Distal femoral arthroplasty using custom-made prostheses. The first 218 cases

The first 218 cases of limb salvage using cemented intramedullary Stanmore massive distal femoral arthroplasties with a single-axis hinged knee, followed for an average of 58 months with a maximum of 251 months, were reviewed. Loosening (5%), local recurrence (4%), intramedullary stem fracture (3%), and infection (2%) were the major complications requiring surgical intervention. Loosening and implant fracture were treated by the insertion of a second massive replacement in all but one case. All recurrences and all but one infected case required amputation. Survivorship analysis showed that the overall probability of one of these early prostheses surviving for 10 years was 65%, and for 20 years it was 53%. For cases of bone tumor, the probability of surviving for 10 years was 68% (not including recurrence), for primary knee replacement cases it was 32%, for other bony diseases plus trauma it was 86%, and for cases of revised massive prostheses it was 53%. It was concluded that this type of distal femoral arthroplasty provided good medium-term results, but showed some deficiencies in the long term, particularly in younger patients.