gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017)

24.10. - 27.10.2017, Berlin

Patient outcome after total femur replacement. A single center retrospective analysis of indication, complication and outcome

Meeting Abstract

  • presenting/speaker Tilman Graulich - Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Hannover, Germany
  • Mohamed Omar - Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Hannover, Germany
  • Sanjay Weber-Spickschen - Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Hannover, Germany
  • Christian Krettek - Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Hannover, Germany
  • Martin Panzica - Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Hannover, Germany

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017). Berlin, 24.-27.10.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocIN26-1389

doi: 10.3205/17dkou057, urn:nbn:de:0183-17dkou0577

Veröffentlicht: 23. Oktober 2017

© 2017 Graulich et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives: Total femur replacement (TFR) as a salvage operation is used in patients after tumor resection, endoprosthesis loosening, periprosthetic fractures, primary fracture condition, after removal of endoprosthesis due to infection, pseudarthrosis and recurrent dislocation of a endoprosthesis. Although these operations offer the opportunity to get fully reintegrated into daily live they are often associated with major complications and reduced function. Only limited data is known about the outcome and therefore our aim was to analyze patients who underwent TFR in our level one trauma center.

Methods: We retrospectively analyzed all patients who underwent TFR in our hospital between 2006 and 2016 and included them for final follow up (fup). All patients received an individualized megaprosthesis total femur replacements MUTARS® system. We grouped patients into three groups according to there initial indication of TFR implantation: i) trauma, ii) tumor, iii) post infection. We evaluated (i) survival of patients, (ii) postoperative function with power for knee extension and flexion and the Musculoskeletal Tumor Society Score (MSTS) (range 0-30) with high values indicating good function and acceptance, range of motion (ROM) and (iii) complication like infection and revision.

Results and Conclusion: In total between 2006 and 2016 TFR was performed in 22 patients with a mean age of 64 +/-17 years. Out of these we had 13 (59%) female and 9 (41%) male patients. The mean ASA-Score was 2.59. Indication for TFR was six times after tumor, eight times after infection and eight times due to periprosthetic fracture. The mean fup was 19+/-21 months. Mean MSTS was 7 +/- 5. For knee power fup only 7 patients (31%) could be included and showed a power of 63% compared to the healthy side. Mean knee flexion was 66°+/-36°. Before final clinical fup five patients (22%) died, 5 (22%) underwent hip exarticulation and 12 (54%) suffered major complication. The mortality was, three (37,5%) in the infection group, 0 (0%) in the tumor group and two (25%) in the fracture group. At final fup we observed 11 infections (50%). Out of these five died (45%), four (36%) were treated with debridement and were classified as persistent low grade infect and five (45 %) were treated with hip exarticulation. Nevertheless 15 (68%) could maintain their limb and are still alive at final fup.

We conclude that the implantation of a TFR is still a selvage procedure with limited functional outcome, high complication rates like infection, amputation and death but nevertheless the major part of our collective could maintain their limb. Limb selvage and early amputation are discussed controversially in literature. Therefore further evaluation needs to be done to elucidate the indications for both options.