Resection and reconstruction of the proximal femur with revision stems: a cost-effective alternative.

Abstract

Modular oncologic megaprosthesis is the standard method for reconstruction after resection of tumors of the proximal femur. These implants have been utilized for either primary tumors or metastatic disease of bone and multiple myeloma. Fixation is based on either cemented or cementless stems, and a collar supporting the body of the prosthesis. For those patients with advanced disease and/or limited life span, a judicious approach should balance the functional expectations, prognosis, and the issue of cost of the surgical procedure and the implant that is selected. Based on the principles of distal fixation of tapered stems, the authors have utilized implants originally designed for hip revision surgery to reconstruct the proximal femur in 19 patients, after resection because of metastases, multiple myeloma and some aggressive primary tumors. The essentials of the technique consist of distal fixation in the remaining isthmus of the femur by means of tapered stems, impacted in such a way to achieve solid primary fixation, balanced with accurate leg length restoration. Proximally, the implant remains devoid of bone coverage. In this retrospective study, proper distal fixation, leaving the proximal part of the implant uncovered with bone, has resulted in good functional results in mid-term follow-up of patients. Primary fixation has led to secondary bone ongrowth and remodeling, providing secondary fixation. Complications such as instability, loosening and infection are comparable with those associated to the traditional management with mega prosthesis. The utilization of tapered stems for distal fixation after proximal femoral resections has shown reliable results after mid-term follow-up. The method might be considered as a cost-effective alternative for selected patients.