Abstract
BackgroundCompromised bone stock and heavily impaired structural integrity after multiple endoprosthetic revision surgeries can lead to a comparable condition as encountered in musculoskeletal tumor surgery. Total femoral replacement (TFR) can restore femoral integrity and allow patients to resume ambulation. Even though several authors reported their results of TFR, so far many questions are still on debate: Which patients are at risk to experience low functional outcome? Do complications and clinical outcome after TFR depend on the indication for the surgery (e.g. periprosthetic fractures or aseptic loosening) or the age of the patients? The purpose of the present study was to compare complication rates after TFR performed with modular total femur prosthesis MML (Fa. ESKA/Orthodynamics) in patients without malignant disease.MethodsWe conducted a retrospective chart review and functional investigation of patients treated with a TFR for non-oncologic conditions from 1995 to 2015 and a minimum follow-up of 2 years. Complications were recorded according to the Henderson-Classification; outcome was evaluated with established clinical scores. The indication for TFR was periprosthetic fracture (Group A, n = 11) or aseptic loosening (Group B, n = 7) with massive bone defect of the femur deemed unsuitable for conventional arthroplastic or biologic reconstruction.ResultsEighteen patients matched the inclusion criteria and could be investigated clinically after a mean follow-up of 80 months (range: 28–132). Before TFA, all patients had previously undergone multiple operations (range: 1–8). The overall failure rate for any reason was 72% (n = 13/18), leading to a total of 37 surgical revisions with total exchange of TFR in 22% (n = 4/18). Most common failure mechanism was Type I (soft tissue), followed by Type IV (infection) and Type III (mechanical failure). According to Enneking’s functional evaluation method (MSTS-Score), the function ranged from 1 to 15 with a mean of 10 ± 4 out of 30.ConclusionTFR is a salvage procedure to restore mechanical integrity and regain functional ability after extensive femoral bone loss. Outcome of the patients in the present study did mainly depend on the age at reconstruction and not on the indication for TFR.
Highlights
Compromised bone stock and heavily impaired structural integrity after multiple endoprosthetic revision surgeries can lead to a comparable condition as encountered in musculoskeletal tumor surgery
Patients were subdivided into group: patient (Group A) and B according to the indication for Total femoral replacement (TFR): Group A consisted of patients with a periprosthetic fracture (n = 11; mean age at reconstruction with TFR 77 years (±8 years), range 67– 90), Group B had surgery for aseptic loosening (n = 7; mean age at reconstruction with TFR: 79 years (±7 years), range: 70–88)
ESKA/Orthodynamics); we investigated the TFRs of a single centre University Institute for implant survival, functional outcomes and different types of complications
Summary
Compromised bone stock and heavily impaired structural integrity after multiple endoprosthetic revision surgeries can lead to a comparable condition as encountered in musculoskeletal tumor surgery. With increasing numbers of primary total hip and total knee arthroplasty, largely attributed to demographic changes in our society, endoprosthetic revision surgeries will become even more important in orthopedic surgery. It is the sheer number and the severity of revisions with massive, segmental bone loss and highly compromised soft tissues that will represent a major challenge to the future of joint replacement (Fig. 1). Total femoral replacement (TFR) can restore femoral integrity and allow patients to resume ambulation, at a compromised level This compromised functional capacity is deemed superior to that achieved after hip exarticulation. There have been some reports analyzing functional outcome after treatment with TFR for aggressive musculoskeletal tumors [3,4,5,6,7,8], but only few for non-oncologic indications [1, 9–12]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
