Abstract
This technical choice constitutes an effective solution for all those cases where, due to the infective damage, the radical surgical debridement needed or in presence of a septic pseudoarthrosis, there is a relevant loss of bone stock in the proximal femur.
As a treatment for these specific clinical patterns oncological prosthetic implants can be used, to overcome the amount of bone loss.
Sometimes acetabular prosthetic implantation, or reimplantation, is also needed because of its septic mobilization, otherwise a bicentric endoprosthesis can be implanted.
The main issue for the surgeon is the gluteal muscular deficiency, caused often by the loss of the great trochanter, a severe condition often worsened by the damage on muscles and soft tissues given by previous surgical procedures and debridements.
The offset itself, really often not sufficient for the limited amount of sizes and lengths of the oncological designed prosthetic implants, represent a key issue of this treatment with a high luxation risk, with a higher rate in those cases when an arthroprosthesis has been performed.
In this article are described 4 cases, all four treated with a two-stage surgical approach and a definitive oncological prosthetic system to overcome the severe bone loss of the proximal femur.
The cases are examined about the surgical indication to this prosthetic choice, the postoperative period with the related complications (1 case of recurrent luxation) and with a minimum follow up of 6 months (maximum 36 months).
In all the cases at the follow up the infection is solved.
At the end the specific rehabilitation program for the range of motion and the muscular strength regain, that we developed in our Operative Unit is described; in this program we occasionally used for the immediate post surgery period a jointed hip brace.
The length of the rehabilitation could not be standard, but should be customized and variations of the program could be done during the follow up.
In the immediate post-surgical period the rehabilitative goals are maintaining the correct posture in bed and regaining the passive articular range of motion.
In the longer period the main goals are regain strength of the gluteal muscles, proprioception and gait, even if claudication (Trendelemburg), hyposthenia a recurrent dislocation can be let.
The weight bearing is allowed usually at the eight week after surgery, but only after clinical and x-ray evaluation.
Correspondence should be addressed to Vienna Medical Academy, Alser Strasse 4, A-1090 Vienna, Austria. Phone: +43 1 4051383 0, Fax: +43 1 4078274, Email: ebjis2009@medacad.org
