Abstract
Background: Limb preserving surgery in patients with tumours involving the whole femur present a formidable challenge.
Results: We present our experience of treating such patients with total femur endoprostheses over the last 30 years (1975 to 2005). There were twenty six consecutive patients including 14 males and 12 females. Average age was 40 years (14 – 82 years) at the time of surgery. Eleven patients were still alive of which nine were free of disease at the time of review. The mean follow-up was 57 months (3 to 348). Using Kaplan Meier estimates, the long-term patient survival at 10 years was 37%. The survival of patients with primary localised tumour was 50% at 10 years.
Revision of the prostheses was necessary in two patients at 110 and 274 months after surgery because of recurrent dislocation in one and aseptic loosening of the acetabular cup and tibial stem in the other. Amputation was necessary in two patients, one due to deep infection and the other due to local recurrence. The long-term limb survival being 92% at 10 years. Nine patients who were alive with no evidence of disease were assessed for function of the salvaged limbs using the musculoskeletal tumour society (MSTS) rating system. The mean functional score was 72%.
Conclusion: We conclude that total femur endoprosthetic replacement offers an excellent method of limb reconstruction following excision of the whole femur either for primary or metastatic tumours. However, patients survival after such operation is poor due to disease related factors.
The abstracts were prepared by Mrs Leslie O’Leary. Correspondence should be addressed to her at British Orthopaedic Association, 35–43 Lincoln’s Inn Fields, London WC2A 3PE or at l.oleary@boa.ac.uk
