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Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 11, 1513-1520.
doi: 10.1302/0301-620X.91B11.21996  
Copyright © 2009 by British Editorial Society of Bone and Joint Surgery
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Total femoral endoprosthetic replacement following excision of bone tumours

M. D. Sewell, MRCS, Specialist Registrar, Trauma and Orthopaedics1; B. G. I. Spiegelberg, MRCS, Research Fellow1; S. A. Hanna, MRCS, Specialist Registrar, Trauma and Orthopaedics1; W. J. S. Aston, FRCS(Orth), Consultant Orthopaedic Surgeon1; W. Bartlett, MRCS, Specialist Registrar Trauma and Orthopaedics1; G. W. Blunn, PhD, Professor of Biomedical Engineering2; L. A. David, FRCS(Orth), Consultant Orthopaedic Surgeon1; S. R. Cannon, MCh(Orth), FRCS, Consultant Orthopaedic Surgeon1; and T. W. R. Briggs, MD(Res), MCh(Orth), FRCS, Consultant Orthopaedic Surgeon1

1 Sarcoma Unit
2 Institute of Orthopaedics and Musculoskeletal Science, The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK.

Correspondence should be sent to Mr M. D. Sewell; e-mail: matbuzz1{at}hotmail.com

We undertook a retrospective review of 33 patients who underwent total femoral endoprosthetic replacement as limb salvage following excision of a malignant bone tumour. In 22 patients this was performed as a primary procedure following total femoral resection for malignant disease. Revision to a total femoral replacement was required in 11 patients following failed segmental endoprosthetic or allograft reconstruction. There were 33 patients with primary malignant tumours, and three had metastatic lesions. The mean age of the patients was 31 years (5 to 68). The mean follow-up was 4.2 years (9 months to 16.4 years). At five years the survival of the implants was 100%, with removal as the endpoint and 56% where the endpoint was another surgical intervention. At five years the patient survival was 32%. Complications included dislocation of the hip in six patients (18%), local recurrence in three (9%), peri-prosthetic fracture in two and infection in one. One patient subsequently developed pulmonary metastases. There were no cases of aseptic loosening or amputation. Four patients required a change of bushings. The mean Musculoskeletal Tumour Society functional outcome score was 67%, the mean Harris Hip Score was 70, and the mean Oxford Knee Score was 34.

Total femoral endoprosthetic replacement can provide good functional outcome without compromising patient survival, and in selected cases provides an effective alternative to amputation.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General