DOS 2020

DOS Kongressen 2020 · 205 Mega-prosthetic joint replacement of the distal femur in non-tumour cases. Ulrik Knudsen, Martin Kirkegaard, Kurt Skovgaard, Christina Holm, Anders Odgaard, Michael Mørk Petersen, Nikolaj Winther Department of Orthopaedic Surgery , Rigshospitalet, Copenhagen, Denmark Background: Mega-prosthetic joint replacement of the distal femur is also an option for management of massive bone loss in revision total knee arthroplasty (TKA) and for fractures. Even though this surgery is challenging with high rate of infection, patellar complications, and implant failure it is often the only option to avoid knee arthrodesis or amputation. Purpose / Aim of Study: The purpose of this study was to evaluate the com- plications and outcome after implantation of mega-prostheses of the distal fe- mur in non-tumour cases. Materials and Methods: We retrospectively reviewed 65 patients mean age 66 (38-84) years, F/M=47/18, mean follow-up 41 (12-220) months that received a distal femoral resection and reconstruction with a mega-prosthesis because of a failed TKA due to aseptic/septic loosening, periprosthetic fracture or complications after a complex fracture with failed osteosynthesis. 41 pa- tients (64 %) had previous TKA revision surgery and 19 patients (29%) previ- ous periprosthetic infection. In this cohort 19 patients were revised for aseptic loosening and 12 patients for septic loosening. 18 patients were diagnosed with periprosthetic fracture and 6 patients with pseudarthrosis. 6 cases with insta- bility, 1 case with a comminute distal femur fractur and in in 3 cases pain were the reason for revision. Findings / Results: We found good patient satisfaction and low pain scores with moderate to low activity level. During the follow-up period 39 patients (60%) had no additional procedures. 18 patients (27%) had major revision defined as removal or exchange of the femoral component because of asep- tic loosening (n=11), periprosthetic fracture (n=4), septic loosening (n=2) and amputation (n=2), and 13 patients had minor revision due to instability, pain or patellar complications. Survival analysis shows that 70 % was free of major revision after 5 years. Conclusions: Mega-prosthetic joint replacement of the distal femur is a good option for management of non-tumor cases (revision TKA and fractures) with massive bone loss, and thus amputation and knee arthrodesis can be avoided in most patients. However, there is a high risk that the patients have to undergo future additional surgery including major revision. 184.