Femoral Tumor Research Articles

Trabecular metal acetabular revision system (cup-cage construct) to address the massive acetabular defects in revision arthroplasty

The increasing number of total hip replacements in the younger clique has added to the demand for revision procedures. Revision situations are often encountered with infection, loss of bone stock and bone defects. There are various methods of reconstruction of acetabular defects. The management options of type 3B Paprosky acetabular defects are limited with allograft and conventional cages. Trabecular metal technology has evolved to address these bone defects. Trabecular metal acetabular revision system (TMARS) cup-cage construct is a new technique to address massive acetabular defects. We describe a case of failed hip reconstruction done for a Giant cell tumour of proximal femur managed by a two stage procedure, initial debridement and second stage reconstruction of acetabulum with TMARS cup-cage construct and femur with allograft prosthesis composite.

Der proximale und komplette Femurersatz

Reconstruction of segmental bone defects of the proximal femur following wide tumor resection or revision arthroplasty. Aggressive benign or primary malignant bone tumors of the proximal femur; destructive metastases; massive segmental bone defects of the proximal femur; periprosthetic fractures. Local infection; very short life expectancy (< 3months); massive deficiency of acetabular bone stock. Anterolateral approach. Exposure and detachment of the iliopsoas and gluteus medius muscle from the proximal femur with a sufficient safety margin to the bone; distal transsection of the vastus lateralis/intermedius and rectus femoris muscle according to the extraosseous tumor extension; distal femur osteotomy al least 3cm beyond the farthest point of tumor extension; in case of total femur replacement, additional lateral arthrotomy of the knee with resection of the ligaments and menisci; reaming of the medullary canal after securing the shaft with a Verbrugge clamp; trial assembly and reduction followed by the definitive implantation of the prosthesis with adjustment of the femoral neck anteversion in 5° increments; soft tissue reconstruction and fixation to an attachment tube covering the prosthesis; in case of total femur replacement, the preparation of the tibia is followed by the coupling of the tibial and femoral components. Infection prophylaxis, 20kg partial weight bearing, continuous passive motion. A total of 20 patients with proximal femur replacement and 2patients with total femur replacement implanted between June 2007 and December 2011 were retrospectively reviewed. Three patients had primary malignant bone tumors, while 19patients underwent resection for metastatic disease. The mean age at surgery was 62.0 ± 18.1years (18-82years). Fifteen patients with a mean follow-up of 20.3 ± 17.2months (4-51months) were studied. Among the 22cases, periprosthetic infection occurred in 3patients (13.6%), dislocation in 2patients (9.1%). Evaluation of the functional outcome in 15patients using the MSTS score by Enneking revealed 3very good (20%), 4good (26.7%), 6fair (40%), and 2poor (13.3%) results.

Granulocyte colony-stimulating factor-producing squamous cell carcinoma of the lower gingiva: a case report

The present study summarizes our experience in treating a patient with a suspected granulocyte colony-stimulating factor (G-CSF)-producing squamous cell carcinoma (SCC) of the lower gingiva, which is a rather rare entity.A 56-year-old woman underwent surgical excision of palate leukoplakia in 1996. In 2009, however, a leukoplakic superficial tumor was detected in the lower left gingiva, for which the patient underwent gingivectomy. This was subsequently diagnosed as SCC. The patient also underwent superselective arterial injection chemotherapy combined with radiotherapy, after local recurrence was observed. The patient was subsequently found to have bone metastasis. After chemotherapy combined with radiotherapy, the patient underwent segmental resection of the lower left jaw, left supraomohyoid neck dissection, and lower jaw reconstruction using titanium plates. Resection of the left femoral tumor and left total knee replacement were also performed. Computed tomography scan performed 1 month after the surgeries revealed multiple lung, liver, spine, and subcutaneous metastases. The patient also exhibited a sudden increase in her white blood cell (WBC) count and a fever that could not be alleviated, despite treatment with antibacterial drugs. A G-CSF-producing tumor was therefore suspected. Serum G-CSF level was high at 250 pg/ml.The patient's WBC count increased to 32 × 103/ml and her general condition suddenly deteriorated, and she died as a result of multiple organ failure. A final diagnosis of G-CSF-producing SCC of the lower gingiva was made based on the patient's clinical course.

Factors affecting outcome of massive intercalary bone allografts in the treatment of tumours of the femur

We retrospectively reviewed 101 consecutive patients with 114 femoral tumours treated by massive bone allograft at our institution between 1986 and 2005. There were 49 females and 52 males with a mean age of 20 years (4 to 74). At a median follow-up of 9.3 years (2 to 19.8), 36 reconstructions (31.5%) had failed. The allograft itself failed in 27 reconstructions (24%). Mechanical complications such as delayed union, fracture and failure of fixation were studied. The most adverse factor on the outcome was the use of intramedullary nails, followed by post-operative chemotherapy, resection length > 17 cm and age > 18 years at the time of intervention. The simultaneous use of a vascularised fibular graft to protect the allograft from mechanical complications improved the outcome, but the use of intramedullary cementing was not as successful. In order to improve the strength of the reconstruction and to advance the biology of host-graft integration, we suggest avoiding the use of intramedullary nails and titanium plates, but instead using stainless steel plates, as these gave better results. The use of a supplementary vascularised fibular graft should be strongly considered in adult patients with resection > 17 cm and in those who require post-operative chemotherapy.

Technique de la membrane induite pour la reconstruction de pertes de substances osseuses après résection tumorale chez l’enfant : une étude préliminaire

Segmental long-bone defect due to tumor resection remains a challenge to treat. The induced membrane technique is a new alternative for biological reconstruction. During the first stage, a cement spacer is inserted after bone resection and stabilisation. The cement spacer is removed during a second stage procedure performed after chemotherapy, and corticocancellous bone autograft was placed in the biological induced chamber. The aim of this study was to assess preliminary results in eight children. This prospective study included six girls and two boys, with a mean age of 12.1 years (range 9.5 to 18) and treated for a mean of 15 cm defect (range 10 to 22 cms) due to resection of osteosarcoma ( n = 4), Ewing sarcoma ( n = 3) and low-grade sarcoma. All patients except one, were given pre- and postoperative chemotherapy. Surgery was performed for three patients with a distal femur tumor, two patients with a proximal tibial tumor and three patients who had proximal humerus, shaft of humerus and fibular tumors. Fixation was mainly performed with locking compression plate ( n = 4) and locked nail ( n = 2). The mean operating times for first and second step procedures were 4.8 and 4 hours respectively. The healing process was radiologically assessed. After a mean follow-up of 21,6 months (15 to 30), all patients were free of disease and seven had bony union. For the lower limb reconstructions, full weight bearing was possible after a mean of 116 days (range 90 to 150) following the second stage. Mean time to bone union was 4.8 months (1.5 to 10). The early MSTS score was 25.2/30 (range 20 to 30). Complications were: non-union ( n = 1), paradoxical graft resorption ( n = 1) requiring graft revision. This two-stage procedure reduces the operating time during the first stage and it also reduces early complications. Rapid bone union is objectively obtained despite major bone resection and the patients receiving chemotherapy. The induced membrane technique could be an excellent alternative for biological reconstruction after tumor resection in children.

Induced membrane technique for reconstruction after bone tumor resection in children: A preliminary study

Segmental long-bone defect due to tumor resection remains a challenge to treat. The induced membrane technique is a new alternative for biological reconstruction. During the first stage, a cement spacer is inserted after bone resection and stabilisation. The cement spacer is removed during a second stage procedure performed after chemotherapy, and cortico-cancellous bone autograft was placed in the biological induced chamber. The aim of this study was to assess preliminary results in eight children. This prospective study included six girls and two boys, with a mean age of 12.1 years (range 9.5 to 18) and treated for a mean 15 cm defect (range 10 to 22 cms) due to resection of osteosarcoma (n=4), Ewing sarcoma (n=3) and low grade sarcoma. All patients except one, were given pre- and postoperative chemotherapy. Surgery was performed for three patients with a distal femur tumor, two patients with a proximal tibial tumor and three patients who had proximal humerus, shaft of humerus and fibular tumors. Fixation was mainly performed with locking compression plate (n=4) and locked nail (n=2). The mean operating times for first and second step procedures were 4.8 and 4h respectively. The healing process was radiologically assessed. After a mean follow-up of 21.6 months (15 to 30), all patients were free of disease and seven had bony union. For the lower limb reconstructions, full weight bearing was possible after a mean of 116 days (range 90 to 150) following the second stage. Mean time to bone union was 4.8 months (1.5 to 10). The early Musculoskeletal Tumor Society (MSTS) score was 25.2/30 (range 20-30). Complications were: non-union (n=1), paradoxical graft resorption (n=1) requiring graft revision. This two stage procedure reduces the operating time during the first stage and it also reduces early complications. Rapid bone union is objectively obtained despite major bone resection and the patients receiving chemotherapy. The induced membrane technique could be an excellent alternative for biological reconstruction after tumor resection in children.

大腿骨巨細胞腫の多発肺転移に起因した同時性両側気胸の１例

症例は30歳，男性．突然の呼吸困難のため近医を受診し，気胸を指摘された．胸部CTで両側気胸および両肺に多発結節影を認め，2ヵ月前に他院整形外科で大腿骨巨細胞腫に対し切除術が行われていたことから，転移性肺腫瘍を疑った．肺結節の診断も兼ねて右胸腔鏡下手術を施行，胸膜欠損を伴う血腫様の結節性病変を認め，同部位に気瘻を確認した．これを部分切除し骨巨細胞腫の肺転移と診断，胸膜直下病変を可及的に部分切除した．2ヵ月後，左気胸が再発し，翌日には右気胸も再発．気胸のコントロールのため胸膜癒着術を追加する方針とし，気瘻部分のみを部分切除した後，壁側胸膜全体を擦過，OK-432とミノマイシンを胸腔内に散布し胸膜癒着術を施した．骨巨細胞腫は稀に肺転移を来たす良性腫瘍であるが，この肺転移に起因する気胸は極めて稀で，同時性両側気胸をきたした症例は，本邦での報告は1例のみであった．

Extramedullary versus intramedullary tibial cutting guides in megaprosthetic total knee replacement

BackgroundIn a standard total knee replacement, tibial component alignment is a key factor for the long term success of the surgery. The purpose of this study is to compare the accuracy of extramedullary and intramedullary tibial cutting guides used in indigenous and imported implants respectively, in positioning of the tibial components in megaprosthetic knee replacements.MethodsA comparative study of the accuracy of extramedullary and intramedullary tibial cutting guides was carried out in 92 megaprosthetic knee replacements for distal femoral tumors. For the proximal tibia cut for tibial component placement, an extramedullary guide was used in 65 patients and an intramedullary guide was used in 27 patients. Tibial component alignment angles were measured in postoperative X-rays with the help of CAD software.ResultsThere was more varus placement in coronal plane with extramedullary cutting guide (−1.18 +/− 2.4 degrees) than the intramedullary guide (−0.34 +/− 2.31 degrees) but this did not reach statistical significance. The goal of 90 +/− 2 degrees alignment of tibial component was achieved in 54% of patients in the extramedullary group versus 67% in the intramedullary group. In terms of sagittal plane alignment, extramedullary guide showed less accurate results (2.09 +/− 2.4 degrees) than intramedullary guide (0.50 +/− 3.80 degrees) for tibial component alignment, though 78% of patients were aligned within the goal of 0–5 degrees of tibial slope angle in extramedullary group versus 63% in intramedullary group. The mean error in the measurements due to rotation of the knee during taking the X-rays was less than 0.1 degrees and distribution of the X-rays with the rotation of knee was similar in both the groups.ConclusionsOverall, in megaprosthetic knee replacement intramedullary guides gave more accurate results in sagittal plane and exhibited similar variability as of extramedullary guides in coronal plane.

Computer navigation used in precise resection and jiont-sparing surgery for limbs with malignant bone tumor

Objective To report our experience of using image-guided computer navigation for precise resection and joint-sparing reconstruction in musculoskeletal tumor surgery. Methods Between September 2008 and March 2011 surgical resections and joint-sparing reconstruetions,with assistance of imag-guided computer navigation,were performed for 12 patients with malignant bone tumors,There were 5 femals and 7 males,with an average age of 26.7years (from 12 to 59 years).The tumor was located at distal femur diaphysis in 8 cases,at proximal tibia in 3 and at distal tibia in one.By pathological diagnosis,there were 7 osteosarcoms,3 chondrosarecomas,one hemendothelioma and one spindal cell saroma.Three-dimensiomal models of bone tumor were reconstructed for each patient on the basis of prcoperative CT and MRI data.Using the models,we made preoperative plan for each patient with the navigation system software to locate tumor surgical margin and design rsection and reconstruction with a custom-made jdint-sparing prosthesis for femur tumors and an allograft for tibia tumors.Intraoperatively.we carred out theprocess of registration and matching the operative anatomy to the virtual image generated by the navigation system software.Then we performed surgical processes according to the preoperative.plan. Results The tumor resections and joint-spariug reconstructiorns with custom-made prostheses and allografts were completed for all cases as precisely as preopcrative plan designed.All the resection specimens showed a safe and clear marghn.The average distance from the resection margin to the joint were 35 mm ( from 12 mm to 80 mm).All the patients were followed for an average of 21 months (from 7 to 37 months).By the Musculoskeletal.Tumor Sociery (MSTS) evalnation system,the patients achieved 92％to 96％ of limb fuctional recovery (average,94％ ).No wound or joint infection,no local relapse or remote metastasis occurred. Conclusion The image-guided computer navigation system greatly facilitate precise resection and joint-sparing reconstruction for patients with bone tumor near the joint. Key words: Bone tunmor; Surgery, computer-assisted; Prosthesis implantation

Weight bearing evaluation in inflammatory, neuropathic and cancer chronic pain in freely moving rats

Preclinical pain assessment remains a key step for the development of new and potent painkillers. Significant progress in pain evaluation has been achieved with the development of non-reflexive tools. Seeking efficient and clinically relevant devices for pain-related quality of life assessment, we evaluated a new Dynamic Weight Bearing (DWB) device based on pressure captors in three different preclinical chronic pain models. Inflammatory (CFA), neuropathic (CCI) and bone cancer pain (femoral tumor) models were evaluated in Sprague Dawley rats for mechanical allodynia using dynamic von Frey for pain-related behaviors and DWB for discomfort. We observed similar impairment patterns in all of the models for both von Frey (allodynia) and DWB (weight balance) during the complete observation period, starting at day 3 in CCI- and CFA-affected limbs and at day 14 in bone cancer-afflicted rats, indicating that the DWB could be a useful tool for supporting pain assessment. Interestingly, we demonstrated that the main compensation, when animals experienced pain, was seen in the forepaws, ranging from 46% to 69% of increased load compared to normal. Other pain-related coping behaviors were also measured, such as the time spent on each paw and the contact surface. Our results revealed that CFA, CCI and cancerous rats decreased the use of their ipsilateral hind paws by 30% and showed a 50% reduction in paw surface pressed against the floor. In conclusion, this new device improves methods for preclinical evaluation of discomfort and quality of life proxies and could be helpful in screening putative analgesics.

The impact of amount of bone resection on uncemented prosthesis failure in patients with a distal femoral tumor

Previous reports on the correlation between the amount of bone resection and prosthetic failure might be confounded by variability in the amount of soft tissue resected and by the mode of prosthesis fixation. We analyzed 117 patients who underwent intra-articular resection and cementless modular tumor prosthetic reconstruction for a distal femoral tumor. Mean follow-up duration was 95 months (range, 15-271 months). Associations between the prognostic variables and prosthesis survival were assessed. A receiver operating characteristic (ROC) curve was plotted for resection percentage to predict prosthetic failure. Prostheses were removed in 35 (30%) patients for; infection (17), local recurrence (5), loosening (7), stem fracture (4), or periprosthetic fracture (2). The 10-year prosthetic survivals of the 117 implants were 65.2 ± 5.4%. A percentage bone resection (>40%) was found to be associated with mechanical prosthesis failure by multivariate analysis (P = 0.003). ROC curve analysis demonstrated that an optimal cut-off point of 43% for resection percentage had a sensitivity of 95.9% and a specificity of 45.5% for predicting mechanical prosthesis failure. Infection is the major cause of prosthetic failure, and amount of bone resection is negatively correlated with implant longevity.

Extensive Brown Tumors of Spine, Distal femur and Patella Presenting with Acute Cord Compression. A Case Report

We report a case of end-stage renal failure in a patient who presented with acute cord compression and extensive brown tumour involving the spine, distal femur and patella. Brown tumours of the long bone, spine and pelvis have been documented previously. However, the occurrence of brown tumour in sesamoid bones such as the patella is extremely rare and is indicative of widespread lesions and severe secondary hyperparathyroidism. These tumours typically respond poorly to medical treatment alone. The acute cord compression by spinal brown tumour necessitated urgent surgical decompression while the other lesions were treated with medical treatment and surgical parathyroidectomy.

Clinical outcomes of the KYOCERA Physio Hinge Total Knee System Type III after the resection of a bone and soft tissue tumor of the distal part of the femur

The KYOCERA Physio Hinge Total Knee System Type III (PHKIII) was developed to reconstruct bony defects of the distal femur. The PHKIII is originative in that the metallic parts are fully made of titanium alloy, and this prosthesis has a unique semi-rotating hinge joint and was designed especially for people with the Asian physical body-type. The clinical outcomes of the PHKIII after the resection of musculoskeletal tumors of the distal femur were evaluated. There were 41 males and 28 females with a median age of 48-years. The median duration of follow-up was 57 months. Eleven early complications and 37 late complications were observed, including 10 recurrences, 7 deep infections, 7 aseptic loosenings, 4 stem breakages, 4 displacements of shaft cap, and one wear of rotation sleeve. Twenty four prosthesis (35%) required a secondary operation because of complications. The five-year overall prosthetic survival rates, -prosthetic survival rate without aseptic loosening, and -limbs preservation rate were 85%, 90%, and 86%, respectively. The mean functional score according to the classification system of the Musculoskeletal Tumor Society was 20.5 points (68%). Although continuous follow-up is required, reconstructions using PHKIII are considered to achieve more acceptable functional results.

Integration of CAD/CAM planning into computer assisted orthopaedic surgery

Modern Computer Aided Design/Modeling (CAD/CAM) software allows complex surgical simulations, but it is often difficult to transfer and execute precisely the planned scenarios during actual operations. We describe a new method of integrating CAD/CAM surgical plans directly into a computer surgical navigation system, and demonstrate its use to guide three complex orthopaedic surgical procedures: a periacetabular osteotomy of a dysplastic hip, a corrective osteotomy of a post-traumatic tibial deformity, and a multi-planar resection of a distal femoral tumor followed by reconstruction with a CAD custom prosthesis.

Surgical treatment of metastatic tumors of the femur

To evaluate the patients functional outcome and pain control after resection of metastatic femoral tumors. A prospective randomized clinical study was conducted, which included 26 cases of metastatic tumors of the femur with an associated pathologic fracture. These selected cases were randomly divided into two groups based upon the using of methylmethacrylate cement in fracture fixation. Group 1 (n=13) included all cases where the fractures were treated with bone cement augmentation. Group 2 (n=13) included all cases where the fractures were treated without bone cement augmentation. Functional outcome was evaluated according the American Musculoskeletal Tumor Society system. Good and excellent pain control was achieved in 61.5%, satisfactory in 38.5% of all cases in the Group 1 versus 15.5% (P=0.015) and 69% (chi(2)=2.4762; P=0.115) of all cases in the Group 2. Functional outcome after femoral metastasis resection and pathologic fracture fixation was significantly better in the Group 1. Total lower extremity function of full normal function was 67% in the Group 1 versus 49% in the Group 2 (P<0.05). We did not observe significant difference between patients' postoperative survival in the groups (P>0.05). The postoperative durability of stable pathologic fracture fixation was shorter in the Group 2 (273.9+/-51.7 vs. 358.9+/-116.8 days) comparing with Group 1 (P=0.03). The introduction of bone cement as the adjunct to the pathologic femoral fracture fixation significantly improved the clinical our study results: we achieved better functional outcome and better pain control.

Phosphaturic mesenchymal tumor of spinal nerve in a patient with osteomalacia and multiple fractures

Osteomalacia associated with a neoplasm (oncogenic osteomalacia, OO) is a rare and unusual paraneoplastic syndrome that subsides after complete tumor resection. It results from hypophosphatemia due to renal phosphate loss [6]. OO was originally reported by McCance in 1947 in a patient with a femoral tumor, while Prader et al. described its direct correlation with giant cell reparative granuloma of the rib [3]. The term phosphaturic mesenchymal tumor (PMT) was proposed by Weidner and Santa Cruz [7] in 1987 and the largest series was reported by Folpe et al. [3] in 2004. OO depends on tumor secretion of phosphatonins. Fibroblast growth factor-23 (FGF23), which is expressed in almost 90% of PMTs, plays a significant role in the pathogenesis of OO [3]. We report a 56-year-old female with osteomalacia and multiple fractures associated with PMT developing within the Th5 nerve. Laboratory examination disclosed hypophosphatemia (1.9 mg/dl), elevated serum alkaline phosphatase activity (217 U/l), and normal serum calcium level (9.07 mg/dl). Parathyroid and thyroid gland dysfunction and multiple myeloma were excluded as a potential cause of the osteolysis. CT and MRI scans revealed an extradural spindle lesion measuring 30 9 22 mm within the confines of the Th5 nerve. It compressed the meninges and the spinal cord (Fig. 1). The tumor was resected with the surgical diagnosis of neurofibroma. After surgery, blood concentrations of calcium and phosphate gradually returned to normal levels. In the following 6 months the bone lesions receded. Morphologically, the tumor was delivered in pieces measuring up to 1 cm in the largest diameter. Microscopically, cellular areas of the tumor were intermingled with hypocellular ones (Fig. 2a). The tumor cells were monomorphous with bland nuclei (Fig. 2b). Small spindle cells were arranged in a storiform pattern. Small conglomerates of tumor cells were surrounded by a network of capillaries, but larger angulated vessels were also present. The hypocellular areas were rich in eosinophilic matrix with

Epiphyseal femoral tumour resection under intraosseous endoscopic control

We have resected 4 benign cystic femoral head tumours under intraosseous endoscopic control. The resections were completely extraarticular through a tunnel made in the femoral neck from the lateral cortex. The procedures were assessed endoscopically with the help of a standard arthroscope. With a minimum follow-up of 1 year (range 1-16 years), there were no recurrences. Mean age at time of surgery was 23 years (range 19-26 years). Only 1 (fibrous defect) needed prophylactic osteosynthesis with a dynamic hip screw. The lateral approach through a bone tunnel allows preservation of the joint. The creation of a wider tunnel (10-15 mm) avoids the need for an irrigation system, without debilitating the bone structure, and simplifies the surgical procedure.

Telomerase enzyme inhibition (TEI) and cytolytic therapy in the management of androgen independent osseous metastatic prostate cancer.

Recurrent prostate cancer can be osseous, androgen independent and lethal. The purpose is to discern the efficacy of synthetic small molecule telomerase enzyme inhibitors (TEI) alone or in combination with other cytotoxic therapies in controlling metastatic osseous prostate cancer. C4-2B was pre-treated with a match or mismatch TEI for 6 weeks and then inoculated into nude mice subcutaneously or intraosseously. In a separate experiment, untreated C4-2B was injected into femur of nude mice. The mice were divided into seven systemic "combination" treatment groups of control, Ad-BSP-E1a virus, docetaxel, mismatch and match TEI. Serum PSA was followed longitudinally. Histology analyses and histomorphometry were performed. Repeated measure analysis was applied for statistical analysis and Bonferroni method was used in multiple comparisons. In the pre-treated study, the PSA of match treated cells in subcutaneous or intraosseous model was significantly lower than mismatch TEI or PBS treated group (P < 0.05). Histology revealed increased fibrosis, apoptosis and decreased PSA staining in the match TEI treated subcutaneous xenografts. In the combination treatment study, the PSA was significantly lower in single/double treatment and triple treatment than control (P < 0.05). Histology revealed that triple therapy mice had normal femur architecture. Histomorphometrics revealed that the area of femur tumor and woven bone was significantly positively correlated (P = 0.007). Multiple lines of data point toward the efficacy of systemically administered telomerase inhibitors. Combining cytotoxic regimens with telomerase inhibitors could be beneficial in controlling prostate cancer. Clinical trials are warranted to explore the efficacy of TEI in prostate cancer.

Endoprosthetic Replacement for Giant Cell Tumour of the Proximal Femur

To evaluate the functional and oncological outcomes of 12 patients with giant cell tumour (GCT) of the proximal femur treated with customized endoprosthesis. Nine men and 3 women aged 26 to 52 (mean, 36) years with Campanacci stage-III GCTs of the proximal femur were included. All underwent a wide excision of the tumour with clear margins and replacement using a customized, bipolar, cemented proximal femoral megaprosthesis. Functional outcomes were evaluated using the Musculoskeletal Tumor Society functional scores. The mean follow-up period was 4.8 (range, 4-6) years. There were no instances of recurrence, dislocation, aseptic loosening, deep infection, or death. At the end of 4 years, 8 patients were walking unassisted, 2 used a cane to support during outdoor activities, one used a walking frame at home and outdoors, and one was lost to follow-up. The mean pain relief score was 5.0, the mean functional score was 4.3, the mean emotional acceptance of the procedure and its outcome was 4.7, the mean lower extremity score for support use was 4.7, for walking ability was 4.5, and for gait was 4.3, and the mean total score was 28.3 (out of the maximum of 30). Endoprosthetic replacement for Campanacci stage-III GCT of the proximal femur achieves good to excellent functional and oncological outcomes.

Proximal Femoral Allograft: Prognostic Indicators

Between 1972 and 1999, the Orthopedic Oncology Service treated 150 patients with resection and allograft transplantation of the proximal femur. Of the group, 121 patients had malignant tumors of the proximal femur and 29 had benign disorders. Four types of allografts were used: osteoarticular (46 patients), allograft-prosthesis (73), intercalary (20), and allograft-arthrodesis (5). Only 16% of the patients died of disease and 3% required amputation. The overall success rate for the series was 77% with the best results for the allograft prosthetic (82%) and intercalary procedures (87%). Graft infection (15 patients), allograft fracture (26 patients), and local recurrence (11 patients) most markedly affected outcome. With the exception of deaths of disease, no significant outcome difference occurred between the patients with malignant and benign disorders. In conclusion, allograft implantation especially for aggressive or malignant tumors of the proximal femur appears to be a competent system for therapy.