gms | German Medical Science

Objectives: Total femur replacement is a rescue procedure as a consequence of a tumor, infectious, trauma or degenerative process as origin. This procedure is made when both joints are compromised or the remaining stock bone in one of them does not allow a prosthetic fixation. The aim of our work is to show the results of total femur replacement in one centre by one surgeon.

Methods: The average follow-up is 4 years (2-6 years). The previous diagnosis was: 4 previously infected patients and one patient with a periprosthetic diaphysis comminuted fracture with osteoporotic bone. Three of the infected patients had full proximal femoral stock bone loss with an average of 21.6cm (12-32 cm). The other infected patient did not suffer stock bone loss, had a well-fixed subsidence femoral stem with severe knee damage. The average leg shortening of these patients without fracture at the moment of procedure was of 6.5cm (4-8cm). All patients had a cemented spacer to maintain limb lenght. In the infected group, one patient, had 11 surgeries before total femur replacement. The remaining three patients showed an average of 19 previous procedures. Before surgery, laboratory tests (ESR, PCR) and bone biopsies were carried out with negative results. Implant brands set in patients were 2 of Biomet®, 1 Stryker®, 1 MDT ® and 1 FICO®. Five constrained non cemented acetabular cups, and modular femoral and tibial stems cemented with Vancomicyn were used. To prevent hip dislocation, abductor mechanism was restored.

Results: Four patients recovered positively having no procedure complications. No patient showed postoperative dislocation. The average elongation achieved was of 4.9cm. None patient shows sciatic lesion. One patient showed a tibia periprosthetic fracture (due to tibia stress because a short stem available in the set), and was treated with a brace for 4 weeks.

All patients returned to active life very fast being the most significant effect of the surgery.

Conclusions:

Due is a complex surgery it must be done by an expertise surgeon in knee and hip. We have an small series of cases similar to world literature, but we don't have the usual complication of hip dislocation because with performed an abductor mechanism restoration