The push-through total femoral prosthesis offers a functional alternative to total femoral replacement: a case series

Abstract

Purpose Oncologic resections or complications of segmental femoral prostheses can result in severe bone loss of the femur for which a total femoral prosthesis (TFP) is required. This study assesses whether the loss of stability and function caused by the loss of muscle attachments can be improved by using a push-through total femoral endoprosthesis (PTTF), because it saves parts of the femur and its muscle attachments. Methods In this retrospective case series, ten patients aged 25-77 (mean 54) who received a PTTF between 2005 and 2014 were included for baseline, complications and survival analysis with a mean follow-up of 5.3 (1.1-9.6) years. Functional outcome was assessed in six patients using the Musculoskeletal Tumor Society (MSTS) score, WHO performance scale, Toronto Extremity Salvage Score (TESS), SF36, EQ-5D, NRS pain score, fatigue score and satisfaction score. Results The mean MSTS score was 64% (23-93%). Five patients had a WHO performance scale of 1, one patient of 3. Mean TESS was 69% (13-90%). SF36 was most notably limited by physical functioning (mean 48), vitality (68) and general health (67). NRS score was 1.9, 1.8 and 8.3 for pain, fatigue and satisfaction, respectively. There were four failures: two infections (one resulting in amputation and one in a minor revision) and two mechanical failures (which required one revision to a TFP and one minor revision). Patient survival was 100%, limb survival 90%, and prosthesis survival 80%. Conclusion The push-through total femoral endoprosthesis allows preservation of muscle attachments and offers a good alternative to total femoral prostheses.

Advances in tumour endoprostheses: a systematic review

“…12 Interestingly, though, a mean MSTS score of 64.0% was achieved in their cohort, in comparison to 72.3% in the group by Du et al, where additional reconstruction with a LARS band significantly increased the postoperative MSTS score from 70.4% to 80.0%. 11,12 Moreover, the authors observed that simple re-attachment of the gluteus maximus to the LARS band does not improve active ROM, whilst re-attachment of other external rotators (i.e. gemellus, obturator, piriformis, quadratus femoris) may improve external rotation.…”

“…11 These infection rates are less than the 20.0% observed by Gorter et al in 10 patients treated with push-through total femoral endoprostheses. 12 However, this system allows preservation of parts of the femur as well as its muscle attachments, thus potentially resulting in a better postoperative function. 12 Interestingly, though, a mean MSTS score of 64.0% was achieved in their cohort, in comparison to 72.3% in the group by Du et al, where additional reconstruction with a LARS band significantly increased the postoperative MSTS score from 70.4% to 80.0%.…”

“…12 However, this system allows preservation of parts of the femur as well as its muscle attachments, thus potentially resulting in a better postoperative function. 12 Interestingly, though, a mean MSTS score of 64.0% was achieved in their cohort, in comparison to 72.3% in the group by Du et al, where additional reconstruction with a LARS band significantly increased the postoperative MSTS score from 70.4% to 80.0%. 11,12 Moreover, the authors observed that simple re-attachment of the gluteus maximus to the LARS band does not improve active ROM, whilst re-attachment of other external rotators (i.e.…”

Total femur replacement with 18 years of follow-up: A case report

“…Since traditional total femoral replacement requires the removal of many muscle attachment points, the function of the affected limb is poor after surgery, and hip dislocation is more common. Ward et al [ 10 ] and Gorter et al [ 23 ] have developed a full-femoral intramedullary prosthesis to replace the traditional full-femoral prosthesis. This surgical method retains the attachment points of some bones and muscles, maintains stability to the maximum extent, and yields better function.…”

Femoral neck fracture to total femoral replacement: a case report

“…Based on the site of fracture, stability of fracture, and bone quality, either fixation, revision arthroplasty, or total femoral replacement (TFR) are possible, 4 or in some circumstances, a push through stem offers an alternative to TFR. 5 Management of infected arthroplasty is a complex multidisciplinary effort. In selected patients who have infection from a single organism that is sensitive to appropriate antibiotics, a single-stage radical debridement and revision arthroplasty is associated with similar reinfection rates as two-stage arthroplasty.…”