Proximal Femur Megaprostheses in Orthopedic Oncology: Evaluation of a Standardized Post-operative Rehabilitation Protocol

Abstract

Background: Reconstructions of the proximal femur after massive resections represent one of the main challenges in orthopedic oncology. Among the possible treatments, megaprostheses represent one of the most used and reliable reconstructive approaches. Although literature about their outcomes has flourished through the last decades, a consensus rehabilitative treatment is still far from being established.

Materials and methods: We evaluated the functional results of all our oncologic cases treated between 2016 and 2022 that could follow our standardized post-operative rehabilitative approach, consisting in progressive hip mobilization and early weight-bearing.

Results: Twenty-two cases were included in our study. On average, their hospitalization lasted 15.1 days. The seated position was achieved on average within 3.7 days after surgery, the standing position reached 5.4 after surgery, while assisted deambulation was started 6.4 days after surgery. After a mean post-operative follow-up of 44.0 months, our patients' mean MSTS score was 23.2 (10-30). Our data suggested a statistically significant inverse linear correlation between post-operative functionality and patients' age, resection length, and the start of deambulation.

Conclusions: A correct rehabilitation, focused on early mobilization and progressive weight-bearing, is crucial to maximize patients' post-operative functional outcomes.

Keywords: Bone tumor; Megaprosthesis; Oncology; Proximal femur; Rehabilitation; Resection.

Fig. 1

Post-operative X-Ray of a megaprosthesis of the proximal femur. Sites for the reattachment of the gluteal insertion are present in the trochanteric region of the implant

Fig. 2

Intra-operative images of a proximal femur resection and megaprosthetic replacement. The proximal femur is resected and replaced with a prosthetic implant with comparable size and shape (A). The implant is then assembled and set in place; an adequate coverage of the quadriceps and gluteal region are necessary in order to achieve good post-operative stability and mobility (B)