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

Jelle Gorter,Joris J W Ploegmakers,Hendrik W B Schreuder,Bas L E F Ten Have,Paul C Jutte

doi:10.1007/s00264-017-3467-5

Abstract

PurposeOncologic 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.MethodsIn 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.ResultsThe 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%.ConclusionThe push-through total femoral endoprosthesis allows preservation of muscle attachments and offers a good alternative to total femoral prostheses.

Highlights

Overall outcome and survival rates of lower limb malignancies have improved rapidly since the 1970s due to improved adjuvant chemotherapy and limb-salvaging procedures [1,2,3]
The severe femoral bone loss and extensive soft tissue damage that is associated with limb-salvaging surgery and complications of arthroplasty required the development of megaprostheses [3]
This study reports the results of the push-through—total femoral endoprosthesis (PTTF) and assesses this concept as a potential alternative to total femur reconstruction

Summary

Introduction

Overall outcome and survival rates of lower limb malignancies have improved rapidly since the 1970s due to improved (neo) adjuvant chemotherapy and limb-salvaging procedures [1,2,3]. The severe femoral bone loss and extensive soft tissue damage that is associated with limb-salvaging surgery and complications of arthroplasty required the development of megaprostheses [3]. The current megaprostheses offer satisfying results, complications such as infection or dislocation are common [4,5,6,7,8]. 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]

Methods

Results

Conclusion