假体柄长度与股骨远端肿瘤术后假体无菌性松动的关系

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Abstract Objective〓To investigate the effect of stem length on aseptic loosening after knee prosthesis replacement for tumors of distal femur.Methods〓A total of 164 patients with tumors of distal femur who underwent knee prosthesis replacement in Sichuan friendship hospital from June 2015 to June 2021 were selected.According to the aseptic loosening of the prosthesis during the follow-up of 2 to 8 years，the patients were divided into two groups：non-loosening group and loosening group.There were 126 patients in the non-loosening group，71 males and 55 females，aged from 25 to 69 years old，with an average age of (47.69±5.48) years old.There were 38 patients in the loosening group，including 24 males and 14 females，aged from 27 to 70 years old，with an average age of (46.12±5.33) years old.The clinical data of the two groups were compared.Kaplan-Meier method was used to analyze the relationship between the length of the stem and the service life of the prosthesis.Random forest algorithm and multivariate Logistic regression were used to analyze the factors affecting postoperative aseptic loosening of the prosthesis.The sensitivity of the research results was analyzed by correlation E-value method.The dose-effect relationship between the length of prosthesis stalk and postoperative aseptic loosening was analyzed by restriction cubic spline.Establish a prediction model and evaluate its prediction efficiency.Results〓The results of Kaplan-Meier analysis showed that the length of prosthesis handle was related to the service life of prosthesis (P＜0.001).The increase of the distance between the lower limb force line and the center of the knee joint were the risk factors of postoperative aseptic loosening of the prosthesis (P＜0.05)，the length of the prosthesis，the ratio of the diameter of the medullary stalk to the femur，mechanical lateral distal femoral angle (mLDFA) and the increase of postoperative hip knee ankle angle (HKAA) were protective factors (P＜0.05).Sensitivity analysis showed that E=2.015.In both male and female patients，there was no non-linear relationship between stem length and postoperative aseptic loosening (P＞0.05).When the model predicted that the probability of aseptic loosening of the prosthesis was 0.80，the Jordan index was the highest (77.77)，the accuracy was 92.24%，the sensitivity was 85.63%，the specificity was 92.14%，and the area under the subject working characteristic (ROC) curve was 0.825 (95% CI：0.766~0.884，P＜0.001).Conclusion〓The distance of lower limb force line from the center of knee joint，the length of prosthetic stem and the ratio of medullary stalk to femoral diameter are the influencing factors of aseptic loosening after knee prosthesis replacement in patients with distal femoral tumor.It is suggested that surgeons should choose longer prosthetic handle and thicker medullary handle to increase the fit of prosthetic medullary handle to the diameter of femur and medullary cavity diameter.Regular postoperative monitoring of the deviation of the lower limb force line is recommended，with prompt reconstruction of the lower limb force line when necessary.

Key words： stem length of prosthesis knee prosthesis replacement aseptic loosening of prosthesis tumor of distal femur

Corresponding Authors: Chen Yu

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Xu Gang,Chen Yu. Relationship Between Stem Length and Aseptic Loosening of Prosthesis After Operation of Distal Femoral Tumor[J]. sygkzz, 2024, 30(3): 226-.

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http://www.sygkzz.com/EN/ OR http://www.sygkzz.com/EN/Y2024/V30/I3/226

［1］Kim S，Ryu C，Jung ST.Differences in kinematic and kinetic patterns according to the bone tumor location after endoprosthetic knee replacement following bone tumor resection：A comparative gait analysis between distal femur and proximal tibia［J］.J Clin Med，2021，10(18)：4100-4112.
［2］Bodden J，Neumann J，Rasper M，et al.Diagnosis of joint invasion in patients with malignant bone tumors：Value and reproducibility of direct and indirect signs on MR imaging［J］.Eur Radiol，2022，32(7)：4738-4748.
［3］Li ZM，Yu XC，Zheng K.Radiographic assessment of aseptic loosening of tumor-type knee prosthesis in distal femur［J］.Orthop Surg，2022，14(6)：1143-1151.
［4］Mitchell S，Lee A，Stenquist R，et al.Extensive adhesion formation in a total knee replacement in the setting of a gastrointestinal stromal tumor：A case report［J］.World J Orthop，2022，13(5)：538-543.
［5］Gkiatas I，Karasavvidis T，Sharma AK，et al.Highly cross-linked polyethylene in primary total knee arthroplasty is associated with a lower rate of revision for aseptic loosening：A meta-analysis of 962 467 cases［J］.Arch Orthop Trauma Surg，2022，142(6)：1177-1184.
［6］van Otten TJM，van Loon CJM.Early aseptic loosening of the tibial component at the cement-implant interface in total knee arthroplasty：A narrative overview of potentially associated factors［J］.Acta Orthop Belg，2022，88(1)：103-111.
［7］Barrett MC，Wilkinson FO，Blom AW，et al.Incidence，temporal trends and potential risk factors for aseptic loosening following primary unicompartmental knee arthroplasty：A meta-analysis of 96 294 knees［J］.Knee，2021，31(8)：28-38.
［8］Greig D，Trikha R，Geiger EJ，et al.Metaphyseal stem tip location is a risk factor for aseptic loosening of cemented distal femoral replacements［J］.J Arthroplasty，2021，36(9)：3174-3180.
［9］Linke P，Wilhelm P，Levent A，et al.Anatomical risk factors for aseptic loosening of full hinge knee prosthesis in primary and revision TKAs［J］.Arch Orthop Trauma Surg，2023，143(7)：4299-4307.
［10］Peng Z，Jia Y，Li J，et al.Diagnostic performance of single-photon emission computed tomography/computed tomography in aseptic loosening：A systematic review and meta-analysis［J］.J Arthroplasty，2021，36(12)：4003-4012.
［11］Xu H，Li Y，Yu F，et al.GMRS oncological prosthesis with a porous coating collar：A good option for revision of aseptic loosening in the lower extremity［J］.J Clin Med，2023，12(3)：892-901.
［12］Gusho CA，Greenspoon JA，Clayton B，et al.Long-term outcomes and improved risk of revision following tumor endoprosthetic replacement of the distal femur：Single institutional results［J］.J Orthop，2021(25)：259-264.
［13］Errani C，Tsukamoto S，Almunhaisen N，et al.Intercalary reconstruction following resection of diaphyseal bone tumors：A systematic review［J］.J Clin Orthop Trauma，2021(19)：1-10.
［14］Hinman AD，Prentice HA，Paxton EW，et al.Modular tibial stem use and risk of revision for aseptic loosening in cemented primary total knee arthroplasty［J］.J Arthroplasty，2021，36(5)：1577-1583.
［15］Prock-Gibbs H，Pumilia CA，Meckmongkol T，et al.Incidence of osteolysis and aseptic loosening following metal-on-highly cross-linked polyethylene hip arthroplasty：A systematic review of studies with up to 15-year follow-up［J］.J Bone Joint Surg (Am)，2021，103(8)：728-740.
［16］Li Z，Yu X，Xu M，et al.Aseptic loosening of tumor prostheses in distal femur after revision surgery：A retrospective study［J］.World J Surg Oncol，2023，21(1)：164-173.
［17］宗雅琪，刘嵬，张英剑，等.性别、吸烟和BMI对髋膝关节置换术后假体无菌性松动的影响［J］.透析与人工器官，2021，32(3)：32-34.
［18］李子明.肿瘤型膝关节假体无菌性松动的X线测量及术后膝关节功能与中医体质关系的临床研究[D].济南：山东中医药大学，2022.
［19］Stancil R，Goldberg M，Bouchard M，et al.Complex primary total knee arthroplasty in a patient with achondroplasia，osteoarthritis，and severe coronal instability［J］.Arthroplast Today，2021(8)：24-28.