Advances in total femur replacement_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WU Fan ^1,2 , FANG Xiang ¹ , LANG Zhigang ¹ , LIU Hongyuan ¹ ,  DUAN Hong ¹

1. Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;
2. Department of Orthopedics, Fourth People’s Hospital of Zigong, Zigong Sichuan, 643000, P.R.China;

Corresponding author：

DUAN Hong, Email: duanhong1970@126.com

Keywords：

Total femur replacement; femur tumor; revision

DOI：

10.7507/1002-1892.201804006

Video：

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Objective To summarize the advances of total femur replacement in recent years. Methods The literature related to total femur replacement was reviewed, and the indications, techniques, prosthesis design, complications, rehabilitation, and function were summarized. Results The indication of total femur replacement is a wide involvement of the femur, skip lesions and a huge bone defect in revision. Watson-Jone is the main incision in the proximal, and then the full length of the thigh to the patella. Vascular and nerve bundle, abduction muscles are well protected, and combined or costumed prosthesis are replaced. The prosthesis design progresses, showing a diversified prostheses. Complication is frequent and varied. Rehabilitation in early stage is physical therapy, weight training is evolutionary. The main function evaluation system is Musculoskeletal Tumor Society (MSTS) score. Conclusion Total femur replacement is effective in limb salvage. Large sample size and long-term follow-up study should be carried out to unify indications and functional exercise standards and reduce postoperative complications.

Citation： WU Fan, FANG Xiang, LANG Zhigang, LIU Hongyuan, DUAN Hong. Advances in total femur replacement. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(10): 1346-1350. doi: 10.7507/1002-1892.201804006 Copy

1.	张清, 牛晓辉, 蔡槱伯, 等. 人工全股骨关节置换治疗股骨骨肉瘤. 中华外科杂志, 2007, 45(10): 661-664.
2.	Kalra S, Abudu A, Murata H, et al. Total femur replacement: primary procedure for treatment of malignant tumours of the femur. Eur J Surg Oncol, 2010, 36(4): 378-383.
3.	Buchman J. Total femur and knee joint replacement with a vitalium endoprosthesis. Bull Hosp Joint Dis, 1965, 26: 21-34.
4.	Present DA, Kuschner SH. Total femur replacement. A case report with 35-year follow-up study. Clin Orthop Relat Res, 1990, (251): 166-167.
5.	Hu QT, Jiang QW, Su GL, et al. Total femur and adjacent joint replacement with endoprosthesis: report of 2 cases. Chin Med J (Engl), 1980, 93(2): 86-89.
6.	Lombardi AV Jr, Berend KR. The shattered femur: radical solution options. J Arthroplasty, 2006, 21(4 Suppl 1): 107-111.
7.	Katznelson A, Nerubay J. Total femur replacement in sarcoma of the distal end of the femur. Acta Orthop Scand, 1980, 51(5): 845-851.
8.	Bielack S, Carrle D, Casali PG, et al. Osteosarcoma: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol, 2009, 20 Suppl 4: 137-139.
9.	Pan K, Chan W, Shanmugam P, et al. Large volume osteosarcomas of the femur treated with total femoral replacement. Malays Orthop J, 2014, 8(1): 32-36.
10.	Liu T, Zhang X, Zhang Q, et al. Total femoral reconstruction with custom prosthesis for osteosarcoma. World J Surg Oncol, 2016, 14: 93.
11.	Ahmed AR. Total femur replacement. Arch Orthop Trauma Surg, 2010, 130(2): 171-176.
12.	Sewell MD, Spiegelberg BG, Hanna SA, et al. Total femoral endoprosthetic replacement following excision of bone tumours. J Bone Joint Surg (Br), 2009, 91(11): 1513-1520.
13.	Yoshida Y, Kojima T, Taniguchia M, et al. Experiences with total femur replacement for malignant bone and soft tissue tumors. Asian Biomedicine, 2012, 6(1): 123-127.
14.	郭春, 甘林, 屠重棋. 全股骨人工假体置换治疗复发性骨肉瘤. 华西医学, 2003, 18(1): 86-87.
15.	Sanz-Ruiz P, Villanueva-Martinez M, Calvo-Haro JA, et al. Total femur arthroplasty for revision hip failure in osteogenesis imperfecta: limits of biology. Arthroplast Today, 2017, 3(3): 154-159.
16.	Buchowski JM, Cascio BM, Streiff MB, et al. Resection and reconstruction of a massive femoral hemophilic pseudotumor. Clin Orthop Relat Res, 2005, (430): 237-242.
17.	Davis N, Curry A, Gambhir AK, et al. Intraoperative bacterial contamination in operations for joint replacement. J Bone Joint Surg (Br), 1999, 81(5): 886-889.
18.	Berend KR, Lombardi AV Jr, Mallory TH, et al. Total femoral arthroplasty for salvage of end-stage prosthetic disease. Clin Orthop Relat Res, 2004, (427): 162-170.
19.	Friesecke C, Plutat J, Block A. Revision arthroplasty with use of a total femur prosthesis. J Bone Joint Surg (Am), 2005, 87(12): 2693-2701.
20.	Amanatullah DF, Trousdale RT, Hanssen AD, et al. Non-oncologic total femoral arthroplasty: retrospective review. J Arthroplasty, 2014, 29(10): 2013-2015.
21.	Sherman SL, Cunneen KP, Walcott-Sapp S, et al. Custom total femur spacer and second-stage total femur arthroplasty as a novel approach to infection and periprosthetic fracture. J Arthroplasty, 2008, 23(5): 781-786.
22.	Fountain JR, Dalby-Ball J, Carroll FA, et al. The use of total femoral arthroplasty as a limb salvage procedure: the Sheffield experience. J Arthroplasty, 2007, 22(5): 663-669.
23.	Nakayama T, Matsumoto S, Shimoji T, et al. The significance of rectus femoris for the favorable functional outcome after total femur replacement. Plast Reconstr Surg Glob Open, 2016, 4(3): e630.
24.	Natarajan MV, Balasubramanian N, Jayasankar V, et al. Endoprosthetic reconstruction using total femoral custom mega prosthesis in malignant bone tumours. Int Orthop, 2009, 33(5): 1359-1363.
25.	Morris HG, Capanna R, Campanacci D, et al. Modular endoprosthetic replacement after total resection of the femur for malignant tumour. Int Orthop, 1994, 18(2): 90-95.
26.	Schindler OS, Cannon SR, Briggs TW, et al. Use of extendable total femoral replacements in children with malignant bone tumors. Clin Orthop Relat Res, 1998, (357): 157-170.
27.	Peters CL, Hickman JM, Erickson J, et al. Intramedullary total femoral replacement for salvage of the compromised femur associated with hip and knee arthroplasty. J Arthroplasty, 2006, 21(1): 53-58.
28.	Glehr M, Leithner A, Friesenbichler J, et al. Argyria following the use of silver-coated megaprostheses: no association between the development of local argyria and elevated silver levels. Bone Joint J, 2013, 95-B(7): 988-992.
29.	Mankin HJ, Hornicek FJ, Harris M. Total femur replacement procedures in tumor treatment. Clin Orthop Relat Res, 2005, 438: 60-64.
30.	Sevelda F, Schuh R, Hofstaetter JG, et al. Total femur replacement after tumor resection: limb salvage usually achieved but complications and failures are common. Clin Orthop Relat Res, 2015, 473(6): 2079-2087.
31.	Henderson ER, Groundland JS, Pala E, et al. Failure mode classification for tumor endoprostheses: retrospective review of five institutions and a literature review. J Bone Joint Surg (Am), 2011, 93(5): 418-429.
32.	Henderson ER, O'Connor MI, Ruggieri P, et al. Classification of failure of limb salvage after reconstructive surgery for bone tumours: a modified system including biological and expandable reconstructions. Bone Joint J, 2014, 96-B(11): 1436-1440.
33.	Katrak P, O’connor B, Woodgate I. Rehabilitation after total femur replacement: a report of 2 cases. Arch Phys Med Rehabil, 2003, 84(7): 1080-1084.
34.	Hwang JS, Beebe KS, Patterson FR, et al. Infected total femoral replacements: evaluation of limb loss risk factors. Orthopedics, 2011, 34(11): e736-e740.
35.	Toepfer A, Harrasser N, Petzschner I, et al. Is total femoral replacement for non-oncologic and oncologic indications a safe procedure in limb preservation surgery? A single center experience of 22 cases Eur J Med Res, 2018, 23(1): 5.
36.	Jones KB, Griffin AM, Chandrasekar CR, et al. Patient-oriented functional results of total femoral endoprosthetic reconstruction following oncologic resection. J Surg Oncol, 2011, 104(6): 561-565.
37.	Enneking WF, Dunham W, Gebhardt MC, et al. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res, 1993, (286): 241-246.
38.	Ruggieri P, Bosco G, Pala E, et al. Local recurrence, survival and function after total femur resection and megaprosthetic reconstruction for bone sarcomas. Clin Orthop Relat Res, 2010, 468(11): 2860-2866.
39.	Nakamura S, Kusuzaki K, Murata H, et al. More than 10 years of follow-up of two patients after total femur replacement for malignant bone tumor. Int Orthop, 2000, 24(3): 176-178.

1. 张清, 牛晓辉, 蔡槱伯, 等. 人工全股骨关节置换治疗股骨骨肉瘤. 中华外科杂志, 2007, 45(10): 661-664.
2. Kalra S, Abudu A, Murata H, et al. Total femur replacement: primary procedure for treatment of malignant tumours of the femur. Eur J Surg Oncol, 2010, 36(4): 378-383.
3. Buchman J. Total femur and knee joint replacement with a vitalium endoprosthesis. Bull Hosp Joint Dis, 1965, 26: 21-34.
4. Present DA, Kuschner SH. Total femur replacement. A case report with 35-year follow-up study. Clin Orthop Relat Res, 1990, (251): 166-167.
5. Hu QT, Jiang QW, Su GL, et al. Total femur and adjacent joint replacement with endoprosthesis: report of 2 cases. Chin Med J (Engl), 1980, 93(2): 86-89.
6. Lombardi AV Jr, Berend KR. The shattered femur: radical solution options. J Arthroplasty, 2006, 21(4 Suppl 1): 107-111.
7. Katznelson A, Nerubay J. Total femur replacement in sarcoma of the distal end of the femur. Acta Orthop Scand, 1980, 51(5): 845-851.
8. Bielack S, Carrle D, Casali PG, et al. Osteosarcoma: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol, 2009, 20 Suppl 4: 137-139.
9. Pan K, Chan W, Shanmugam P, et al. Large volume osteosarcomas of the femur treated with total femoral replacement. Malays Orthop J, 2014, 8(1): 32-36.
10. Liu T, Zhang X, Zhang Q, et al. Total femoral reconstruction with custom prosthesis for osteosarcoma. World J Surg Oncol, 2016, 14: 93.
11. Ahmed AR. Total femur replacement. Arch Orthop Trauma Surg, 2010, 130(2): 171-176.
12. Sewell MD, Spiegelberg BG, Hanna SA, et al. Total femoral endoprosthetic replacement following excision of bone tumours. J Bone Joint Surg (Br), 2009, 91(11): 1513-1520.
13. Yoshida Y, Kojima T, Taniguchia M, et al. Experiences with total femur replacement for malignant bone and soft tissue tumors. Asian Biomedicine, 2012, 6(1): 123-127.
14. 郭春, 甘林, 屠重棋. 全股骨人工假体置换治疗复发性骨肉瘤. 华西医学, 2003, 18(1): 86-87.
15. Sanz-Ruiz P, Villanueva-Martinez M, Calvo-Haro JA, et al. Total femur arthroplasty for revision hip failure in osteogenesis imperfecta: limits of biology. Arthroplast Today, 2017, 3(3): 154-159.
16. Buchowski JM, Cascio BM, Streiff MB, et al. Resection and reconstruction of a massive femoral hemophilic pseudotumor. Clin Orthop Relat Res, 2005, (430): 237-242.
17. Davis N, Curry A, Gambhir AK, et al. Intraoperative bacterial contamination in operations for joint replacement. J Bone Joint Surg (Br), 1999, 81(5): 886-889.
18. Berend KR, Lombardi AV Jr, Mallory TH, et al. Total femoral arthroplasty for salvage of end-stage prosthetic disease. Clin Orthop Relat Res, 2004, (427): 162-170.
19. Friesecke C, Plutat J, Block A. Revision arthroplasty with use of a total femur prosthesis. J Bone Joint Surg (Am), 2005, 87(12): 2693-2701.
20. Amanatullah DF, Trousdale RT, Hanssen AD, et al. Non-oncologic total femoral arthroplasty: retrospective review. J Arthroplasty, 2014, 29(10): 2013-2015.
21. Sherman SL, Cunneen KP, Walcott-Sapp S, et al. Custom total femur spacer and second-stage total femur arthroplasty as a novel approach to infection and periprosthetic fracture. J Arthroplasty, 2008, 23(5): 781-786.
22. Fountain JR, Dalby-Ball J, Carroll FA, et al. The use of total femoral arthroplasty as a limb salvage procedure: the Sheffield experience. J Arthroplasty, 2007, 22(5): 663-669.
23. Nakayama T, Matsumoto S, Shimoji T, et al. The significance of rectus femoris for the favorable functional outcome after total femur replacement. Plast Reconstr Surg Glob Open, 2016, 4(3): e630.
24. Natarajan MV, Balasubramanian N, Jayasankar V, et al. Endoprosthetic reconstruction using total femoral custom mega prosthesis in malignant bone tumours. Int Orthop, 2009, 33(5): 1359-1363.
25. Morris HG, Capanna R, Campanacci D, et al. Modular endoprosthetic replacement after total resection of the femur for malignant tumour. Int Orthop, 1994, 18(2): 90-95.
26. Schindler OS, Cannon SR, Briggs TW, et al. Use of extendable total femoral replacements in children with malignant bone tumors. Clin Orthop Relat Res, 1998, (357): 157-170.
27. Peters CL, Hickman JM, Erickson J, et al. Intramedullary total femoral replacement for salvage of the compromised femur associated with hip and knee arthroplasty. J Arthroplasty, 2006, 21(1): 53-58.
28. Glehr M, Leithner A, Friesenbichler J, et al. Argyria following the use of silver-coated megaprostheses: no association between the development of local argyria and elevated silver levels. Bone Joint J, 2013, 95-B(7): 988-992.
29. Mankin HJ, Hornicek FJ, Harris M. Total femur replacement procedures in tumor treatment. Clin Orthop Relat Res, 2005, 438: 60-64.
30. Sevelda F, Schuh R, Hofstaetter JG, et al. Total femur replacement after tumor resection: limb salvage usually achieved but complications and failures are common. Clin Orthop Relat Res, 2015, 473(6): 2079-2087.
31. Henderson ER, Groundland JS, Pala E, et al. Failure mode classification for tumor endoprostheses: retrospective review of five institutions and a literature review. J Bone Joint Surg (Am), 2011, 93(5): 418-429.
32. Henderson ER, O'Connor MI, Ruggieri P, et al. Classification of failure of limb salvage after reconstructive surgery for bone tumours: a modified system including biological and expandable reconstructions. Bone Joint J, 2014, 96-B(11): 1436-1440.
33. Katrak P, O’connor B, Woodgate I. Rehabilitation after total femur replacement: a report of 2 cases. Arch Phys Med Rehabil, 2003, 84(7): 1080-1084.
34. Hwang JS, Beebe KS, Patterson FR, et al. Infected total femoral replacements: evaluation of limb loss risk factors. Orthopedics, 2011, 34(11): e736-e740.
35. Toepfer A, Harrasser N, Petzschner I, et al. Is total femoral replacement for non-oncologic and oncologic indications a safe procedure in limb preservation surgery? A single center experience of 22 cases Eur J Med Res, 2018, 23(1): 5.
36. Jones KB, Griffin AM, Chandrasekar CR, et al. Patient-oriented functional results of total femoral endoprosthetic reconstruction following oncologic resection. J Surg Oncol, 2011, 104(6): 561-565.
37. Enneking WF, Dunham W, Gebhardt MC, et al. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res, 1993, (286): 241-246.
38. Ruggieri P, Bosco G, Pala E, et al. Local recurrence, survival and function after total femur resection and megaprosthetic reconstruction for bone sarcomas. Clin Orthop Relat Res, 2010, 468(11): 2860-2866.
39. Nakamura S, Kusuzaki K, Murata H, et al. More than 10 years of follow-up of two patients after total femur replacement for malignant bone tumor. Int Orthop, 2000, 24(3): 176-178.

Chinese Journal of Reparative and Reconstructive Surgery

Advances in total femur replacement

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