Joint preservation in revision arthroplasty and intercalary tumour implants using custom stem solutions.

Background: Off-the-shelf stems offer a wide variety of fixation methods for revision arthroplasty and intercalary tumour implants. However, in extensive defects or needed resection with minimal bone stock left, solid fixation is often not feasible with these implants. Custom-made stem solutions (CSS) offer a viable alternative in these cases to achieve joint preservation.

Methods: Between 2017 and 2024 14 patients (15 implants) were treated in a single-centre study. CSS were indicated if the remaining bone stock was deemed insufficient for normal stem fixation due to tumour resection or previous operations. Postoperative analysis was conducted to evaluate the functional outcome as well as revision rates.

Results: Implantation was possible in all cases, during the follow-up of 30 (SD 18; 6-66) months revision was needed in five cases; with one aseptic loosening, one screw loosening and three PJI cases. Mean MSTS score was 24 (SD 5; 17-30).

Conclusion: Custom-made stem solutions show promising results in extreme cases. Especially as a preservation of the joint is possible, this treatment algorithm should be considered on a case-by-case basis.