Influence of cerclages on primary stability of tumor megaprostheses subjected to distal femur defects

BackroundPurpose of this experimental study was to investigate the influence of cerclages on the primary stability of the MUTARS® system using distally fractured synthetic femora.Methods4 MUTARS® prostheses were implanted in synthetic femora respectively. Groups consisted of 4 intact bones, 4 fractured with cerclages and 4 fractured bones without cerclages. Spatial micromovements were measured with a high-precision rotational setup.FindingsThe order from the weakest to the strongest torque transmission of the intact bones was rm1-rm4-rm2-rm3 (p = 0.011) and of the fractured bones with cerclages rm4-rm1-rm3-rm2 (p = 0.013). The MUTARS® stems broke out of the fractured femoral shaft by removing cerclages (p < 0.001) and by the influence of bone defect A (p < 0.001). Overall micromovements of the intact bones were lower than those of the fractured bones without cerclages (p < 0.001) and overall micromovements of the fractured bones with cerclages were lower than those of bones without cerclages (p < 0.001).InterpretationDue to high press-fit at the proximal and distal isthmus region fissural fractures of the femur may occur. This should always be taken into account. It is advisable to secure them and provide a prophylaxis for these fissural fractures by means of cerclages.