Total femoral endoprosthetic replacement following excision of bone tumours

Abstract

We undertook a retrospective review of 33 patients who underwent total femoral endoprosthetic replacement as limb salvage following excision of a malignant bone tumour. In 22 patients this was performed as a primary procedure following total femoral resection for malignant disease. Revision to a total femoral replacement was required in 11 patients following failed segmental endoprosthetic or allograft reconstruction. There were 33 patients with primary malignant tumours, and three had metastatic lesions. The mean age of the patients was 31 years (5 to 68). The mean follow-up was 4.2 years (9 months to 16.4 years). At five years the survival of the implants was 100%, with removal as the endpoint and 56% where the endpoint was another surgical intervention. At five years the patient survival was 32%. Complications included dislocation of the hip in six patients (18%), local recurrence in three (9%), peri-prosthetic fracture in two and infection in one. One patient subsequently developed pulmonary metastases. There were no cases of aseptic loosening or amputation. Four patients required a change of bushings. The mean Musculoskeletal Tumour Society functional outcome score was 67%, the mean Harris Hip Score was 70, and the mean Oxford Knee Score was 34. Total femoral endoprosthetic replacement can provide good functional outcome without compromising patient survival, and in selected cases provides an effective alternative to amputation.

Total Femur Replacement After Tumor Resection: Limb Salvage Usually Achieved But Complications and Failures are Common

“…Our local recurrence rate of 2% with conventional total femur replacements is in accordance with published ranges of 0% to 9% [13,28,30,31]. Studies including only patients with sarcoma [28,30] reported lower local recurrence rates than studies including patients with metastatic disease [13,31].…”

“…We used the comprehensive ISOLS classification system published in 2011 [8] and modified in 2014 [9]. Sewell et al [31] used a similar classification system and reported implant failure in 33% of patients and revision-free implant survival of 56% at 5 years. Our study showed a patient survival rate of 59% at 10 years compared with 16% in the series of Sewell et al [31].…”

“…Sewell et al [31] used a similar classification system and reported implant failure in 33% of patients and revision-free implant survival of 56% at 5 years. Our study showed a patient survival rate of 59% at 10 years compared with 16% in the series of Sewell et al [31]. Thus, there is a life-long risk for revision and because our study patients had prolonged survival, it may be an explanation for our higher failure rate.…”

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

“…Mean MSTS score in this study was 64%, which is comparable to mean MSTS scores after primary TFPs (50-73%) [4,8,20]. Secondary TFPs might result in lower MSTS scores than primary TFPs (60% versus 73%) [10]. MSTS scores were positively influenced by the lack of use of pain medication; nevertheless, functional impairment and gait decreased the scores.…”

“…Proximal or distal femoral prostheses outperform total femoral prostheses (TFPs), which is often attributed to the conservation of the muscle insertions at the remaining femoral bone [4,7,9]. The integrity of the hip abductors and knee extensors affects the functional result of a TFP; hip dislocations occur more often after the abductor muscles are excised [10]. Attempts to fixate these muscles on the prosthesis have mostly been unsuccessful [9,11].…”