Uncemented tumor endoprostheses at the knee - Root causes of failure

Although cemented tumor endoprostheses are the most commonly used method for reconstruction of the distal femur or proximal tibia after resection of primary bone tumors, aseptic loosening remains a common complication. Uncemented tumor prostheses may minimize this problem. We investigated the root causes of prosthetic failure for 99 patients with a fixed-hinge, bone-ingrowth Kotz Modular Femur and Tibia Resection System endoprosthesis and compared complications that led to implant failure with results in the literature. Of the 74 distal femoral implants and 25 proximal tibial implants, 25 patients had complications that resulted in prosthetic failure (removal of the prosthesis) at a median of 24.1 (range, 0.8-72.6) months. Failure was caused by prosthesis (n = 18) or oncologic-related (n = 7) complications. However, limb-salvage was possible for 87 of 99 patients. Smaller stem size in the distal femur and longer bone resection length in the proximal tibia were significantly associated with increased risk of prosthetic failure by multivariate analysis. The risk of stem fracture (6 of 99 patients) and infection (10 of 99 patients) was higher than other reports, but aseptic loosening (2 of 99 patients) was uncommon. These results suggest that although the bone-ingrowth surface of this prosthesis leads to a very low aseptic loosening rate, the higher risk of stem fracture and infection must be addressed in future implant designs.