0
Scientific Articles   |    
Failure Mode Classification for Tumor Endoprostheses: Retrospective Review of Five Institutions and a Literature Review
Eric R. Henderson, MD1; John S. Groundland, MS, PT1; Elisa Pala, MD2; Jeremy A. Dennis, BS3; Rebecca Wooten, PhD4; David Cheong, MD1; Reinhard Windhager, MD5; Rainer I. Kotz, MD5; Mario Mercuri, MD2; Philipp T. Funovics, MD5; Francis J. Hornicek, MD, PhD6; H. Thomas Temple, MD3; Pietro Ruggieri, MD2; G. Douglas Letson, MD1
1 Sarcoma Program, H. Lee Moffitt Cancer and Research Institute, 12902 Magnolia Drive, Tampa, FL 33612. E-mail address for E.R. Henderson: eric.r.henderson@gmail.com
2 Istituto Ortopedico Rizzoli, University of Bologna, via di Barbiano, 40136 Bologna, Italy
3 Orthopaedic Oncology Division, Department of Orthopaedic Surgery, 1400 N.W. 12th Avenue, Room 4036, University of Miami, Miami, FL 33136
4 Department of Mathematics and Statistics, University of South Florida, 4202 East Fowler Drive, Tampa, FL 33612
5 Department of Orthopaedic Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
6 Division of Orthopaedic Oncology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 3B, Boston, MA 02114
View Disclosures and Other Information
Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors, or a member of his or her immediate family, received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from commercial entities (DePuy [Johnson & Johnson] and Stryker).

Investigation performed at the Sarcoma Program, H. Lee Moffitt Cancer and Research Institute, Tampa, Florida; Orthopaedic Oncology Division, Department of Orthopaedic Surgery, University of Miami, Miami, Florida; Division of Orthopaedic Oncology, Massachusetts General Hospital, Boston, Massachusetts; Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy; and Department of Orthopaedic Surgery, Medical University of Vienna, Vienna, Austria
A commentary by Dempsey Springfield, MD, is available at www.jbjs.org/commentary and is linked to the online version of this article.

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Mar 02;93(5):418-429. doi: 10.2106/JBJS.J.00834
A commentary by Dempsey Springfield, MD, is available here
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Abstract

Background: 

Massive endoprostheses provide orthopaedic oncologists with many reconstructive options after tumor resection, although failure rates are high. Because the number of these procedures is limited, failure of these devices has not been studied or classified adequately. This investigation is a multicenter review of the use of segmental endoprostheses with a focus on the modes, frequency, and timing of failure.

Methods: 

Retrospective reviews of the operative databases of five institutions identified 2174 skeletally mature patients who received a large endoprosthesis for tumor resection. Patients who had failure of the endoprosthesis were identified, and the etiology and timing of failure were noted. Similar failures were tabulated and classified on the basis of the risk of amputation and urgency of treatment. Statistical analysis was performed to identify dependent relationships among mode of failure, anatomic location, and failure timing. A literature review was performed, and similar analyses were done for these data.

Results: 

Five hundred and thirty-four failures were identified. Five modes of failure were identified and classified: soft-tissue failures (Type 1), aseptic loosening (Type 2), structural failures (Type 3), infection (Type 4), and tumor progression (Type 5). The most common mode of failure in this series was infection; in the literature, it was aseptic loosening. Statistical dependence was found between anatomic location and mode of failure and between mode of failure and time to failure. Significant differences were found in the incidence of failure mode Types 1, 2, 3, and 4 when polyaxial and uniaxial joints were compared. Significant dependence was also found between failure mode and anatomic location in the literature data.

Conclusions: 

There are five primary modes of endoprosthetic failure, and their relative incidences are significantly different and dependent on anatomic location. Mode of failure and time to failure also show a significant dependence. Because of these relationships, cumulative reporting of segmental failures should be avoided because anatomy-specific trends will be missed. Endoprosthetic design improvements should address failure modes specific to the anatomic location.

Level of Evidence: 

Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

     
    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org

    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe





    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    PubMed Articles
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    03/17/2014
    CT - Orthopaedic Foundation
    10/12/2011
    NY - Modern Chiropractic Care, P.C.
    05/03/2012
    CA - UCLA/OH Department of Orthopaedic Surgery
    02/19/2014
    OH - University Hospitals Case Medical Center