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Two Revision Surgeries on Cemented Custom-made Tumor Prostheses.

Yukihiro Yoshida1, Yuki Okamura, Mamoru Akita

  • 1Department of Orthopedic Surgery, Nihon University School of Medicine, Itabashi-ku, Tokyo 173-8610, Japan.yoshida.yukihiro@nihon-u.ac.jp.

Acta Medica Okayama
|February 27, 2017
PubMed
Summary

Revision surgery for fractured cemented tumor prostheses, especially after 25 years, can be challenging. Using a thicker stem with the cement-in-cement technique may be a viable option when bone cement removal is difficult.

Keywords:
custom-made tumor prosthesismalignant bone tumorrevision

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Area of Science:

  • Orthopedic surgery
  • Biomaterials engineering
  • Musculoskeletal oncology

Background:

  • Revision surgery for failed cemented tumor prostheses presents unique challenges.
  • Long-term complications, such as stem fracture, can occur decades after initial implantation.
  • Management strategies must address both implant failure and the integrity of the surrounding bone.

Observation:

  • Two patients underwent revision surgery for stem fracture of cemented tumor prostheses >25 years post-implantation.
  • The global modular replacement system (GMRS) was utilized for revision.
  • Complete removal of the original bone cement was not feasible in either case.

Findings:

  • Revision involved inserting larger diameter stems (11 and 12.5 mm) due to cement impaction.
  • The cement-in-cement technique was employed for stem fixation.
  • This approach allowed for stable fixation despite challenges with cement removal.

Implications:

  • Adequate removal of bone cement is ideal in revision arthroplasty.
  • When cement removal poses a fracture risk, alternative fixation methods are crucial.
  • The cement-in-cement technique offers a viable solution for revision of cemented tumor prostheses with challenging cement removal.