title: Tumor endoprosthesis revision rates increase with peri-operative chemotherapy but are reduced with the use of cemented implant fixation.
abstract: Chemotherapy may reduce osseointegration of tumor endoprosthesis, while delaying chemotherapy may reduce survival. We studied the effects of chemotherapy and cemented fixation on tumor endoprosthesis survivorship with a retrospective analysis of 50 consecutive patients receiving lower limb salvage surgery. We compared rates of radiographic loosening/revision and effect of cement fixation between chemotherapy/no chemotherapy cohorts. Chemotherapy increased the total revision rate (HR = 3.8 [1-14], P = 0.033), but did not affect aseptic loosening. Cement fixation reduced revision for loosening (HR = 0.09 (0.008-0.98), P = 0.012) and showed less radiographic loosening (HR = 0.09 (0.02-0.51), P = 0.00066). Cement fixation had lower rates of revision for loosening and radiographic loosening regardless of whether chemotherapy was given. We conclude that for these implants, cement fixation provides superior results to uncemented fixation.
authors.affiliation: Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Luke R
authors.initials: LR
authors.lastname: Pugh
authors.affiliation: Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Clarkson
authors.affiliation: Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Phillips
authors.affiliation: Department of Orthopaedic Surgery, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, 27 rue du Faubourg Saint Jacques, Paris, France.
authors.forename: David J
authors.initials: DJ
authors.lastname: Biau
authors.affiliation: Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Bassam A
authors.initials: BA
authors.lastname: Masri
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001843:Bone Cements / Q000627:therapeutic use*; D002813:Chondrosarcoma / Q000188:drug therapy / Q000601:surgery; D005260:Female; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D012516:Osteosarcoma / Q000188:drug therapy / Q000601:surgery; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D016879:Salvage Therapy
chemical_list: D000970:Antineoplastic Agents; D001843:Bone Cements
keywords: cementation; chemotherapy; endoprosthesis; implant survivorship; malignancy; surgical fixation