Cemented rotating hinge endoprosthesis for limb salvage of distal femur tumors.

UNLABELLED: We retrospectively ascertained the outcomes and complications with a cemented rotating hinge implant. Implant failure was defined as amputation of the affected limb and revision of part or all of the components. We included 77 consecutive distal femoral replacements performed between 1989 and 2004. The mean age was 42 years (range, 12-87 years) and the mean length of followup was 52 months (range, 1.5-157 months). Five-year implant survival was 84% and 10-year survival was 79%. There were 67 bone sarcomas, two soft tissue sarcomas and eight metastatic carcinomas. At followup, 54 patients had no evidence of disease, 16 were alive with disease, and seven were dead from disease. Six patients had deep infection, two of which required amputations. There were five local recurrences; three needed amputation and two soft-tissue excisions only. Three patients sustained a tibial bearing fracture and one required replacement of loose bumper. No revision was performed for stem loosening, stem fracture, or bushing wear. Musculoskeletal Tumor Society 1987 scores averaged 30 and Toronto Extremity Salvage Scores averaged 77.6 at latest followup. Cemented endoprosthesis is a reliable procedure after resection of the distal femur for tumors.

LEVEL OF EVIDENCE: Therapeutic study, level IV (case series).