Bipolar hemiarthroplasty versus total hip arthroplasty in allograft-prosthesis composite reconstruction of the proximal femur following primary bone tumour resection

Abstract

Aims The consensus is that bipolar hemiarthroplasty (BHA) in allograft-prosthesis composite (APC) reconstruction of the proximal femur following primary tumour resection provides more stability than total hip arthroplasty (THA). However, no comparative study has been performed. In this study, we have compared the outcome and complication rates of these two methods. Methods In a retrospective study, 57 patients who underwent APC reconstruction of proximal femur following the primary tumour resection, either using BHA (29) or THA (28), were included. Functional outcome was assessed using the Musculoskeletal Tumour Society (MSTS) scoring system and Harris Hip Score (HHS). Postoperative complications of the two techniques were also compared. Results The mean follow-up of the patients was 8.3 years (standard deviation (SD) 5.5) in the BHA and 6.9 years (SD 4.7) in the THA group. The mean HHS was 65 (SD 16.6) in the BHA group and 88 (SD 11.9) in the THA group (p = 0.036). The mean MSTS score of the patients was 73.3% (SD 16.1%) in the BHA and 86.7% (SD 12.2%) in the THA group (p = 0.041). Limping was recorded in 19 patients (65.5%) of the BHA group and five patients (17.8%) of the THA group (p < 0.001). Dislocation occurred in three patients (10.3%) of the BHA group and two patients (7.1%) of the THA group. Conclusion While the dislocation rate was not higher in THA than with BHA, the functional outcome was significantly superior. Based on our results, we recommend THA in APC reconstruction of the proximal femur. Cite this article: Bone Joint J 2020;102-B(4):524–529.

Megaprosthesis Reconstruction of the Proximal Femur following Bone Tumour Resection: When Do We Need the Cup?

“…A total of 104 consecutive patients who underwent PFE for oncologic reasons between January 2005 and December 2017 were identified from the Rizzoli Institute prospectively maintained database ( Table 1 ) 2 6 8 9 10 11 13 14) . All patients consented to the use of their clinical information at the time of admission and the complete medical records and images were available for revision.…”

“…Limb salvage is possible in most cases. Reconstruction can be performed with either an allograft prosthesis composite or a proximal femoral endoprosthesis (PFE) 2 3) . In both cases reconstruction can be a total hip arthroplasty (THA) or a bipolar hemiarthroplasty (BHA).…”

“…A few studies 2 3 6 7 8 9 10 11 12) have compared the results of THA and BHA in PFE. Most of them suggested that BHA are more stable than THA, with good functional results 5) , even though a considerable number of patients may require a revision from BHA to THA because of painful cotyloiditis 5) .…”

Artificial intelligence-based classification of bone tumors in the proximal femur on plain radiographs: System development and validation

“…The proximal part of the femur, i.e., the head, neck, and trochanteric areas, is one of the most common anatomic locations for benign bone tumors and tumor-like conditions [ 1 ] and a common location for bone metastasis of malignant tumors from other organs. Primary malignancies, such as osteosarcoma, chondrosarcoma, and Ewing’s sarcoma can also develop at the proximal femur [ 2 – 4 ]. As high mechanical stress is concentrated during weight-bearing activities, it is also the most common site of pathological fractures secondary to bone tumors [ 5 , 6 ].…”

“…Early detection and classification should be performed to ensure successful treatment of bone tumors. For primary malignancies, radical surgical resection is possible only when they are detected in the early stages [ 2 , 3 ]. Protected weight-bearing, surgical augmentation, or radiotherapy may be needed to prevent fractures around osteolytic tumors [ 5 , 6 ].…”