Intramedullary and total femur replacement in revision arthroplasty as a last limb-saving option

Abstract

There has been a substantial increase in the number of hip and knee prostheses implanted in recent years, with a consequent increase in the number of revisions required. Total femur replacement (TFR) following destruction of the entire femur, usually after several previous revision operations, is a rare procedure but is the only way of avoiding amputation. Intramedullary femur replacement (IFR) with preservation of the femoral diaphysis is a modification of TFR. Between 1999 and 2010, 27 patients with non-oncological conditions underwent surgery in our department with either IFR (n = 15) or TFR (n = 12) and were included in this study retrospectively. The aim of the study was to assess the indications, complications and outcomes of IFR and TFR in revision cases. The mean follow-up period was 31.3 months (6 to 90). Complications developed in 37% of cases, 33% in the IFR group and 4% in the TFR group. Despite a trend towards a slightly better functional outcome compared with TFR, the indication for intramedullary femur replacement should be established on a very strict basis in view of the procedure's much higher complication rate.

Total Femoral Replacement for Salvage of Periprosthetic Fractures

“…Authors reporting the use of a megaendoprosthesis for TFR as a salvage procedure for periprosthetic disease included various indications, 8,9,[23][24][25] with 21% 25 to 41% 9 of reported cohorts sustaining Patients with a periprosthetic fracture represent a distinct subgroup of patients who may have had a well-functioning implant before their injury, and this was found in the current cohort, with a high physical component score on preinjury SF-12. The surgical goal for these patients is to return them to their preinjury functional status rather than to improve this status, and the current study showed that this can be achieved with TFR.…”

“…These authors showed good functional results, according to the Harris Hip score, and these findings were comparable to other studies reporting the outcome of TFR for all-cause salvage of periprosthetic disease. 8,9,24 This series reported by Peters et al 23 was also retrospective, with no preinjury outcome scores available for comparison with postoperative results.…”

“…As a limb-saving procedure, some authors have described the use of a mega-endoprosthesis for revision arthroplasty surgery. 8,9 Buchman 10 first described total femoral prosthesis in 1965. Since then, there have been numerous reports of total femoral prosthesis for malignant tumors of the femur 11 and for limb-saving revision arthroplasty surgery.…”

“…Since then, there have been numerous reports of total femoral prosthesis for malignant tumors of the femur 11 and for limb-saving revision arthroplasty surgery. 8,9 The use of total femoral replacement (TFR) for revision arthroplasty has been reported in heterogeneous cohorts of patients with multiple indications, such as aseptic loosening, periprosthetic infection, and periprosthetic fracture. The outcome of patients with these various indications may be different, and patients with aseptic loosening or infection usually have worse preopera-tive function than patients who sustained a periprosthetic fracture with a previously well-functioning implant.…”

Salvage of an Infected Periprosthetic Failed Fracture Fixation in a Nonagenarian

“…Total femoral replacement could have addressed the intercalary nonunion and provided the potential for immediate weight bearing. [9][10][11] One of the authors (HAC) has used this option in similar patients. However, to mitigate the risks of persistent infection, this would have been best performed as a staged procedure to follow placement of an antibiotic spacer and given this patient's age and the nature of her infection, she would have remained at high risk of a recurrence with few options for salvage of her limb.…”