Knee function after limb salvage surgery for malignant bone tumor: comparison of megaprosthesis and distal femur allograft with epiphysis sparing

• Published in: International orthopaedics Vol. 42; no. 2; pp. 427 - 436
• Main Authors: Pesenti, Sébastien, Peltier, Emilie, Pomero, Vincent, Authier, Guillaume, Roscigni, Lionel, Viehweger, Elke, Jouve, Jean-Luc
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.02.2018
• Subjects: Adolescent; Adult; Allografts; Arthroplasty, Replacement, Knee - adverse effects; Arthroplasty, Replacement, Knee - methods; Biomechanical Phenomena; Bone Neoplasms - surgery; Bone Transplantation - adverse effects; Bone Transplantation - methods; Epiphyses - surgery; Female; Femur - pathology; Femur - surgery; Gait - physiology; Humans; Knee Joint - physiopathology; Knee Joint - surgery; Knee Prosthesis - adverse effects; Limb Salvage - methods; Male; Medicine; Medicine & Public Health; Original Paper; Orthopedics; Range of Motion, Articular - physiology; Retrospective Studies; Spatio-Temporal Analysis; Transplantation, Homologous; Treatment Outcome; Young Adult; Megaprosthesis; Limb salvage surgery; Knee; gait; Massive distal femur allograft; Malignant bone tumour
• ISSN: 0341-2695; 1432-5195; 1432-5195
• DOI: 10.1007/s00264-017-3608-x

Purpose Limb salvage surgery is increasingly used for the treatment of distal femur bone sarcomas. Total knee replacement using megaprosthesis and epiphysis-sparing biologic reconstruction using an allograft are widely used in order to preserve joint motion. We aimed to compare the results of these procedures using gait analysis in patients undergoing limb salvage surgery. Methods Fifteen patients were included, nine undergoing allograft with epiphysis sparing (Allograft group) and six undergoing megaprosthesis (Megaprosthesis group). Every patient underwent a gait analysis using the Plug-in-Gait protocol. Spatiotemporal parameters, knee kinematics, and kinetics were compared between the two groups and a cohort of ten asymptomatic subjects. Knee function was assessed by the Gait Deviation Index (GDI) and the Gilette Gait Index (GGI). Results Both treatment groups showed decreased knee flexion during the loading response phase. Megaprosthesis patients showed a decreased knee flexion all along stance phase. There was no difference in gait pattern between the treatment groups. GDI was significantly lower in Megaprosthesis and Allograft patients when compared to controls (86.4 and 84.3 vs 94, all p  < 0.05). This difference was not clinically relevant. Conclusion Our study reveals that Megaprosthesis and Allograft patients did not show differences in gait patterns and global function. Even though Allograft and Megaprosthesis patients have significant changes in gait pattern, knee function is acceptable with effective gait mechanisms. Changes occur during stance phase and are due to the quadriceps weakness. The particular pattern of gait in Megaprosthesis patients could be a concern for prosthesis wear and should be investigated on this specific aspect. Level of evidence: 4