MUTARS® Humero pro Femur replacement: A novel reconstructive procedure after malignant bone tumor resection of the femur in young children

Abstract

Limb-preserving surgery in young children suffering malignant bone tumor of the femur is challenging due to the specific anatomical conditions. Extendable tumor endoprostheses are often oversized, while custom-made endoprostheses do not provide the intraoperatively required variability regarding reconstruction length. Allo- and autograft replacements, on the other hand, show high complication and revision rates. We report a novel reconstructive procedure after resection of malignant bone tumors of the femur in young children, and present our preliminary results of this technique.

Keywords: Bone sarcoma; Ewing’s sarcoma; LLD, leg length discrepancy; MSTS, Musculoskeletal Tumor Society; MUTARS; Osteosarcoma; a.p., anteroposterior.

Fig. 1

Patient 1. Female patient with Ewing’s sarcoma of the right femur (A. MRI, coronal view; B. radiograph, anteroposterior (a.p.) view). Total femur resection and MUTARS® Humero pro Femur reconstruction at the age of 3 years (C. a.p. view; D. lateral view). First revision with 10 mm lengthening of the modular prosthetic system 3 years after the initial surgery (E.). 5 years after tumor resection a triple osteotomy of the right pelvis was performed (F.). At the time of last follow-up at the age of 12 years the patient showed a remaining LLD of 13.5 cm (G.).

Fig. 2

Patient 2. Female patient with osteosarcoma of the left distal femur (A. MRI, coronal view; B. radiograph, a.p. view). Tumor resection and reconstruction of the distal femur and diaphysis was performed at the age of 8 years (C. a.p. view; D. lateral view; E. intraoperative view of the femoral reconstruction).

Fig. 3

Patient 3. Male patient with osteosarcoma of the right distal femur, presenting with pathological fracture of the distal femur at the time of initial consultation (A. a.p. view; B. lateral view). MUTARS® Humero pro Femur reconstruction was performed at the age of 4 years (C. a.p. view; D. lateral view; E. intraoperative view of femoral reconstruction).

Fig. 4

Patient 4. Male patient with Ewing’s sarcoma of the right distal femur (A. a.p. view). MUTARS® Humero pro Femur reconstruction was performed at the age of 4 years (B., C. 2 years postoperatively, a.p. (B.) and lateral (C.) views). 2.5 cm LLD 3 years postoperatively (D. a.p. view).

Fig. 5

Patient 5. Male patient with Ewing’s sarcoma of the left femur (A. a.p. view). After total femur resection, diaphyseal reconstruction was performed with a distractable vertebral body replacement, while the knee joint was reconstructed with an inverse humerus cap, a glenoid and a 40 mm glenosphere (B. a.p. view). 2 months after the initial reconstruction a revision surgery was performed with exchange of the prosthesis and implantation of a MUTARS® Humero pro Femur replacement; in this case, an ulna anchorage stem served as a tibial plateau (C. a.p. view; D. lateral view; E. intraoperative view of the femoral reconstruction).