Reconstruction With Megaprothesis After Bone and Joint Ressection. Prof. Rodolfo Capanna

MEGASYSTEM C
Department of Oncological and Reconstructive Surgery

CTO Florence Italy
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MEGASYSTEM C
Eclectic Device Different Clinical Conditions
tumor revision posttraumatic

MEGASYSTEM C
Modularity
From a minimum of 5 cm
(revision surgery)
to the
“en bloc” knee
&
entire femur and tibia
(extensive tumor resection)
MEGASYSTEM C
Modularity
1 cm
2cm
Accurate length adjustment 1cm by 1cm

( instead 2 by 2 )
Further accomodation
with extension ring
in hip reconstructions
MEGASYSTEM C
Complete Hip Joint System
- hip arthroplasty
conventional
snap fit
fully retentive
- bypolar cup
- saddle prosthesis
MEGASYSTEM C
üAntiversion - adjustable at
surgery

MEGASYSTEM C
New
endomodel
kinematic rotating hinge knee

MEGASYSTEM C
Intraoperative changeable from rotational to total hinged
knee without removing stems or joint components
Assembly without
Component for rotation Component for extension between
and extension/flexion extension/flexion only femur and tibia

MEGASYSTEM C

MEGASYSTEM C
Same system : Conversion

3 Extensive revisions from arthroplasty
3 Resection arthroplasty to arthrodesis
3 Intercalary resections feasible at any time
3 Resection arthrodesis without stem removal

MEGASYSTEM C
Stem fixation
Interchange ability
cemented cementless
Older pt. Younger pt.

Metastases Primary tumors
Osteoporotic Normal bone
Previous Rxth. None
Scheduled Rxth. None
Inadequate press fitt Adequate press fit

MEGASYSTEM C
Cemented stem
Rough Collar Ring

MEGASYSTEM C
enhanced scar tissue

prevents
polyethilene debris
migration
at the interface
stem / inner cortex
“purse string effect”

MEGASYSTEM C
Cementless fixation
Rough titanium trunco conical flanged stems

(1 mm steps)
MEGAPROSTHESIS C
Cementless fixation
Two antirotational pegs

MEGASYSTEM C
The anchorage elements absorbs rotational forces

acting on the intramedulary stem anchorage. This
assures a bone-safe transmission between the
anchorage of the prosthesis and the bone

MEGASYSTEM C
short cone
connection

MEGASYSTEM C
Implant Flexibility
Conventional
megaprosthesis
Composite
allograft- prosthesis
Ibrid solutions
“encased grafts”

MEGASYSTEM C

MEGASYSTEM C
Implant Flexibility
Conventional
megaprosthesis
Composite
Ibrid solutions

Rationale for alloprosthesis
üThe allograft allows a

normal distribution of
forces from implant to
host bone when union
has been achieved

Alloprostheses vs Megaprostheses:
Outcome (10 years survival)
Alloprosthesis Megaprosthesis
Anract 77 none
Zehr 76 58
Capanna 85 83
Robb -- 63
Horowitz -- 67
Urwin -- 94

Alloprostheses vs Megaprostheses:
Functional Results
Alloprosthesis Megaprosthesis
score limp can score limp can
Zehr 87 64 43 80 90 60
Anract 83 52 10 75 75 35

MEGASYSTEM C
Implant Flexibility
Conventional
megaprosthesis
Composite
Ibrid solutions

Rationale for alloprosthesis
Reattachment of bone and muscles is feasable and effective

MEGASYSTEM C
osteosarcoma
MEGASYSTEM C
osteosarcoma
allograft
conventional

MEGASYSTEM C : “conventional” tibia

MEGASYSTEM C : “conventional” tibia

MEGASYSTEM C : tibial “ encased graft ”

Chondrosarcoma involving the entire tibia
with pathological fracture & closed nail fixation

Osteoarticular
with
capsular repair
5 years
follow up
MEGASYSTEM C : knee “ ibrid” implant
Recurrent
G. C. T.
extensively
involving
the knee joint

MEGASYSTEM C : knee “ ibrid” implant
Recurrent
G. C. T.
extensively
involving
the knee joint

SERIES OF PATIENTS
Total 297 cases
Department of Orthopaedics, Florence, Italy
from june 2001 to july 2007
213 cases
University of Innsbruck, Austria
from maj 2002 to july 2007
60 cases
University of Hamburg, Germany
24 cases
SERIES OF PATIENTS
297 cases
RECONSTRUCTION TYPE CASES
Proximal femur 130 (44%)
Distal femur 108 (36%)
Total femur 35 (12%)
Proximal tibia (sept. 2005) 10 (3.2%)
A-P composite of the knee 8 (3%)
Knee arthrodesis 5 (1.5%)
Intercalary resection of the femur 1 (0.3%)

COMPLICATIONS
297 cases
34 cases (11.4%)
Type Florence Innsbruck Hamburg Tot.
Infection 14 1 2 17 (5.7%)
Mechanical 6 1 - 7 (2.3%)
failure
Dislocation 3 - 1 4 (1.3%)
Loosening 2 1 - 3 (1%)
Shaft perforation - 2 - 2 (0.6%)
Prosthetic 1 - - 1 (0.3%)
disconnection
PROSTHETIC
COMPLICATIONS
17 out of 297 cases ( 6 %)
Type Florence Innsbruck Hamburg Tot.
Cone breakage 6 1 - 7 (2.3%)
Hip dislocation 3 - 1 4 (1.3%)
Stem loosening 2 1 - 3 (1%)
Shaft perforation - 2 - 2 (0.6%)
Cone 1 - - 1 (0.3%)
disconnection

Mechanical failure
Florence experience
Total # %
213 pts 6 2.8%
493 cones 8 1.6%

Further recent improvements
Modification on
cone
slope obliquity
shifting
stress
distribution
more at its basis
Mechanical failure
Personal experience
Total # %
Before 150 pts 5 3.3
322 cones 7 2.1
Total # %
After 63 pts 1 1.5
171 cones 1 0.6
Transfixing screws
for cone stability
were found
prudential
excessive
tools
Elimination of any stress riser or week point

• Full thickness
cone
with total contact
• Removal of
transfixing screws
To avoid any stress riser or week point

Further recent improvements :
biomechanical tests
Disassembling
forces :
6500 N without screw
8000 N with screw
Very safe locking

device
biomechanical tests
Small screw gripping
in a notch of the
collar
very effective
locking device
(up to 8000 N )
in a safe area
biomechanical tests
3 points bending stresses :
3500 N 10 Hz 10,000,000 cycles
No failure
ALLOGRAFT COMPLICATIONS
TYPE NUMBER EFFECT

PARTIAL 1 CASE NO INFLUENCE ON
RESORPTION & FUNCTIONAL
FRACTURE (PROX FEM) OUTCOME
PARTIAL REMOVAL AFTER 4
1 CASE YEARS REVISION
RESORPTION FOR COTYLOIDITIS
POST-TRAUMATIC
EXTENSOR
1 CASE EXTENSOR LAG
APPARATUS
ELONGATION
PRE RESORPTION & FRACTURE

POST RESORPTION
&
FRACTURE

ALLOGRAFT COMPLICATIONS
TYPE NUMBER EFFECT

PARTIAL 1 CASE NO INFLUENCE ON
RESORPTION & FUNCTIONAL
FRACTURE (PROX FEM) OUTCOME
REMOVAL AFTER 4
PARTIAL
1 CASE YEARS REVISION
RESORPTION
FOR COTYLOIDITIS
POST-TRAUMATIC
EXTENSOR
1 CASE EXTENSOR LAG
APPARATUS
ELONGATION

Reconstruction With Megaprothesis After Bone and Joint Ressection. Prof. Rodolfo Capanna

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Reconstruction With Megaprothesis After Bone and Joint Ressection. Prof. Rodolfo Capanna

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MEGASYSTEM C

Department of Oncological and Reconstructive Surgery

PDF created with pdfFactory Pro trial version www.pdffactory.com

Eclectic Device Different Clinical Conditions

tumor revision posttraumatic

Accurate length adjustment 1cm by 1cm

PDF created with pdfFactory Pro trial version www.pdffactory.com

PDF created with pdfFactory Pro trial version www.pdffactory.com

PDF created with pdfFactory Pro trial version www.pdffactory.com

PDF created with pdfFactory Pro trial version www.pdffactory.com

Same system : Conversion

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Older pt. Younger pt.

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Rough Collar Ring

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enhanced scar tissue

“purse string effect”

PDF created with pdfFactory Pro trial version www.pdffactory.com

Rough titanium trunco conical flanged stems

Two antirotational pegs

PDF created with pdfFactory Pro trial version www.pdffactory.com

The anchorage elements absorbs rotational forces

PDF created with pdfFactory Pro trial version www.pdffactory.com

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üThe allograft allows a

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score limp can score limp can

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Proximal femur 130 (44%)

Distal femur 108 (36%)

Total femur 35 (12%)

Proximal tibia (sept. 2005) 10 (3.2%)

A-P composite of the knee 8 (3%)

Knee arthrodesis 5 (1.5%)

Intercalary resection of the femur 1 (0.3%)

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Elimination of any stress riser or week point

To avoid any stress riser or week point

Very safe locking

TYPE NUMBER EFFECT

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TYPE NUMBER EFFECT

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