Endoprosthetic reconstruction for neoplasms of the proximal femur

Abstract

Limb salvage has become an important alternative to amputation in the treatment of bone neoplasms. We sought to determine whether the survivorship of modular proximal femur endoprostheses compares to that of custom implants and if specified factors predict failure. We additionally assessed the intermediate clinical and functional results with regard to complications and outcome. We retrospectively reviewed 96 consecutive patients who underwent endoprosthetic reconstruction for neoplastic disease and assessed patient, implant, and limb survivorship. The mean patient age was 59 years (range, 14-86 years). The average duration of followup was 18.1 months (range, 1-129 months). Nine (9.3%) prostheses failed and the rate of revision was 7.3% (7/96). Overall implant survival was 82% at 5 years and 10 years. Survivorship of the limb was 99% at 5 years. Patients in whom the articulating head segment was a total hip had a higher rate of revision compared with those who had undergone bipolar replacement. The mean MSTS score was 22 points (range, 15-25 points). Modular endoprosthetic replacement of the proximal femur is a durable reconstructive option and implants will generally outlive the patient with neoplastic disease. Bipolar head segments should be used whenever possible because of increased survival and decreased rates of dislocation.

Level of evidence: Therapeutic study, level IV (case series).