Modular endoprosthetic replacement after total resection of the femur for malignant tumour

Morris, H. G.; Capanna, Rodolfo; Campanacci, D; Ben, M. Del; Gasbarrini, A.

doi:10.1007/bf02484417

Cited by 52 publications

(65 citation statements)

References 10 publications

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“…Whenever possible, the main previous incision should be used. It is of upmost importance to preserve blood supply to the soft tissues in order to lower the risk of infection and to help the reconstruction during closure, assisting therefore in prosthetic stability and functional results [3,4,[7][8][9]14].…”

Section: Surgical Techniquementioning

confidence: 99%

“…The Vastus Lateralis and Gluteus Medius must be moved as one unit to the front. This step is essential in cases in which there is no Greater Trochanter, to facilitate abductor function [9]. To minimize bleeding from the perforators, the linea aspera is better osteotomized rather than dissected [20].…”

Section: Surgical Techniquementioning

confidence: 99%

“…Closure with soft tissue reconstruction is begun distally, with the consequent covering of the prosthesis with muscles if is possible [20]. The muscle reconstruction requires special attention to guarantee a good prosthetic stability and to improve biomechanics and gait [1,3,9,14,15]. It is preferable to close the capsule with non absorbable suture 1 since this provides immediate stability.…”

Section: Surgical Techniquementioning

confidence: 99%

“…It is important to check the mobility of the limb to be sure that it is not limited by soft tissue tension [14]. Careful hemostasis and minimizing dead space allow for better tissue healing [4,9]. It is advisable to place drains for 48 to 72 hours and the use of a knee immovilizer during the first 4 to 8 weeks reduces the probability of dislocation [1,4,12].…”

Section: Surgical Techniquementioning

confidence: 99%

“…Nevertheless, in certain cases, the femoral bone deficit is so significant that there is not enough bone to properly fix any of these revision implants. In these patients, an option is the total hip replacement with a megaprosthesis, and among them, the total femur replacement (TFR) [4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

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Total Femoral Replacement in Non-Neoplastic Disorders

Vedoya¹

2017

MOJOR

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Submit Manuscript | http://medcraveonline.com IntroductionThe deficit of femoral bone stock is a frequent finding. This situation is mostly derived from the increased number of hip and knee arthroplasties and the consequent increase of failed implants, periprosthetic fractures and infections. There are other non-tumoral causes that generate this type of deficit, such as hardware failures in pathological bone, osteomielytis, congenital bone defects and metabolic bone diseases, etc [1-3].Several solutions have been proposed, which must be analyzed depending on the cause and magnitude of the femoral and acetabular bone loss, the patient's muscle status (particularly the gluteus medius), the presence of infection, the age and background of the patient, and, of course, the surgeon's expertise and his surgical facilities. This last aspect is essential, as revision and conversion surgeries are very demanding, for both patient and surgeon.The most frequent alternatives include the use of cemented or non cemented long femoral stems, with proximal or distal fixation, associated or not to bone graft. Many studies have referred to the advantages and disadvantages of each of these treatment alternatives [2][3][4]. Nevertheless, in certain cases, the femoral bone deficit is so significant that there is not enough bone to properly fix any of these revision implants. In these patients, an option is the total hip replacement with a megaprosthesis, and among them, the total femur replacement (TFR) [4][5][6][7][8][9].Buchman was the first to report a total femur replacement in a patient with Paget´s disease 10 . The first total femur implants were made of hip and knee prosthesis united by a polyethylene shaft, to which these components were adapted [5,10]. Even if this was a low cost versatile design, in time it was observed that polyethylene alone was not an adequate material to bear the load and torsions at a femoral level, particularly in young patients with high functional demand, since most of the initial patients were operated due to tumours [4]. In the mid 80s, modularity revolutionized reconstruction prosthesis, allowing the surgeon to estimate the existing bone defect, and therefore select the appropriate components for more accurate reconstructive surgery [1,11].The good outcome of patients treated with TFR for neoplastic causes widened the indication of this treatment to patients with massive femoral bone loss due to several non-neoplastic causes, not being the estimated survivorship of the patient an excluding factor in the decision process [12]. However, except for the publications from Endo-Klinik in Hamburg, Germany, which exceed 100 cases [7], the rest of TFR reports in non-neoplastic pathology analyze around 20 cases at the most. Additionally, in all these series the pre-operative diagnosis is varied, making it difficult to obtain from them a clear conclusion on the evolution of these patients on the medium and long term. In this study we evaluate the indications, surgical technique and post operative care of TFR ...

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Section: Surgical Techniquementioning

confidence: 99%

Section: Surgical Techniquementioning

confidence: 99%

Section: Surgical Techniquementioning

confidence: 99%

Section: Surgical Techniquementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Total Femoral Replacement in Non-Neoplastic Disorders

Vedoya¹

2017

MOJOR

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Voice outcomes after concurrent chemoradiotherapy for advanced nonlaryngeal head and neck cancer: A prospective study

et al. 2012

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Patient‐oriented functional results of total femoral endoprosthetic reconstruction following oncologic resection

Jones

Griffin

Chandrasekar

et al. 2011

Journal of Surgical Oncology

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Background and Objectives Functional outcomes following oncologic total femoral endoprosthetic reconstruction (TFR) are lacking. We compared patient-oriented functional results of TFRs to proximal femur and distal femur reconstructions (PFR and DFR). We also compared function and complications with regard to knee and hip componentry. Methods 54 TFR patients were identified from 3 institutional prospective databases. 41 had fixed- and 13 had rotating-hinge knees, 37 hemiarthroplasty and 17 total hip arthroplasty componentry. Toronto Extremity Salvage Scores (TESS) for n=27 were compared between groups and to cohorts of PFR (n=31) and DFR (n=85) patients using the Mann-Whitney U test. Results Follow-up averaged 4 years. Mechanical complications included 5 hip dislocations and 1 femoral malrotation. Four dislocations were in fixed-hinge implants, all in those lacking abductor reattachment. TESS averaged 69.3±17.8, statistically decreased from DFR (p=0.002) and PFR patients (p=0.036). No significant differences were detected between patients in the fixed-hinge (n=18) and rotating-hinge (n=9) groups (p = 0.944), or total hip (n=8) and hemiarthroplasty (n=19) groups (p=0.633). Conclusions TFR is reserved for extreme cases of limb salvage, portending a poor prognosis overall. Function reflects additive impairments from PFR and DFR. TFR outcomes differ little with rotating- or fixed-hinge, total hip or hemiarthroplasty implants.

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Modular endoprosthetic replacement after total resection of the femur for malignant tumour

Cited by 52 publications

References 10 publications

Total Femoral Replacement in Non-Neoplastic Disorders

Total Femoral Replacement in Non-Neoplastic Disorders

Voice outcomes after concurrent chemoradiotherapy for advanced nonlaryngeal head and neck cancer: A prospective study

Patient‐oriented functional results of total femoral endoprosthetic reconstruction following oncologic resection

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