Tumeurs malignes osseuses du fémur proximal : exérèses et reconstructions

Abstract

The femur upper extremity is the second most frequent localisation of bone primitive tumours. In most cases, reconstruction must be performed by the implementation of a composite total hip prosthesis with combined allograft. Resection includes the upper extremity of the femur together with the surrounding muscles, and the gluteï tendons. An allograft composite prosthesis is used, with the suture of the patient’s gluteal tendons on the allograft gluteal tendons. The distal prosthetic stem is fixed in the recipient femur. The prosthesis stability is ensured by a capsuloplasty and the tendon suture allows restoring adequate abduction. Rarely, the tumour spreads to the joint; in such case a total resection of the upper femur, capsule and acetabulum must be performed, using the Ollier approach. Femoral reconstruction consists of a combined composite prosthesis, while the pelvis is reconstructed by acetabular allograft in which a cup is fixed. Alternative solutions exist, such as a saddle prosthesis. Upper extremity of the femur is the most frequent site of limb metastases. Palliative therapy is undergone for metastatic osteolysis, using a reconstruction prosthesis implanted in the healthy bone after resection of the osteolytic zone. The approach is a digastric trochanteric slide. A capsuloplasty stabilises the hip. This simple intervention allows rapid restoration of full weight bearing and early complementary radiotherapy.