Hemipelvic and proximal femoral limb salvage endoprosthesis with tendon ongrowth in a dog

Abstract

Objective To report the clinical application of a hemipelvic and proximal femoral endoprosthesis for limb salvage. Study design Retrospective case report. Animal One 5‐year‐old, neutered female, flat coated retriever with a malignant neoplasia of the left coxofemoral joint. Methods An invasive soft tissue mass (histiocytic sarcoma) with bone lysis of the femoral head and acetabulum was noted on radiographs, computed tomography (CT), and MRI. Custom‐designed hemipelvic and proximal femoral endoprostheses were produced from CT images and manufactured with hydroxyapatite coated surfaces to allow tissue integration. The proximal femoral implant allowed tendon ongrowth and muscle attachment. The pelvic implant was anchored to the ilium and ischium with screws, and the femoral implant was cemented. Chemotherapy consisted of lomustine (CCNU). Results No evidence of implant loosening or local/thoracic metastases was noted on radiographs or CT at 6 weeks and at 3, 6, 9, and 12 months after surgery. A neurapraxia resolved 14 weeks postoperatively. Intensive rehabilitation was performed. At 12 months, activity was unrestricted with minimal residual lameness. The dog was euthanized at 14 months for metastatic disease. Conclusion Limb salvage with a hemipelvic and proximal femoral endoprosthesis resulted in limb function and survival for 14 months. Clinical significance Neoplasia involving the bones of the coxofemoral joint traditionally requires hemipelvic resection and pelvic limb amputation. This report provides evidence that limb salvage can result in satisfactory levels of activity.

Custom acetabular prosthesis for total hip replacement: A case report in a dog with acetabular bone loss after femoral head and neck ostectomy

“…The implant functioned as a supporting shell for the UHMWPE cup, which was fixed into the CAP with cement. Cementation of UHMWPE cups into a metal reinforcement is a validated strategy for revision THR in man and has been previously described by Fitzpatrick et al for limb salvage in a dog with a neoplasia affecting the hip joint. We used a similar strategy in this case, which allowed alignment of the cup independently from the position of the titanium shell.…”

“…The use of similar implants in dogs may represent an alternative treatment option in the case of severe acetabular defects. A custom‐made hemipelvic and proximal femoral limb salvage endoprosthesis was recently designed to salvage the acetabulum of a dog affected by a malignant neoplasia of the hip joint, resulting in satisfactory levels of activity …”

“…A custom-made hemipelvic and proximal femoral limb salvage endoprosthesis was recently designed to salvage the acetabulum of a dog affected by a malignant neoplasia of the hip joint, resulting in satisfactory levels of activity. 18 The objective of this case report is to describe the surgical technique, complications, and outcome of a THR with a custom acetabular prosthesis (CAP) in a dog with acetabular bone loss after FHNO.…”

Limb-Sparing Surgery in Two Cats Using a Femoral Endoprosthesis with an Integrated Total Knee Replacement Implant

“…8,11 Single case reports have also described the utilization of custom-made total joint replacement implants for limb salvage. 12,13 In one case, a custom total knee replacement (TKR) prosthesis was used for limb salvage after medial femoral condylar non-union fracture with bone loss in a dog and achieved excellent long-term function. 12 Replacement of a large bone defect following resection of a coxofemoral histiocytic sarcoma using a hemipelvic and proximal femoral endoprosthesis for limb salvage has also been performed with satisfactory functional outcome.…”

“…12 Replacement of a large bone defect following resection of a coxofemoral histiocytic sarcoma using a hemipelvic and proximal femoral endoprosthesis for limb salvage has also been performed with satisfactory functional outcome. 13 Limb salvage utilizing an endoprosthesis is an established treatment strategy for primary malignant bone tumours, bone metastasis, end-stage revision arthroplasty and major trauma in humans. 14 Total femoral endoprosthetic replacements, with integrated total joint arthroplasty of both the hip and the knee, are used in human patients with malignant bone tumors.…”