaran  1 , Dhanasekara Raja Palanisami  2 , Rajkumar Natesan  2 , Dheenadhayalan Jayaramaraju  2 , Shanmuganathan Rajasekaran  2
Affiliations
Case Reports

Megaprosthesis in distal femur nonunions in elderly patients-experience from twenty four cases

Raja Bhaskara Rajasekaran et al. Int Orthop. 2020 Apr.

Abstract

Purpose of the study: To evaluate the outcomes and complications using cemented megaprosthesis in elderly patients with distal femur nonunions (DFN).

Materials and methods: Between 2012 and 2016, 24 patients of DFN with an average age of 71.8 years (66-83) and an average 1.9(1-3) prior surgery was managed with distal femur replacement using cemented modular endoprosthesis. Outcomes were analysed on the following criteria: implant status, complications, knee range of motion, Knee Society Score (KSS) and Musculoskeletal Tumor Society (MSTS) score.

Results: All patients were extremely satisfied with their outcomes. At an average 22.1 months (10-43) follow-up, patients had an average 69.5° (40°-110°) knee flexion, an average KSS of 75.7 (63-88) and an average MSTS score of 19.3 (17-25). Four patients died at an average 21.3 months after surgery due to causes unrelated to the fracture. One patient (4.1%) had implant-related complication; deep infection which required debridement and intravenous antibiotics. There were no late amputations or peri-operative deaths and no patient had aseptic loosening of components.

Conclusion: By permitting immediate full weight-bearing ambulation and with most patients returning to an acceptable functional status, cemented megaprosthesis is a viable and useful single-stage management option in elderly patients with DFN.

Keywords: Arthroplasty; Distal femur nonunions; Elderly; Knee Society Score; Megaprosthesis.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

The study was performed in accordance with the ethical standards in the 1964 Declaration of Helsinki.

Figures

Fig. 1
Fig. 1
Distal femur nonunion with implant failure (a, b) following two previous attempts at fixation in a 72-year-old patient. Resected nonunion segment of the distal femur (c) with portion of the shaft resected (d) during surgery and manages with Depuy LPS Prosthesis (e). Follow-up radiographs (f, g) at 18 months post-surgery
Fig. 2
Fig. 2
Radiographs (a, b) of a 66-year-old patient with nonunion of the distal femur with implant failure was managed with LINK Megasystem-C. Radiographs (c, d) at 24 months follow-up showing a well-functioning prosthesis
Fig. 3
Fig. 3
Nonunion with implant failure coupled with severe arthritis (a, b) in an 80-year-old patient was managed with ResTOR prosthesis. Radiographs (c, d) at 19 months post-surgery
See this image and copyright information in PMC

Comment in

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