Comparative Analysis of Early Follow‐up of Biologic Fixation and Cemented Stem Fixation for Femoral Tumor Prosthesis

Abstract

Objective To compare the safety and efficacy between biologic fixation and traditional cement stems for the fixation of distal femoral prostheses for reconstruction following tumor resection. Methods Retrospective analysis was performed of patients who received a first distal femoral tumor prosthesis, with a rotating hinge, in the Department of Orthopaedic Oncology of Beijing Jishuitan Hospital between October 2011 and January 2016. Two hundred and sixty eligible cases were enrolled, with a cemented fixation used in 199 of these cases and a biologic fixation in 61 cases. Survival rates and survival time of prostheses were analyzed, with prosthetic failure considered as the endpoint event for survival time of the prosthesis. Kaplan–Meier survival curve and the log‐rank test were used to compare survival rates between the two types of fixation methods, and factors that may affect the survival rate of prosthesis were evaluated. Results Of the 260 cases forming our study group, 138 were males and 122 females, with 102 males and 97 females in the cemented fixation group (mean age, 25.8 years; range, 8–72 years) and 36 males and 25 females in the biologic fixation group (mean age, 25.5 years; range, 12–59 years). Osteosarcoma was the most common type of tumor (188 cases, 72.3%), of which 145 cases (72.9%) were in the cemented and 45 cases (72.1%) in the biologic fixation group. Among the 260 cases enrolled into the study group, 13 patients were lost to follow‐up. The average duration of follow‐up for the remaining 247 cases was 28.8 months (median, 28.8 months; range, 4–61 months). The 3‐year overall survival rate of prostheses was 87.2% for the biologic fixation group and 80.4% in the cemented fixation group (P = 0.389). The 3‐year mechanical survival rate (excluding cases of infection and oncologic progression) was 100% for the biologic fixation and 97.6% for the cemented fixation group (P = 0.468). Complications were identified in 21 cases: 3 cases (5%) in the biologic and 18 cases (9.6%) in the cemented fixation group (P = 0.264). Two revisions were required in the cemented fixation group, but no revision was required in the biologic fixation group. A total of 10 patients required amputation after prosthesis implantation. Of these, 7 cases (4 cement and 3 biologic) were due to tumor recurrence; 3 cases were due to infection, with all cases occurring in the cement fixation group. Conclusion The current study provides a baseline reference for future mid‐term to long‐term follow‐up, laying the foundation for further studies and comparison of the incidence of aseptic loosening of both types of prosthesis.

Keywords

• Biological fixation
• Distal femoral tumor prosthesis
• Prosthesis survival rate