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

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Abstract

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

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Acknowledgements

Authors declare no conflict of interest regarding this article.

SP received a grant from SOFCOT, SOFOP and ADEREM for this work

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Authors and Affiliations

  1. Pediatric Orthopaedics, Hopital d’enfants de la Timone, Aix-Marseille University, 264 rue Saint Pierre, 13005, Marseille, France

    Sébastien Pesenti, Emilie Peltier, Elke Viehweger & Jean-Luc Jouve

  2. Gait Analysis Laboratory, Timone, Aix Marseille University, Marseille, France

    Sébastien Pesenti, Emilie Peltier, Vincent Pomero, Guillaume Authier, Lionel Roscigni, Elke Viehweger & Jean-Luc Jouve

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  1. Sébastien Pesenti
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  2. Emilie Peltier
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Correspondence to Sébastien Pesenti.

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Pesenti, S., Peltier, E., Pomero, V. et al. Knee function after limb salvage surgery for malignant bone tumor: comparison of megaprosthesis and distal femur allograft with epiphysis sparing. International Orthopaedics (SICOT) 42, 427–436 (2018). https://doi.org/10.1007/s00264-017-3608-x

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  • DOI: https://doi.org/10.1007/s00264-017-3608-x

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