Abstract
Introduction: Limb salvage through a total femur (TOFEM) prosthesis is a rare procedure. The infection rate is high due to the large implant surface, a long OR-time and often severely compromised soft tissues. In case of infection the one stage procedure is the way of revision to avoid impairing instability for the patient.
Material + Methods: Between 1996 and 2005 46 one stage exchanges were performed in 37 patients. 23 patients were available for review in 2006. 13 had died, 1 could not be located. The infection-free periods, subjective satisfaction with the procedure and clinical outcome were evaluated. The average follow-up time (FU) was 46 months (8/104). Male/female ratio 10/27, average age 66 yrs. (30/87). The average number of revisions before the TOFEM was 5 (1/11).
Indication for a TOFEM was fracture in 43%, bone loss in 51% and others in 6 %. Infection occurred at primary intervention in 32%, in connection with revisions in 18% or delayed in 49%.
Results: 16 Patients were cured in a one step procedure. 10 Patients underwent further revisions. Two or more exchanges were carried out in 6 cases with success. Patient’s satisfaction rate was 55%. 13 were valued unsatisfied. 8 exarticulations became necessary later and 5 Patients died in the course of the treatment. 2 of those were exarticulated before.
Conclusion: One stage exchange is a promising procedure avoiding loss of the limb. A high complication rate exists and secondary exarticulation may still become necessary.
Summary: The infectious complication in total femur prosthesesis presents a severe problem. A one stage revision offers another good chance for limb salvage, but morbidity and mortality risks are high.
Correspondence should be addressed to Ms Larissa Welti, Scientific Secretary, EFORT Central Office, Technoparkstrasse 1, CH-8005 Zürich, Switzerland
