Our study includes 20 patients with femoral tumors during the years 1997–2002. The primary tumors were 5 sarcomas and 3 myelomas and we had 12 metastatic bone tumors. We used 12 modular prothesis and 8 long stem revision both for primary and for metastatic bone tumors. We applied special surgical techniques for the prevention of hip dislocation, the most common complication of proximal femoral resections. In our study we describe the various surgical techniques used, the modes of application of the endoprothesis and also the techniques of the soft tissue reconstruction, hi 17 cases we used bipolar hemiarthroplasty and in 3 cases, where acetabular metastasis was evident, we used special endoprothesis which allowed us to reconstruct the acetabulum with the use of a special plexus. The most frequently used approach was the anterolateral. In one case we used an anteromedial approach due to the femoral triangle invasion by the tumor. We put special emphasis in the techniques of the soft tissue reconstruction, like capsuloplasty, with the use of a Dacron plexus under a specific modification. This plexus was also used as an extension to cover the muscular defects created due to wide tumor resection. The follow up period ranged from 6 months up to 5 years. Out of the 20 cases we had only one dislocation. The functional results according to the Ennekin scale were: Excellent – Good: 65%, Fair: 30%, Poor: 5%. In conclusion, the new reconstruction techniques and the appropriate application of the modular prothesis that also preserve the femoral length, provide very good joint stability with good functional results

We used dual-energy x-ray absorptiometry (DEXA) to evaluate the extent of periprosthetic bone remodelling around a prosthesis for distal femoral reconstruction, the Kotz modular femoral tibial replacement (KMFTR; Howmedica, Rutherford, New Jersey). A total of 23 patients was entered into the study which had four parts: 1) 17 patients were scanned three times on both the implant and contralateral legs to determine whether the precision of DEXA measurements was adequate to estimate bone loss surrounding the anchorage piece of the KMFTR; 2) in 23 patients the bone mineral density (BMD) in different regions of interest surrounding the diaphyseal anchorage was compared with that of the contralateral femur at the same location to test whether there was consistent evidence of loss of BMD adjacent to the prosthetic stem; 3) in 12 patients sequential studies were performed about one year apart to compare bone loss; and 4) bone loss was compared in ten patients with implants fixed by three screws and in 13 without screws.

The mean coefficients of variation (SD/mean) for the 17 sets of repeated scans ranged from 2.9% to 7.8% at different regions of interest in the KMFTR leg and from 1.4% to 2.5% in the contralateral leg. BMD was decreased in the KMFTR leg relative to the contralateral limb and the percentage of BMD loss in general increased as the region of interest moved distally in the femur. Studies done after one year showed no consistent pattern of progressive bone loss between the two measurements. The ten patients with implants fixed by screws were found to have a mean loss of BMD of 42% in the most distal part of the femur, while the 13 without screw fixation had a mean loss of 11%.

DEXA was shown to have adequate precision to evaluate loss of BMD around the KMFTR. This was evident relative to the contralateral leg in all patients and generally increased in the most distal part of the femur. In general, it stabilised between two measurements taken one year apart and was greater surrounding implants fixed by cross-locking screws.

Aims. The aim of this study was to investigate the safety and efficacy of 3D-printed modular prostheses in patients who underwent joint-sparing limb salvage surgery (JSLSS) for malignant femoral diaphyseal bone tumours. Methods. We retrospectively reviewed 17 patients (13 males and four females) with femoral diaphyseal tumours who underwent JSLSS in our hospital. Results. In all, 17 patients with locally aggressive bone tumours (Enneking stage IIB) located in the femoral shaft underwent JSLSS and reconstruction with 3D-printed modular prostheses between January 2020 and June 2022. The median surgical time was 153 minutes (interquartile range (IQR) 117 to 248), and the median estimated blood loss was 200ml (IQR 125 to 400). Osteosarcoma was the most common pathological type (n = 12; 70.6%). The mean osteotomy length was 197.53 mm (SD 12.34), and the median follow-up was 25 months (IQR 19 to 38). Two patients experienced local recurrence and three developed distant metastases. Postoperative complications included wound infection in one patient and screw loosening in another, both of which were treated successfully with revision surgery. The median Musculoskeletal Tumor Society score at the final follow-up was 28 (IQR 27 to 28). Conclusion. The 3D-printed modular prosthesis is a reliable and feasible reconstruction option for patients with malignant femoral diaphyseal tumours. It helps to improve the limb salvage rate, restore limb function, and achieve better short-term effectiveness. Cite this article: Bone Jt Open 2024;5(4):317–323

We retrospectively reviewed 101 consecutive patients with 114 femoral tumours treated by massive bone allograft at our institution between 1986 and 2005. There were 49 females and 52 males with a mean age of 20 years (4 to 74). At a median follow-up of 9.3 years (2 to 19.8), 36 reconstructions (31.5%) had failed. The allograft itself failed in 27 reconstructions (24%). Mechanical complications such as delayed union, fracture and failure of fixation were studied. The most adverse factor on the outcome was the use of intramedullary nails, followed by post-operative chemotherapy, resection length > 17 cm and age > 18 years at the time of intervention. The simultaneous use of a vascularised fibular graft to protect the allograft from mechanical complications improved the outcome, but the use of intramedullary cementing was not as successful. In order to improve the strength of the reconstruction and to advance the biology of host–graft integration, we suggest avoiding the use of intramedullary nails and titanium plates, but instead using stainless steel plates, as these gave better results. The use of a supplementary vascularised fibular graft should be strongly considered in adult patients with resection > 17 cm and in those who require post-operative chemotherapy

Aims

Dislocation rates are reportedly lower in patients requiring proximal femoral hemiarthroplasty than for patients undergoing hip arthroplasty for neoplasia. Without acetabular replacement, pain due to acetabular wear necessitating revision surgery has been described. We aimed to determine whether wear of the native acetabulum following hemiarthroplasty necessitates revision surgery with secondary replacement of the acetabulum after proximal femoral replacement (PFR) for tumour reconstruction.

The August 2024 Oncology Roundup. 360. looks at: What factors are associated with osteoarthritis after cementation for benign aggressive bone tumour of the knee joint: a systematic review and meta-analysis; Recycled bone grafts treated with extracorporeal irradiation or liquid nitrogen freezing after malignant tumour resection; Intercalary resection of the tibia for primary bone tumours: are vascularized fibula autografts with or without allografts a durable reconstruction?; 3D-printed modular prostheses for the reconstruction of intercalary bone defects after joint-sparing limb salvage surgery for femoral diaphyseal tumours; Factors influencing the outcome of patients with primary Ewing’s sarcoma of the sacrum; The significance of surveillance imaging in children with Ewing’s sarcoma and osteosarcoma; Resection margin and soft-tissue sarcomas of the extremities treated with limb-sparing surgery and postoperative radiotherapy

Seven patients who had malignant proximal femoral tumours were selected for resection and limb salvage with a modular megaprosthesis. Histopathological diagnosis confirmed one solitary bone metastasis from renal cell carcinoma, one dedifferentiated chondrosarcoma, two primary non-Hodgkin lymphomas non-responsive to adjuvant chemo- and radiotherapy and three low-grade chondrosarcomas. The mean age at the time of surgery was 53.5 years. Post-operative survival averaged 54.5 months. The mean functional status score was satisfactory. There was no local tumour recurrence or dislocation of the prosthesis. There were one superficial wound infection and one post-surgical haematoma. Care must be taken in selecting patients to for resection of the proximal femur and implantation of modular megaprostheses. We reserve such treatment only for tumours that, because of the histopathological diagnosis and spread, chemotherapy or radiotherapy alone is not enough. Modular megaprosthesis is currently the method of choice in the treatment of malignant proximal femoral tumours. With this implant joint function can be restored after wide resection, too, offering a valid alternative to the bony massive allografts that are characterised by a high rate of complications and failure

Aims

For rare cases when a tumour infiltrates into the hip joint, extra-articular resection is required to obtain a safe margin. Endoprosthetic reconstruction following tumour resection can effectively ensure local control and improve postoperative function. However, maximizing bone preservation without compromising surgical margin remains a challenge for surgeons due to the complexity of the procedure. The purpose of the current study was to report clinical outcomes of patients who underwent extra-articular resection of the hip joint using a custom-made osteotomy guide and 3D-printed endoprosthesis.

Introduction:. Distal femoral replacement is recognised as the optimum treatment for malignant distal femoral tumours. Aseptic loosening is known to be a major cause for failure in these implants. Studies have indicated that the HA coated collar promotes osteointegration and bony in growth. This study compares long term aseptic loosening in implants with HA coated collars to those without in the immature skeleton. Objectives:. To assess the effect of HA coated collars on aseptic loosening in extendable distal femoral replacement prosthesis in the immature skeleton. Methods:. All paediatric patients undergoing distal femoral replacement with extendable prosthesis were retrospectively reviewed between 1980–2003. A total of 32 patients were reviewed. 24 patients underwent distal femoral replacement with extendable prostheses without a HA coated collar. This cohort was compared to 18 patients who were treated with an extendable prosthesis with a HA coated collar between 2001–03. Average follow up in patients without a collar was 10.1 yrs (6–18) and 8.1 yrs in those with a collar (4–11). All patients with identified infection were excluded. Radiographs taken at last follow-up were analysed for loosening. Results:. Thirty-one patients were treated for primary osteosarcoma and one for a histiocytoma. Average age at operation was 13 yrs for both groups (non-collared 6–17, collared 4–11). Three of 24 patients in the non-collared cohort underwent revision compared to 1 of 18 in the collared group. The cause of revision in the collared group was infection. One patient in each cohort died within 5 years of surgery. Mean loosening score at last follow up for the non-collared group was 11.2 compared to 2.5 for the collared group with a p value of <0.05 (Mann Whitney-U). Conclusions:. Aseptic loosening is a major cause of failure for distal femoral replacement prosthesis. HA coated collars have been shown to promote osteointegration. Little comparable data exists between collared and non-collared extendable prosthesis in the immature skeleton. Our data demonstrates that HA coated collars significantly reduce long term loosening in the immature skeleton

To reduce the disability after hip disarticulation customised endoprostheses have been used in our unit to preserve a proximal femoral above knee amputation stump. This procedure involves preservation of a musculocutaneous flap and insertion of a customised stump prosthesis that articulates with the acetabulum. This procedure has been performed not only for primary malignancy but also in the reconstructive setting. Six patients have undergone the above procedure with a good functional outcome-allowing mobilisation with an appropriate orthosis. We will discuss the complications of such a procedure that includes disassociation of the femoral head from the customised prosthesis. We present the technique as a useful adjunct not only in the treatment of large proximal femoral tumours but also in the end stage reconstructive setting

Complex limb-salvage surgical techniques and reconstruction with sophisticated massive endoprostheses prove to be excellent tools for effective bone tumour management. We treated 34 bone tumours (osteosarcoma, chondrosarcoma, plasmatocytoma, Ewing’s, osseous lymphoma, histocytosis-X, MFH, mets). We excised the lesions on oncologically safe surgical margins (wide excision inclunding anatomical barriers to tumour spread) and we reconstructed the defects with 29 modular and 5 custom designed and manufactured massive endoprostheses. Intramedullary stems were all cemented and they were supplied with hydroxyapatite collars that favour callus formation and extramedullary stabilisation. We did 12 proximal femoral tumour reconstructions, 17 distal femoral and proximal tibial tumours with rotating metal or polyethylene fixed-hinge knee implants and 1 total femur. In upper limb we did 2 proximal humerous with reverse polarity shoulder endoprostheses. In 1 humeral shaft case we did subtotal excision and reconstruction with two joint-saving endoprosthesis. In 1 distal humerus tumour we used custom constrained endoprosthesis of distal humerus and elbow. If tumours did not extend too close to the cartilage we applied joint-saving techniques. Function was restored with proper implant size selection and rearrangement of muscle remnants. On follow-up (4–58 months) average TESS score was 83%. There was no local recurrence and no aseptic loosening, dislocation or implant failure. Three patients with metastatic disease DOD. One case presented with late DVT and one with late deep infection. New surgical methods and sophisticated implants with evidence-based design contributed greatly to successful limb salvage surgery as well as in overall patient prognosis and survival who enjoy better function

The treatment of deep prosthetic infection in cancer patients with tumour prostheses remains the major complication to be dealt with in this population. The Vienna Bone Tumour Registry includes information of more than 6500 patients of a period of 36 years. 145 patients with malignant proximal femoral tumors had resection and limb salvage with an uncemented Kotz modular femoral and tibial reconstruction megaprosthesis (KMFTR). There were twenty osteosarcomas, thirteen Ewing’s sarcomas, six chondrosarcomas, six plasmozytomas, three fibrosarcomas, three liposacomas and others. Thirteen patients (7 males, 6 females with an average age of 45 years, range 10 to 75 years) suffered from deep prosthetic infection within an average of 44 months after primary implantation, representing an infection rate of 8,97 percent. Average follow-up was 109 months, range 7 to 339 months. Two patients with only mild signs of infection were treated by a conservative antibiotic regimen. Nine patients were treated by one-stage revision. One of the remaining two patients with severe infection underwent exarticulation of the hip as primary intervention, the other patient died due to general sepsis on the fourth post-operative day. Six patients showed no further signs of infection. Six patients, however, required one or more reoperations due to recurrent prosthetic infection. Among these four patients have successfully been treated by repeated one-stage revision, in two patients the prosthesis had to be removed permanently. Deep prosthetic infection around modular tumour prostheses of the proximal femur and hip seems to be less common compared to distal femur, knee or tibia. However, the treatment of this complication has a higher failure rate due to multiply recurrent infection

Aims

Custom triflange acetabular components (CTACs) play an important role in reconstructive orthopaedic surgery, particularly in revision total hip arthroplasty (rTHA) and pelvic tumour resection procedures. Accurate CTAC positioning is essential to successful surgical outcomes. While prior studies have explored CTAC positioning in rTHA, research focusing on tumour cases and implant flange positioning precision remains limited. Additionally, the impact of intraoperative navigation on positioning accuracy warrants further investigation. This study assesses CTAC positioning accuracy in tumour resection and rTHA cases, focusing on the differences between preoperative planning and postoperative implant positions.

Aims

Osteoarticular reconstruction of the distal femur in childhood has the advantage of preserving the tibial physis. However, due to the small size of the distal femur, matching the host bone with an osteoarticular allograft is challenging. In this study, we compared the outcomes and complications of a resurfaced allograft-prosthesis composite (rAPC) with those of an osteoarticular allograft to reconstruct the distal femur in children.

Aims

The aticularis genu (AG) is the least substantial and deepest muscle of the anterior compartment of the thigh and of uncertain significance. The aim of the study was to describe the anatomy of AG in cadaveric specimens, to characterize the relevance of AG in pathological distal femur specimens, and to correlate the anatomy and pathology with preoperative magnetic resonance imaging (MRI) of AG.

Aims

The aim of this study was to determine the risk of local recurrence and survival in patients with osteosarcoma based on the proximity of the tumour to the major vessels.

Aims

The consensus is that bipolar hemiarthroplasty (BHA) in allograft-prosthesis composite (APC) reconstruction of the proximal femur following primary tumour resection provides more stability than total hip arthroplasty (THA). However, no comparative study has been performed. In this study, we have compared the outcome and complication rates of these two methods.

Aims

The aim of this study was to evaluate the efficacy of the surgical dislocation approach and modified trapdoor procedure for the treatment of chondroblastoma of the femoral head.