Finn/Orthopaedic Salvage System distal femoral rotating-hinge megaprostheses in oncologic patients: Long-term complications, reoperations, and amputations Journal Article


Authors: Ogura, K.; Yakoub, M. A.; Boland, P. J.; Healey, J. H.
Article Title: Finn/Orthopaedic Salvage System distal femoral rotating-hinge megaprostheses in oncologic patients: Long-term complications, reoperations, and amputations
Abstract: BACKGROUND: There is a lack of evidence regarding long-term outcomes of rotating-hinge knee prostheses with distal femoral replacement in a large oncologic patient series. In this study, we investigated the proportion of patients experiencing complications requiring surgery in the long term, as well as the cumulative incidence of implant removal/revision and amputation at 5, 10, 15, and 20 years through competing risk analyses. METHODS: We retrospectively studied 214 patients treated with a Finn/Orthopaedic Salvage System (OSS) knee prosthesis (Zimmer Biomet) after distal femoral resection from 1991 to 2017. The study end points were postoperative complications requiring surgery. Reoperations were classified as major when there was (1) removal of the metal-body femoral component, the tibial component, or the bone-implant fixation; (2) major revision (exchange of the metal-body femoral component, the tibial component, or the bone-implant fixation); or (3) amputation. Minor reoperations were defined as all other reoperations. Competing risk analysis was used to estimate the cumulative incidence of implant removal/revision or amputation. RESULTS: There were 312 reoperations in 113 patients (98 major reoperations in 68 patients and 214 minor reoperations). Seventeen patients (8%) required ≥5 additional operations, and 21 patients (10%) required >1 major reoperation. Although the number of reoperations decreased over time, major and minor reoperations continuously accrued after 10 years. The cumulative incidences of implant removal or revision for any reason at 5, 10, 15, and 20 years were 22.6%, 30.1%, 34.3%, and 42.5%, respectively. Although most implant removals/revisions occurred in the first 10 years, the risk persisted after 10 years, at a mean of 1.24%/year, mainly due to deep infection (1.06%/year). CONCLUSIONS: The long-term outcomes of treatment with a Finn/OSS distal femoral rotating-hinge knee prosthesis showed it to be a durable reconstruction technique. The rate of implant removal/revisions after 10 years was gradual (1.24%/year). Deep infection remains a major late-failure mechanism, and lifetime surveillance for prosthetic problems is needed. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2021 by The Journal of Bone and Joint Surgery, Incorporated.
Journal Title: Journal of Bone and Joint Surgery
Volume: 103
Issue: 8
ISSN: 0021-9355
Publisher: Journal of Bone and Joint Surgery  
Date Published: 2021-04-01
Start Page: 705
End Page: 714
Language: English
DOI: 10.2106/jbjs.20.00696
PUBMED: 33411462
PROVIDER: scopus
DOI/URL:
Notes: Article -- Export Date: 3 May 2021 -- Source: Scopus
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MSK Authors
  1. Patrick J Boland
    151 Boland
  2. John H Healey
    483 Healey
  3. Koichi Ogura
    11 Ogura
  4. Mohamed Ahmed Ali Yakoub
    8 Yakoub