Total femur replacement: Primary procedure for treatment of malignant tumours of the femur☆
Introduction
Tumours involving the whole femur present a challenge when limb preservation is considered. These tumours are often large and resection involves removal of the whole femur with disruption of the hip abductor mechanism. Extensive soft tissue dissection and reconstruction of the joint above and below are required.
The options for treating such patients include amputation by hip disarticulation or limb preserving surgery. Limb preserving surgery is better accepted by patients, is more cost effective in the long term, and is associated with significantly lower oxygen consumption and energy requirements per meter walked compared to amputation.1, 2 Moreover, patients' survival is not improved by amputation.3 The choices available for reconstruction in such patients include the use of endoprostheses, allograft or rotationplasty.4, 5, 6, 7, 8, 9, 10, 11, 12, 18
We carried out a retrospective review of patients treated with Total Femur Endoprosthetic Replacement (TFEPR) at our centre over the past 30 years to identify the factors which affect survival, complications and function following TFEPR.
Section snippets
Data collection and ethics
This was a retrospective analysis of data which had been collected prospectively onto our oncology database with further reference to patient charts and radiographs where necessary. Institutional review board ethical approval was granted prior to the study being undertaken.
Tumour diagnosis, staging of tumour,13 treatment and outcome data was obtained from the database. Functional outcomes were collected on surviving patients using the revised Musculo-skeletal Tumour Society (MSTS) system15 and
Patient survival
Kaplan Meier survival curves are shown in Fig. 2. Survival of the patients was related to their oncologic diagnosis. None of the eight patients with metastases at diagnosis undergoing palliative resection were alive at long followup. However, survival of patients with a primary malignant bone tumour without metastases was 50% at 5 years. Eleven patients were alive with an overall mean followup of 105 months (range 9–348), nine patients being free of disease.
Local recurrence
Local recurrence was seen in patients
Discussion
The last few decades have witnessed increased popularity and wider acceptance of endoprosthetic replacement in treating patients with malignant conditions of the bone due to the availability of effective chemotherapy, improved prosthetic design, availability of modular endoprosthesis and increasing experience in the use of these implants.
Total Femur Endoprosthetic Replacement is a major surgical reconstructive procedure for patients with a bone tumour involving the entire femur. The procedure
Conclusion
We believe that our series presents the results of what can be expected in the long term for patients with malignant bone tumours who require total femur endoprosthetic replacement. This form of reconstruction provides predictable results after excisions of the femur for malignant tumours. The complications are comparable to those for similar procedure performed for non-tumour cases even though those with a tumour have more muscle resection and are immunologically challenged from adjuvant
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Use of an Artificial Ligament Decreases Hip Dislocation and Improves Limb Function After Total Femoral Prosthetic Replacement Following Femoral Tumor Resection
2018, Journal of ArthroplastyCitation Excerpt :In this situation, the LARS may be helpful for periacetabular muscle reconstruction. In the literature, reconstructions involving suturing the abductors to the tensor fascia lata are associated with a hip dislocation rate of 6%-30% after total femoral endoprosthetic reconstruction [17,19,24,25]. In 1 study of 21 patients who received TFR, different techniques were used for gluteus reinsertion to the prosthesis: polyethylene plate fixation to prosthesis in 5 patients, a special device named an “enhanced tendon attachment system” (Stryker Howmedica, Inc) in 2, Dall-Miles cables in 1, and direct reinsertion or suture of the fascia lata to the prosthesis in 13.
Total femur prosthesis in oncological and not oncological series. Survival and failures
2020, Journal of OrthopaedicsCitation Excerpt :The oncological indications could be: involvement for a length greater than 70–80% of the bone segment with or without extension in soft tissue; when less than 12 cm of femoral bone necessary for an adequate fixation of the femoral stem remains; the concomitant presence of more lesions or skip lesions in the femoral segment. Designs of TFP are improved3 and several studies described their use, even if with limited numbers.2,7–21 Some of these studies reported the results of TFP together with proximal or distal femur mega-prosthesis, becoming difficult to draw conclusions about the specific complications of TFP.
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Level of Evidence – Therapeutic Study, Level – IV (Case series).