THE TOTAL FEMORAL REPLACEMENT

Abstract

Salvage procedures for complications following revision arthroplasty are becoming an increasingly necessary intervention. Total femoral replacement (TFR), initially developed for limb salvage in the management of bone malignancy is the most extreme example of this.

Over the last 25 years, 14 patients have undergone TFR at the author’s institution following complications of revision arthroplasty surgery.

We have retrospectively reviewed the medical records and radiographs on this patient group (in terms of operative indication, morbidity and mortality). The clinical outcome has been evaluated using the International Symposium of Limb salvage (ISOLS) criteria.

14 patients, 9 male 5 female were treated with TFR between 1978 and 2003. The average age was 64 years (range 44–79 years). The duration of symptoms from primary intervention to total femoral replacement was on average 8 years (range 1–15 years) and during this period the number of revision procedures undertaken ranged from 1– 4.

In 86 % of cases the operative indication for TFR was for the management of deep sepsis. Other indications include non-union and periprosthetic fracture with massive bone loss.

The post operative course was varied with 4 patients experiencing no significant complications, 2 needing further surgery as a consequence of infection, 5 needed surgery for dislocation with 2 of these patients being left with a permanently dislocated hip.

As all patients had undergone some form of limb salvage procedure prior to TFR their level of function was assessed pre-operatively by the ISOLS criteria. This showed a range 0 – 33% (poor function). Clinical outcome following TFR measured by the same ISOLS criteria showed a range 36 – 80% (poor to good function).

Total femoral replacement has a definite role in the management of complex problems arising following hip and knee revision arthroplasty surgery. Pain can be controlled to an acceptable level and independence can be maintained.