Failure mode classification for tumor endoprostheses: Retrospective review of five institutions and a literature review

Eric R. Henderson, John S. Groundland, Elisa Pala, Jeremy A. Dennis, Rebecca Wooten, David Cheong, Reinhard Windhager, Rainer I. Kotz, Mario Mercuri, Philipp T. Funovics, Francis J. Hornicek, H. Thomas Temple, Pietro Ruggieri, G. Douglas Letson

Research output: Contribution to journalArticle

211 Citations (Scopus)

Abstract

Background: Massive endoprostheses provide orthopaedic oncologists with many reconstructive options after tumor resection, although failure rates are high. Because the number of these procedures is limited, failure of these devices has not been studied or classified adequately. This investigation is a multicenter review of the use of segmental endoprostheses with a focus on the modes, frequency, and timing of failure. Methods: Retrospective reviews of the operative databases of five institutions identified 2174 skeletally mature patients who received a large endoprosthesis for tumor resection. Patients who had failure of the endoprosthesis were identified, and the etiology and timing of failure were noted. Similar failures were tabulated and classified on the basis of the risk of amputation and urgency of treatment. Statistical analysis was performed to identify dependent relationships among mode of failure, anatomic location, and failure timing. A literature review was performed, and similar analyses were done for these data. Results: Five hundred and thirty-four failures were identified. Five modes of failure were identified and classified: soft-tissue failures (Type 1), aseptic loosening (Type 2), structural failures (Type 3), infection (Type 4), and tumor progression (Type 5). The most common mode of failure in this series was infection; in the literature, it was aseptic loosening. Statistical dependence was found between anatomic location and mode of failure and between mode of failure and time to failure. Significant differences were found in the incidence of failure mode Types 1, 2, 3, and 4 when polyaxial and uniaxial joints were compared. Significant dependence was also found between failure mode and anatomic location in the literature data. Conclusions: There are five primary modes of endoprosthetic failure, and their relative incidences are significantly different and dependent on anatomic location. Mode of failure and time to failure also show a significant dependence. Because of these relationships, cumulative reporting of segmental failures should be avoided because anatomy-specific trends will be missed. Endoprosthetic design improvements should address failure modes specific to the anatomic location. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Original languageEnglish
Pages (from-to)418-429
Number of pages12
JournalJournal of Bone and Joint Surgery - Series A
Volume93
Issue number5
DOIs
StatePublished - Mar 2 2011

Fingerprint

Equipment Failure
Neoplasms
Incidence
Infection
Amputation
Orthopedics
Anatomy
Joints
Databases
Therapeutics
Oncologists

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Failure mode classification for tumor endoprostheses : Retrospective review of five institutions and a literature review. / Henderson, Eric R.; Groundland, John S.; Pala, Elisa; Dennis, Jeremy A.; Wooten, Rebecca; Cheong, David; Windhager, Reinhard; Kotz, Rainer I.; Mercuri, Mario; Funovics, Philipp T.; Hornicek, Francis J.; Thomas Temple, H.; Ruggieri, Pietro; Letson, G. Douglas.

In: Journal of Bone and Joint Surgery - Series A, Vol. 93, No. 5, 02.03.2011, p. 418-429.

Research output: Contribution to journalArticle

Henderson, ER, Groundland, JS, Pala, E, Dennis, JA, Wooten, R, Cheong, D, Windhager, R, Kotz, RI, Mercuri, M, Funovics, PT, Hornicek, FJ, Thomas Temple, H, Ruggieri, P & Letson, GD 2011, 'Failure mode classification for tumor endoprostheses: Retrospective review of five institutions and a literature review', Journal of Bone and Joint Surgery - Series A, vol. 93, no. 5, pp. 418-429. https://doi.org/10.2106/JBJS.J.00834
Henderson, Eric R. ; Groundland, John S. ; Pala, Elisa ; Dennis, Jeremy A. ; Wooten, Rebecca ; Cheong, David ; Windhager, Reinhard ; Kotz, Rainer I. ; Mercuri, Mario ; Funovics, Philipp T. ; Hornicek, Francis J. ; Thomas Temple, H. ; Ruggieri, Pietro ; Letson, G. Douglas. / Failure mode classification for tumor endoprostheses : Retrospective review of five institutions and a literature review. In: Journal of Bone and Joint Surgery - Series A. 2011 ; Vol. 93, No. 5. pp. 418-429.
@article{dad6a3b3d2144a6da08407ac8b77e29f,
title = "Failure mode classification for tumor endoprostheses: Retrospective review of five institutions and a literature review",
abstract = "Background: Massive endoprostheses provide orthopaedic oncologists with many reconstructive options after tumor resection, although failure rates are high. Because the number of these procedures is limited, failure of these devices has not been studied or classified adequately. This investigation is a multicenter review of the use of segmental endoprostheses with a focus on the modes, frequency, and timing of failure. Methods: Retrospective reviews of the operative databases of five institutions identified 2174 skeletally mature patients who received a large endoprosthesis for tumor resection. Patients who had failure of the endoprosthesis were identified, and the etiology and timing of failure were noted. Similar failures were tabulated and classified on the basis of the risk of amputation and urgency of treatment. Statistical analysis was performed to identify dependent relationships among mode of failure, anatomic location, and failure timing. A literature review was performed, and similar analyses were done for these data. Results: Five hundred and thirty-four failures were identified. Five modes of failure were identified and classified: soft-tissue failures (Type 1), aseptic loosening (Type 2), structural failures (Type 3), infection (Type 4), and tumor progression (Type 5). The most common mode of failure in this series was infection; in the literature, it was aseptic loosening. Statistical dependence was found between anatomic location and mode of failure and between mode of failure and time to failure. Significant differences were found in the incidence of failure mode Types 1, 2, 3, and 4 when polyaxial and uniaxial joints were compared. Significant dependence was also found between failure mode and anatomic location in the literature data. Conclusions: There are five primary modes of endoprosthetic failure, and their relative incidences are significantly different and dependent on anatomic location. Mode of failure and time to failure also show a significant dependence. Because of these relationships, cumulative reporting of segmental failures should be avoided because anatomy-specific trends will be missed. Endoprosthetic design improvements should address failure modes specific to the anatomic location. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.",
author = "Henderson, {Eric R.} and Groundland, {John S.} and Elisa Pala and Dennis, {Jeremy A.} and Rebecca Wooten and David Cheong and Reinhard Windhager and Kotz, {Rainer I.} and Mario Mercuri and Funovics, {Philipp T.} and Hornicek, {Francis J.} and {Thomas Temple}, H. and Pietro Ruggieri and Letson, {G. Douglas}",
year = "2011",
month = "3",
day = "2",
doi = "10.2106/JBJS.J.00834",
language = "English",
volume = "93",
pages = "418--429",
journal = "Journal of Bone and Joint Surgery - American Volume",
issn = "0021-9355",
publisher = "Journal of Bone and Joint Surgery Inc.",
number = "5",

}

TY - JOUR

T1 - Failure mode classification for tumor endoprostheses

T2 - Retrospective review of five institutions and a literature review

AU - Henderson, Eric R.

AU - Groundland, John S.

AU - Pala, Elisa

AU - Dennis, Jeremy A.

AU - Wooten, Rebecca

AU - Cheong, David

AU - Windhager, Reinhard

AU - Kotz, Rainer I.

AU - Mercuri, Mario

AU - Funovics, Philipp T.

AU - Hornicek, Francis J.

AU - Thomas Temple, H.

AU - Ruggieri, Pietro

AU - Letson, G. Douglas

PY - 2011/3/2

Y1 - 2011/3/2

N2 - Background: Massive endoprostheses provide orthopaedic oncologists with many reconstructive options after tumor resection, although failure rates are high. Because the number of these procedures is limited, failure of these devices has not been studied or classified adequately. This investigation is a multicenter review of the use of segmental endoprostheses with a focus on the modes, frequency, and timing of failure. Methods: Retrospective reviews of the operative databases of five institutions identified 2174 skeletally mature patients who received a large endoprosthesis for tumor resection. Patients who had failure of the endoprosthesis were identified, and the etiology and timing of failure were noted. Similar failures were tabulated and classified on the basis of the risk of amputation and urgency of treatment. Statistical analysis was performed to identify dependent relationships among mode of failure, anatomic location, and failure timing. A literature review was performed, and similar analyses were done for these data. Results: Five hundred and thirty-four failures were identified. Five modes of failure were identified and classified: soft-tissue failures (Type 1), aseptic loosening (Type 2), structural failures (Type 3), infection (Type 4), and tumor progression (Type 5). The most common mode of failure in this series was infection; in the literature, it was aseptic loosening. Statistical dependence was found between anatomic location and mode of failure and between mode of failure and time to failure. Significant differences were found in the incidence of failure mode Types 1, 2, 3, and 4 when polyaxial and uniaxial joints were compared. Significant dependence was also found between failure mode and anatomic location in the literature data. Conclusions: There are five primary modes of endoprosthetic failure, and their relative incidences are significantly different and dependent on anatomic location. Mode of failure and time to failure also show a significant dependence. Because of these relationships, cumulative reporting of segmental failures should be avoided because anatomy-specific trends will be missed. Endoprosthetic design improvements should address failure modes specific to the anatomic location. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

AB - Background: Massive endoprostheses provide orthopaedic oncologists with many reconstructive options after tumor resection, although failure rates are high. Because the number of these procedures is limited, failure of these devices has not been studied or classified adequately. This investigation is a multicenter review of the use of segmental endoprostheses with a focus on the modes, frequency, and timing of failure. Methods: Retrospective reviews of the operative databases of five institutions identified 2174 skeletally mature patients who received a large endoprosthesis for tumor resection. Patients who had failure of the endoprosthesis were identified, and the etiology and timing of failure were noted. Similar failures were tabulated and classified on the basis of the risk of amputation and urgency of treatment. Statistical analysis was performed to identify dependent relationships among mode of failure, anatomic location, and failure timing. A literature review was performed, and similar analyses were done for these data. Results: Five hundred and thirty-four failures were identified. Five modes of failure were identified and classified: soft-tissue failures (Type 1), aseptic loosening (Type 2), structural failures (Type 3), infection (Type 4), and tumor progression (Type 5). The most common mode of failure in this series was infection; in the literature, it was aseptic loosening. Statistical dependence was found between anatomic location and mode of failure and between mode of failure and time to failure. Significant differences were found in the incidence of failure mode Types 1, 2, 3, and 4 when polyaxial and uniaxial joints were compared. Significant dependence was also found between failure mode and anatomic location in the literature data. Conclusions: There are five primary modes of endoprosthetic failure, and their relative incidences are significantly different and dependent on anatomic location. Mode of failure and time to failure also show a significant dependence. Because of these relationships, cumulative reporting of segmental failures should be avoided because anatomy-specific trends will be missed. Endoprosthetic design improvements should address failure modes specific to the anatomic location. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

UR - http://www.scopus.com/inward/record.url?scp=79952431263&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79952431263&partnerID=8YFLogxK

U2 - 10.2106/JBJS.J.00834

DO - 10.2106/JBJS.J.00834

M3 - Article

C2 - 21368074

AN - SCOPUS:79952431263

VL - 93

SP - 418

EP - 429

JO - Journal of Bone and Joint Surgery - American Volume

JF - Journal of Bone and Joint Surgery - American Volume

SN - 0021-9355

IS - 5

ER -