Dr. Randall on Preventing Early Failures With Osseointegrated Endoprostheses in Bone Sarcomas

R. Lor Randall, MD, FACS, The David Linn Endowed Chair for Orthopaedic Surgery, professor and chair, Department of Orthopaedic Surgery, University of California Davis Health, discusses methods of preventing early failures with compressive osseointegrative endoprosthetic devices of the femur in bone sarcomas.

Findings from a single-center, retrospective study showed that in patients with primary bone sarcoma who had compressive osseointegrative endoprosthetic devices of the femur implanted derived long-term benefit without late revisions because of periprosthetic fracture, aseptic loosening, or implant breakage.

The technology requires osseointegration, which happens over time, Randall says. Moreover, a bony hypertrophy happens at the collar of the prothesis where it attaches to the bone. Until the bone hypertrophies, it is subject to torsional force and can become loose, making the osseointegrative technique vulnerable early on, Randal explains.

In the first 6 to 12 weeks following implantation, patients should be protected in their weight bearing. They should continue to use the assistive device for ambulation to share some of the load the prothesis would otherwise experience. Doing so may prevent early failures until the bone hypertrophies, Randall concludes.