Abstract
We performed a retrospective analysis of massive endoprostheses inserted at our unit in the management of Giant Cell Tumours of the distal femur with a minimum follow up of 5 years.
Methods. Twenty-five massive articulating endoprostheses were inserted between 1986 and 1998 at our unit. The case notes and radiographs of all patients were reviewed. A functional and radiological analysis was performed using the MTOS and ISOLS scoring systems. Kaplan-Meier Cumulative Survival Graphs were created for amputation and revision for septic and aseptic loosening. Two patients had died (8%) from unrelated causes. No cases were lost to Follow Up.
Results. Massive replacements were performed for stage 3 (aggressive), pathological fracture (30%) or recurrent disease. The mean follow up was twelve years (range 5–18 years). The average age at time of insertion was 37 years; no patients were skeletally immature. Fifteen implants were fixed hinge devices and ten were rotating hinge devices with HA collars (since 1993). No cases were revised for sepsis. There had been no cases of recurrent disease or amputation. There have been six (26%) revisions for aseptic loosening. Only one of these occurred in the rotating hinge and HA collar group. In the fixed hinge group (38% aseptic loosening rate) revision occurred after an average of six years. There have also been five re-bushings all of which have occurred in the fixed hinge group. The average MTOS score was 74 (range 47–97).
Conclusion. Young patients with fixed hinged devices developed a high incidence of aseptic loosening. They also had a significant rate of re-bushing. Results of the rotating hinge prosthesis with HA collar were much more promising. Functional scores were good after a period of twelve years despite the young age group.
The abstracts were prepared by Mr Roger Tillman. Correspondence should be addressed to BOOS at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PN
