Abstract
A retrospective study focusing on long-term follow up of 28 patients with a malignant bone tumour in the distal femur was conducted. Patients with a mean age of 50 (18–90) were clinically and radiologically followed-up for a mean period of 64 months (7–144). Osteosarcoma was the most common primary bone tumour, occurring in 15 patients. The 5-year survival for all patients was 80,9%. At final follow-up, 19 patients were still alive and had a mean follow up of 74,6 months (7–137).
Clinical evaluation was done with the MSTS questionnaire (mean score: 70,0 (26,7–93,3)) and the use of the TESS (mean score: 82,5 (45–99,2) and SF-36 (mean Physical Component Score (PCS): 46,6 (27,1–56,5), mean Mental Component Score (MCS): 53,7 (range 37,0–62,1) was introduced
There were 12 complications: 5 aseptic loosenings, two deep prosthetic infections, two luxations, one prosthetic fracture and two fissures. Six failures were re-operated. An overall prosthetic survival at 5-years of 77,0 % was found. A total of eight (29%) prostheses were considered to have failed after a mean follow up of 27,4 months (0–97). Risk factors in failure of the prosthetics were: non HA-coated stem and top stem-ratio > 1.2. Not length of the endoprosthesis and base stem-ratio. The top-ratio had a mean value of 1,14 (1,00–1,52) and for the four patients with an aseptic loosening the mean top-ratio was 1,23 (1,12–1,51) which was significantly different (p< 0,05 Mann-Whitney U test).
Our results suggest that of the MUTARS endoprosthesis has a good 5-year survival.
The use with a HA coating is preferable. The use of a stem-cortex ratio (> 1.2) at the top of the prosthetic stem can be predictor for aseptic loosening. The addition of the TESS and SF-36 scores give more insight information in how patients undergo their disease: half do not feel disabled.
Correspondence should be addressed to Professor Stefan Bielack, Olgahospital, Klinikum Stuttgart, Bismarkstrasse 8, D-70176 Stuttgart, Germany. Email: s.bielack@klinikum_stuttgart.de
