Victoria L'Hourre, Agathe Yvinou, Frédéric Dubrana, Marc-Pierre Henry, Antoine Desseaux, Thomas Williams, Vincent Crenn, Louis-Romée Le Nail, Alexandre Tronchot, Mickael Ropars
Kaplan-Meier survivorship was 94.1% at 12 months (95% CI: 84.9-97.8), 91.9% at 24 months (95% CI: 81.2-96.6) and 86.9% at 36 months (95% CI: 73.9-93.7). The corresponding cumulative incidences of failure were 5.9%, 7.9%, and 12.5%. Twenty-eight patients (36.4%) experienced at least one complication, with 32 events occurring in total. The most frequent complication was infection (10/77, 13.0%). Operative time, resection height and polyethylene insert thickness were not associated with the occurrence of the first complication. Two amputations and five deaths occurred, none of which were attributed to prosthetic joint sepsis.
BACKGROUND: Distal femoral megaprostheses are used for oncological and complex non-oncological limb salvage and reconstruction. However, there is limited evidence for the use of the Limb Preservation System™ (LPS™).
HYPOTHESIS: Despite frequent complications, short-term implant survivorship would remain high. We asked: (1) What was the survivorship rate at 12-36 months? (2) Which Henderson failure modes predominated? (3) Did specific structural failure patterns occur? (4) Was operative time, femoral resection height or polyethylene insert thickness associated with a first postoperative complication?
PATIENTS AND METHODS: This retrospective multicentre study included 77 consecutive distal femoral LPS™ reconstructions performed from 2016 to 2023. Implant failure was defined as fixed-component revision, explantation, or amputation. Kaplan-Meier methods were used to estimate survivorship, and cumulative incidence was estimated with death treated as a competing event.
RESULTS: Kaplan-Meier survivorship was 94.1% at 12 months (95% CI: 84.9-97.8), 91.9% at 24 months (95% CI: 81.2-96.6) and 86.9% at 36 months (95% CI: 73.9-93.7). The corresponding cumulative incidences of failure were 5.9%, 7.9%, and 12.5%. Twenty-eight patients (36.4%) experienced at least one complication, with 32 events occurring in total. The most frequent complication was infection (10/77, 13.0%). Operative time, resection height and polyethylene insert thickness were not associated with the occurrence of the first complication. Two amputations and five deaths occurred, none of which were attributed to prosthetic joint sepsis.
DISCUSSION: The LPS™ system offered good short-term implant survival rates, but complications remained common. An exploratory technical-factor analysis did not identify an association between the three selected technical variables and a first postoperative complication. Longer, indication-specific follow-up and functional outcome studies are required.
LEVEL OF EVIDENCE: IV; retrospective cohort study.