Cortical Fenestration for Megaprosthesis Stem Revision

Vincent Y. Ng*, 1, Philip Louie2, Stephanie Punt3, Ernest U. Conrad III.3
1 University of Maryland Medical Center, Department of Orthopedics, Baltimore MD, USA
2 Rush University, Chicago IL, USA
3 University of Washington Medical Center, Department of Orthopaedics and Seattle Children's Hospital, Seattle WA, USA

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Creative Commons License
© 2017 Vincent et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Ng, Vincent, University of Maryland Medical Center - Orthopaedics, 110 S. Paca St, 6th Floor, Baltimore, Maryland 21201, United States, Tel: 443-462-5903; Email:



The most common modes of failure for megaprostheses are aseptic loosening followed by periprosthetic infection and stem fracture. Surgical technique for bone and implant exposure is controversial and may influence the success of revision and the need for additional future revisions. The purpose of this study was to evaluate the effectiveness of cortical fenestration for megaprosthesis revision, particularly for stem fracture.


From 1985-2014, 196 adult and pediatric patients underwent limb salvage with a distal femoral or proximal tibial megaprosthesis (109 cemented, 87 pressfit). A retrospective chart review was performed to assess the rate of revision based on cemented or pressfit fixation and the use of a cortical window to extract the failed stem.


27% (29 of 109) of cemented and 18% (16 of 87) of pressfit implants were revised for stem failure. The reasons for revision in the cemented group were loosening (62%), infection (24%), and stem fracture (13%). In the pressfit group, the reasons were loosening (43%), infection (31%), stem fracture (6%), limb-length discrepancy (6%), malrotation (6%), and local recurrence (6%). A cortical window was used in 10 of 45 initial revisions (7 cemented, 3 pressfit) including all of the stem fractures, and in 2 of 15 subsequent re-revisions.


Cortical fenestration is an effective, bone-preserving method of implant extraction, particularly for broken or cemented stems. It is associated with low rates of loosening and no increase in periprosthetic fractures.

Keywords: Stem fracture, Cortical fenestration, Window, Revision, Megaprosthesis, Tumor.