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Cemented versus cementless endoprostheses for lower limb salvage surgery
E Pala1, A F Mavrogenis, A Angelini
1Department of Orthopedics, University of Bologna, Istituto Ortopedico Rizzoli, Bologna, Italy.
Summary
Cementless endoprostheses demonstrate superior survival rates compared to cemented ones, particularly in preventing infection. Stem fixation is the key factor influencing long-term success in lower limb salvage surgery.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Reconstructive Surgery
Background:
- Lower limb salvage surgery often involves endoprosthetic reconstruction.
- The choice between cemented and cementless endoprostheses impacts patient outcomes.
- Understanding failure modes is crucial for improving surgical success rates.
Purpose of the Study:
- To compare the survival rates and failure modes of cemented versus cementless endoprostheses.
- To identify predictors of endoprosthetic survival in lower limb salvage procedures.
Main Methods:
- Retrospective study of 232 patients undergoing lower limb salvage surgery between 2002 and 2007.
- Comparison of cemented and cementless endoprostheses based on survival, infection, and aseptic loosening.
- Analysis of factors including age, BMI, diagnosis, and stem fixation.
Main Results:
- Overall 60-month survival was higher for cementless (78%) versus cemented (64%) endoprostheses (p=0.0078).
- Survival to infection at 60 months was significantly better for cementless (82%) compared to cemented (68%) (p=0.0248).
- No significant difference in survival to aseptic loosening between cemented and cementless types (94% vs 96%, p=0.1493).
Conclusions:
- Cementless endoprostheses offer improved overall survival and reduced infection rates compared to cemented options.
- Aseptic loosening rates are comparable between cemented and cementless endoprostheses.
- Cementless stem fixation is the sole significant predictor of improved endoprosthetic survival.