Total femur replacement

Total femoral replacement after massive resection of bone and soft tissue sarcoma of the thigh can restore femoral integrity and allow patients to resume ambulation, albeit at a compromised level. This compromised functional capacity is superior to that achieved after hip disarticulation. Most reports of total femoral replacements are isolated case studies. Only few reported series have been identified.

We treated nine consecutive patients by total femur resection and reconstruction with total femur replacement between 1993 and 2007. Four had a primary malignant bone tumor, four had a primary malignant soft-tissue tumor, and one had a metastatic disease.

After a mean follow-up of 51 (8–200) months, four patients were still alive, whereas five patients died of malignant disease. Mechanical loosening of the tibial component was seen in one patient. Infection was encountered in two patients. Four patients had excellent outcomes. Competence of the extensor mechanism is the major determinant of functional outcome of these patients. The flexion range of knee motion ranged from 20 to 120° (mean 60°). According to Enneking’s functional evaluation method, the function ranged from 30 to 93% (mean 72%). Using the International Society of Limb Salvage radiographic evaluation method, all the available radiographs show excellent results. Excellent results also were seen for the radiographic evaluation of the hip.

Endoprosthetic femoral replacement is a reliable mean to restore mechanical and functional results after extensive resection of the femur.