Enhanced clinical outcomes of uncemented prostheses in revision surgery of distal femoral tumor prostheses: a retrospective study.

Abstract

Background: The rising incidence of cancer has highlighted the need for effective treatment strategies, particularly for bone tumors like distal femoral tumors. These tumors are among the most prevalent types of bone malignancies, often necessitating extensive surgical intervention to achieve optimal outcomes. Limb-salvage surgery, which involves resecting the tumor and reconstructing the limb with prosthetic devices, has become the standard approach for managing both malignant and aggressive benign tumors of the distal femur. This technique has largely replaced amputation, allowing patients to retain limb function and improve their quality of life. Despite advancements in surgical methods and prosthetic designs, complications such as aseptic loosening, periprosthetic fractures, and infections remain common, frequently requiring revision surgeries. The choice between cemented and uncemented prostheses in these revision procedures is crucial, as it significantly impacts patient outcomes and long-term functional recovery. This study aims to compare clinical outcomes between cemented and uncemented prostheses in distal femoral tumor revision surgeries, addressing existing gaps in the literature and providing guidance for clinical decision-making.

Methods: This retrospective study analyzed data from 46 patients who underwent revision surgery for distal femoral tumor prostheses at Shanghai Sixth People's Hospital from 2019 to 2024. Patients were divided into two groups: 22 in the cemented prosthesis group (control) and 24 in the uncemented prosthesis group (experimental). Inclusion criteria required patients to be aged 20-50 years, with confirmed epiphyseal closure and clinical diagnosis of aseptic loosening after distal femoral tumor prosthesis replacement. Patients with severe systemic conditions or infections were excluded to ensure a homogeneous study population. Key parameters evaluated included operation time, intraoperative blood loss, length of hospital stay, and postoperative drainage duration. Functional outcomes were assessed using the Musculoskeletal Tumor Society (MSTS) scoring system and the Karnofsky Performance Status (KPS) scale. Statistical analyses were performed using SPSS software, with significance set at a P value of ≤ 0.05, ensuring robust comparisons of clinical, radiological, and functional outcomes between the two prosthesis types.

Results: The uncemented prosthesis group demonstrated superior clinical outcomes compared to the cemented group. Operation time was significantly shorter (124.75 ± 12.54 min vs. 162.67 ± 19.17 min, P < 0.001), and intraoperative blood loss was markedly lower (412.45 ± 32.12 mL vs. 647.56 ± 37.45 mL, P < 0.001). Postoperative recovery indicators also favored the uncemented group, with shorter hospital stays (16.64 ± 2.67 days vs. 19.78 ± 2.86 days, P = 0.004) and reduced drainage duration (9.85 ± 3.52 days vs. 13.47 ± 3.17 days, P = 0.007). Functional outcomes, measured by MSTS scores, were significantly higher in the uncemented group (70.24 ± 7.35 vs. 56.70 ± 4.98, P < 0.001), and KPS scores showed similar trends (78.32 ± 3.87 vs. 62.45 ± 4.12, P < 0.001).

Conclusion: In conclusion, this study demonstrates that uncemented prostheses provide superior clinical outcomes in revision surgeries for distal femoral tumors compared to cemented prostheses. The significant advantages include shorter operation times, reduced intraoperative blood loss, faster recovery, and improved functional outcomes, as indicated by higher MSTS and KPS scores. The biological fixation mechanism of uncemented prostheses promotes osseointegration, enhancing long-term stability and minimizing complications, such as aseptic loosening and infections. Although oncological outcomes, including disease-free survival and overall survival, were comparable between both groups, uncemented prostheses were particularly beneficial for younger patients with adequate bone stock. Despite limitations such as a small sample size and insufficient long-term follow-up, these findings offer valuable insights into the clinical application of uncemented prostheses and underscore the importance of personalized treatment strategies tailored to individual patient needs. Future research should involve larger, multicenter studies to validate these results and further explore the mechanisms behind the observed differences in outcomes.