Total Femoral Replacement in Non-Neoplastic Disorders

Abstract

Submit Manuscript | http://medcraveonline.com IntroductionThe deficit of femoral bone stock is a frequent finding. This situation is mostly derived from the increased number of hip and knee arthroplasties and the consequent increase of failed implants, periprosthetic fractures and infections. There are other non-tumoral causes that generate this type of deficit, such as hardware failures in pathological bone, osteomielytis, congenital bone defects and metabolic bone diseases, etc [1-3].Several solutions have been proposed, which must be analyzed depending on the cause and magnitude of the femoral and acetabular bone loss, the patient's muscle status (particularly the gluteus medius), the presence of infection, the age and background of the patient, and, of course, the surgeon's expertise and his surgical facilities. This last aspect is essential, as revision and conversion surgeries are very demanding, for both patient and surgeon.The most frequent alternatives include the use of cemented or non cemented long femoral stems, with proximal or distal fixation, associated or not to bone graft. Many studies have referred to the advantages and disadvantages of each of these treatment alternatives [2][3][4]. Nevertheless, in certain cases, the femoral bone deficit is so significant that there is not enough bone to properly fix any of these revision implants. In these patients, an option is the total hip replacement with a megaprosthesis, and among them, the total femur replacement (TFR) [4][5][6][7][8][9].Buchman was the first to report a total femur replacement in a patient with Paget´s disease 10 . The first total femur implants were made of hip and knee prosthesis united by a polyethylene shaft, to which these components were adapted [5,10]. Even if this was a low cost versatile design, in time it was observed that polyethylene alone was not an adequate material to bear the load and torsions at a femoral level, particularly in young patients with high functional demand, since most of the initial patients were operated due to tumours [4]. In the mid 80s, modularity revolutionized reconstruction prosthesis, allowing the surgeon to estimate the existing bone defect, and therefore select the appropriate components for more accurate reconstructive surgery [1,11].The good outcome of patients treated with TFR for neoplastic causes widened the indication of this treatment to patients with massive femoral bone loss due to several non-neoplastic causes, not being the estimated survivorship of the patient an excluding factor in the decision process [12]. However, except for the publications from Endo-Klinik in Hamburg, Germany, which exceed 100 cases [7], the rest of TFR reports in non-neoplastic pathology analyze around 20 cases at the most. Additionally, in all these series the pre-operative diagnosis is varied, making it difficult to obtain from them a clear conclusion on the evolution of these patients on the medium and long term. In this study we evaluate the indications, surgical technique and post operative care of TFR ...