Radiographic, Functional, and Oncologic Outcomes of Cemented Modular Proximal Femur Replacement Using the "French Paradox" Technique.

Abstract

BACKGROUND:

Endoprostheses are frequently used in the management of tumors involving the proximal femur. Aseptic loosening is a common complication that has been linked to the cementing technique. The "French paradox" is well-known cementing technique in the arthroplasty literature. No previous reports have assessed loosening in proximal femur replacements using this technique. We examined rates of femoral stem aseptic loosening in proximal femur replacements, functional outcomes, complications, and oncologic outcomes.

METHODS:

We conducted a retrospective review of 47 patients who underwent proximal femur replacement between 2000 and 2019. Two reviewers evaluated preoperative and postoperative radiographs using the International Society of Limb Salvage scoring system and Barrack criteria for stem loosening. The acetabulum was evaluated according to the criteria of Baker et al. Functional outcomes were assessed using Musculoskeletal Tumor Society (MSTS) score and Toronto Extremity Salvage Score. The mean follow-up was 44 months.

RESULTS:

The mean International Society of Limb Salvage scores for the 2 reviewers were 86% ± 6% and 84% ± 6%. The first reviewer graded femoral stem loosening as "possibly loose" in 2 patients, one of whom was graded as possibly loose by the second reviewer. The 2 reviewers found no acetabular erosion in 16 (70%) and 15 (65.4%) patients, respectively. The mean Musculoskeletal Tumor Society score and Toronto Extremity Salvage Score at last follow-up were 61% and 72%, respectively. Twenty complications occurred in 13 patients, and 5 patients experienced local recurrence.

CONCLUSION:

Despite complications, we showed favorable femoral component survival rates. Cementing the proximal femur prosthesis with tight canal fit and thin cement mantle is a viable option for the short and medium term.

LEVEL OF EVIDENCE:

III.

• Authors: Anas Nooh, Abdulrahman Alaseem, Laura M Epure, Marc-Antoine Ricard, Krista Goulding, Robert E Turcotte
• Journal: The Journal of arthroplasty (J Arthroplasty) Vol. 35 Issue 9 Pg. 2567-2572 (09 2020) ISSN: 1532-8406 [Electronic] United States
• PMID: 32418744 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 Elsevier Inc. All rights reserved.

Chemical References

• Bone Cements

Topics

• Acetabulum
• Arthroplasty, Replacement, Hip (adverse effects)
• Bone Cements
• Femur (diagnostic imaging, surgery)
• Humans
• Prosthesis Design
• Prosthesis Failure
• Retrospective Studies
• Treatment Outcome