Short-term clinical outcomes of Kyocera Modular Limb Salvage System designed cementless stems for the endoprosthetic reconstruction of lower extremities: a Japanese Musculoskeletal Oncology Group multi-institutional study
Abstract Background The high rate of aseptic loosening of cemented stems has led to their frequent use in endoprosthetic reconstruction. However, problems, such as stem breakage and stress shielding at the insertion site, remain. The Japanese Musculoskeletal Oncology Group (JMOG) has developed Kyoce...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-07-01
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| Series: | BMC Cancer |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12885-022-09873-x |
| _version_ | 1811293721678839808 |
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| author | Satoshi Tsukushi Yoshihiro Nishida Takeshi Hirose Eiji Nakata Rumi Nakagawa Tomoki Nakamura Jungo Imanishi Akihito Nagano Hironari Tamiya Takafumi Ueda and Japanese Musculoskeletal Oncology Group (JMOG) |
| author_facet | Satoshi Tsukushi Yoshihiro Nishida Takeshi Hirose Eiji Nakata Rumi Nakagawa Tomoki Nakamura Jungo Imanishi Akihito Nagano Hironari Tamiya Takafumi Ueda and Japanese Musculoskeletal Oncology Group (JMOG) |
| author_sort | Satoshi Tsukushi |
| collection | DOAJ |
| description | Abstract Background The high rate of aseptic loosening of cemented stems has led to their frequent use in endoprosthetic reconstruction. However, problems, such as stem breakage and stress shielding at the insertion site, remain. The Japanese Musculoskeletal Oncology Group (JMOG) has developed Kyocera Modular Limb Salvage System (KMLS) cementless stems with a unique tapered press-fit and short fixation design. This study aimed to clarify the short-term postoperative outcomes of this prosthesis and validate the stem design. Methods One hundred cases of KMLS cementless stems (51 male patients; median age, 49 years; mean follow-up period, 35 months), with a minimum follow-up of 2 years, for the proximal femur (PF), distal femur (DF), and proximal tibia were prospectively registered for use. Prosthesis survival, complication rates, postoperative functional, and radiographical evaluation were analyzed. Complications or failures after insertion of the KMLS endoprostheses were classified into five types and functional results were analyzed according to the MSTS scoring system at postoperative 1 year. The diaphyseal interface and anchorage were graded by the ISOLS system at postoperative 2 years. Results The overall prosthesis survival rates at 2 and 4 years were 88.2 and 79.6%, respectively. The prosthesis-specific survival rate excluding infection and tumor recurrence was 90.2 and 87.9%, respectively. Younger age (p = 0.045) and primary tumor (p = 0.057) were associated with poor prognosis of prosthesis-specific survival excluding infection and tumor recurrence. Complications were observed in 31 patients, 13 patients underwent revision surgery. The mean MSTS functional score at 1 year postoperatively was 68%. Early implant loosening was significantly more common in the DF (p = 0.006) and PF/DF straight stem (p = 0.038). The ISOLS radiographic evaluation at 2 years after surgery revealed good bone remodeling and anchorage in most cases (bone remodeling: 90% / excellent and good, anchorage: 97% / excellent and good). Conclusions Tumor endoprosthesis long-term fixation to the diaphysis of the lower extremity remains challenging. The KMLS cementless stem with a unique tapered press fit design showed good short-term results in maintaining bone stock. To prevent early loosening, a curved stem should be used in PF and DF, but long-term follow-up is necessary. |
| first_indexed | 2024-04-13T05:05:48Z |
| format | Article |
| id | doaj.art-c4b9bb36aeb748ceb218c73169456ff1 |
| institution | Directory Open Access Journal |
| issn | 1471-2407 |
| language | English |
| last_indexed | 2024-04-13T05:05:48Z |
| publishDate | 2022-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cancer |
| spelling | doaj.art-c4b9bb36aeb748ceb218c73169456ff12022-12-22T03:01:11ZengBMCBMC Cancer1471-24072022-07-0122111110.1186/s12885-022-09873-xShort-term clinical outcomes of Kyocera Modular Limb Salvage System designed cementless stems for the endoprosthetic reconstruction of lower extremities: a Japanese Musculoskeletal Oncology Group multi-institutional studySatoshi Tsukushi0Yoshihiro Nishida1Takeshi Hirose2Eiji Nakata3Rumi Nakagawa4Tomoki Nakamura5Jungo Imanishi6Akihito Nagano7Hironari Tamiya8Takafumi Ueda9and Japanese Musculoskeletal Oncology Group (JMOG)Department of Orthopaedic Surgery, Aichi Cancer Center HospitalDepartment of Rehabilitation Medicine, Nagoya University HospitalDepartment of Musculoskeletal Oncology, National Cancer Center HospitalDepartment of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesDepartment of Orthopaedic Surgery, Keio University School of MedicineDepartment of Orthopedic Surgery, Mie University Graduate School of MedicineDepartment of Orthopaedic Oncology and Surgery, Saitama Medical University International Medical CenterDepartment of Orthopaedic Surgery, Gifu University School of MedicineDepartment of Orthopedic Surgery, Osaka International Cancer InstituteDepartment of Orthopaedic Surgery, National Hospital Organization Osaka National HospitalAbstract Background The high rate of aseptic loosening of cemented stems has led to their frequent use in endoprosthetic reconstruction. However, problems, such as stem breakage and stress shielding at the insertion site, remain. The Japanese Musculoskeletal Oncology Group (JMOG) has developed Kyocera Modular Limb Salvage System (KMLS) cementless stems with a unique tapered press-fit and short fixation design. This study aimed to clarify the short-term postoperative outcomes of this prosthesis and validate the stem design. Methods One hundred cases of KMLS cementless stems (51 male patients; median age, 49 years; mean follow-up period, 35 months), with a minimum follow-up of 2 years, for the proximal femur (PF), distal femur (DF), and proximal tibia were prospectively registered for use. Prosthesis survival, complication rates, postoperative functional, and radiographical evaluation were analyzed. Complications or failures after insertion of the KMLS endoprostheses were classified into five types and functional results were analyzed according to the MSTS scoring system at postoperative 1 year. The diaphyseal interface and anchorage were graded by the ISOLS system at postoperative 2 years. Results The overall prosthesis survival rates at 2 and 4 years were 88.2 and 79.6%, respectively. The prosthesis-specific survival rate excluding infection and tumor recurrence was 90.2 and 87.9%, respectively. Younger age (p = 0.045) and primary tumor (p = 0.057) were associated with poor prognosis of prosthesis-specific survival excluding infection and tumor recurrence. Complications were observed in 31 patients, 13 patients underwent revision surgery. The mean MSTS functional score at 1 year postoperatively was 68%. Early implant loosening was significantly more common in the DF (p = 0.006) and PF/DF straight stem (p = 0.038). The ISOLS radiographic evaluation at 2 years after surgery revealed good bone remodeling and anchorage in most cases (bone remodeling: 90% / excellent and good, anchorage: 97% / excellent and good). Conclusions Tumor endoprosthesis long-term fixation to the diaphysis of the lower extremity remains challenging. The KMLS cementless stem with a unique tapered press fit design showed good short-term results in maintaining bone stock. To prevent early loosening, a curved stem should be used in PF and DF, but long-term follow-up is necessary.https://doi.org/10.1186/s12885-022-09873-xEndoprosthesisCementless stemComplicationStress shielding |
| spellingShingle | Satoshi Tsukushi Yoshihiro Nishida Takeshi Hirose Eiji Nakata Rumi Nakagawa Tomoki Nakamura Jungo Imanishi Akihito Nagano Hironari Tamiya Takafumi Ueda and Japanese Musculoskeletal Oncology Group (JMOG) Short-term clinical outcomes of Kyocera Modular Limb Salvage System designed cementless stems for the endoprosthetic reconstruction of lower extremities: a Japanese Musculoskeletal Oncology Group multi-institutional study BMC Cancer Endoprosthesis Cementless stem Complication Stress shielding |
| title | Short-term clinical outcomes of Kyocera Modular Limb Salvage System designed cementless stems for the endoprosthetic reconstruction of lower extremities: a Japanese Musculoskeletal Oncology Group multi-institutional study |
| title_full | Short-term clinical outcomes of Kyocera Modular Limb Salvage System designed cementless stems for the endoprosthetic reconstruction of lower extremities: a Japanese Musculoskeletal Oncology Group multi-institutional study |
| title_fullStr | Short-term clinical outcomes of Kyocera Modular Limb Salvage System designed cementless stems for the endoprosthetic reconstruction of lower extremities: a Japanese Musculoskeletal Oncology Group multi-institutional study |
| title_full_unstemmed | Short-term clinical outcomes of Kyocera Modular Limb Salvage System designed cementless stems for the endoprosthetic reconstruction of lower extremities: a Japanese Musculoskeletal Oncology Group multi-institutional study |
| title_short | Short-term clinical outcomes of Kyocera Modular Limb Salvage System designed cementless stems for the endoprosthetic reconstruction of lower extremities: a Japanese Musculoskeletal Oncology Group multi-institutional study |
| title_sort | short term clinical outcomes of kyocera modular limb salvage system designed cementless stems for the endoprosthetic reconstruction of lower extremities a japanese musculoskeletal oncology group multi institutional study |
| topic | Endoprosthesis Cementless stem Complication Stress shielding |
| url | https://doi.org/10.1186/s12885-022-09873-x |
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