INCIDENCE AND MANAGEMENT OF HIP DISLOCATION IN THE MODULAR KOTZ TYPE TUMOR ENDOPROTHESIS OF THE PROXIMAL FEMUR – A RETROSPECTIVE SINGLE CENTER STUDY IN 190 PATIENTS

Abstract

Introduction: Little data are available about the incidence and the management of hip dislocation following the implantation of megaprosthesis of the proximal femur, which is one of the main complications following this procedure.

Material and Methods: 190 patients, who received a proximal femur KMFTR/GMRS at our institution between 1982 and 2007, were retrospectively reviewed with regard to the incidence of hip dislocation as well as the success rate of the subsequent surgical/non-surgical treatment. A proximal femur tumor endoprosthesis was used in 148 patients following the resection of a malignant tumor and in 43 patients in severe revision cases following total hip arthroplasty. The average age at the time of surgery was 48 [6a to 83a] in the tumor group and 57.3 [45a to 78a] in the revision group. All of the revision cases and 12 patients from the tumor group had additional revision cups, such as the Schoellner pedestal cup.

Results: 12.3 % (18/147) of the tumor patients and 13.9% (6/43) of the revision cases dislocated at least once. 66.7% (12/18) of the first dislocations from the tumor and 50 % (3/6) of the revision group were treated with closed reduction, the rest required surgery. All patients received an abduction cast for at least 8 weeks. 38% (7/18) of the dislocated hips of tumor group (4.8% [7/147] total) and 67% (4/6) of the revision group (9.3% [4/43] total) experienced a second dislocation. 57% (4/7) of the dislocations from the tumor and 100 % (4/4) of the revision group were treated with closed reduction. Three patients from the tumor group (2% [3/147] total) experienced a total of three dislocations and one patient four dislocations (< 1% [1/147] total). The first dislocation occurred in 88% of the cases within 5 months following surgery during activities of daily living. 82% of the second dislocations and all third dislocations occurred within 4 months of the previous dislocation. Interestingly, no significant difference was found in the rate of re-dislocation between surgical and non-surgical treatment in either group.

Discussion: Dislocation of a proximal femur tumor endoprosthesis is an early complication following surgery and continues to be a challenging condition to treat, especially in cases with extensive soft-tissue defects. Since 2000, a polyester ligament is successfully used in our institution as a reinforcement to reduce the risk of hip dislocation in proximal femur tumor endoprosthesis. Surgical and non-surgical methods to reduce the risk of hip dislocation are discussed.