Abstract
Limb salvage through 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.
Between 1996 and 2005, 46 one-stage exchanges were performed in 37 patients. Twenty-three patients were available for review in 2006. Thirteen 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 was 10/27, and the average age 66 years. (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%.
Sixteen patients were cured through a one-step procedure with an average FU time of 46 months. Ten patients underwent further revisions. Two or more exchanges were carried out in 6 cases with success. Patients’ satisfaction rate was 55%. Thirteen were valued unsatisfied. Eight exarticulations became necessary later and 5 patients died in the course of the treatment. Two of those were exarticulated before.
The one-stage exchange is a promising procedure towards avoiding loss of the limb. A high complication rate exists and secondary exarticulation may still become necessary.
Correspondence should be addressed to Vasiliki Boukouvala at Department of Orthopaedic Surgery & Traumatology, University Hospital of Larissa, 110 Mezourlo, Larissa, GREECE. Tel: +30 2410 682722, Fax: +30 2410 670107, Email: malizos@med.uth.gr
