Custom cross-pin fixation of 32 tumor endoprostheses stems

The main cause of mechanical failure of primary and revision cemented tumor endoprosthetic stems is aseptic loosening. The placement of custom designed pins through the bone, the cement, and the stem can create a bone-cement-prosthesis composite that resists the rotatory stresses that lead to aseptic loosening. At risk situations include large primary reconstructions where the residual short metaphyseal articular segments lack sufficient length and cortical contact to provide lasting fixation, and revision prostheses that are to be recemented into straight diaphyseal segments that already have experienced aseptic loosening. Current modular tumor endoprosthetic systems have improved availability and allow for some intraoperative flexibility, but they do not provide solutions for these at risk scenarios. Additional customization is necessary. We report on the 16-year experience with 32 custom cross-pin stems at the University of California, Los Angeles (UCLA). Twenty of these patients have been followed up for more than 2 years. There were three mechanical failures, three patients were lost to followup, and five patients died of disease. There have been no cases of aseptic loosening in this series. Cross-pin fixation has been effective when used in carefully selected cases.