Patient-oriented functional results of total femoral endoprosthetic reconstruction following oncologic resection

J Surg Oncol. 2011 Nov 1;104(6):561-5. doi: 10.1002/jso.22003. Epub 2011 Jun 21.


Background and objectives: Functional outcomes following oncologic total femoral endoprosthetic reconstruction (TFR) are lacking. We compared patient-oriented functional results of TFRs to proximal femur and distal femur reconstructions (PFR and DFR). We also compared function and complications with regard to knee and hip componentry.

Methods: Fifty-four TFR patients were identified from three institutional prospective databases. Forty-one had fixed- and 13 had rotating-hinge knees, 37 hemiarthroplasty and 17 total hip arthroplasty componentry. Toronto Extremity Salvage Scores (TESS) for n = 27 were compared between groups and to cohorts of PFR (n = 31) and DFR (n = 85) patients using the Mann-Whitney U-test.

Results: Follow-up averaged 4 years. Mechanical complications included five hip dislocations and one femoral malrotation. Four dislocations were in fixed-hinge implants, all in those lacking abductor reattachment. TESS averaged 69.3 ± 17.8, statistically decreased from DFR (P = 0.002) and PFR patients (P = 0.036). No significant differences were detected between patients in the fixed-hinge (n = 18) and rotating-hinge (n = 9) groups (P = 0.944), or total hip (n = 8) and hemiarthroplasty (n = 19) groups (P = 0.633).

Conclusions: TFR is reserved for extreme cases of limb salvage, portending a poor prognosis overall. Function reflects additive impairments from PFR and DFR. TFR outcomes differ little with rotating- or fixed-hinge, total hip or hemiarthroplasty implants.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Bone Neoplasms / secondary
  • Bone Neoplasms / surgery*
  • Cohort Studies
  • Female
  • Femoral Neoplasms / surgery*
  • Femur / surgery*
  • Follow-Up Studies
  • Humans
  • Knee Joint / surgery
  • Knee Prosthesis
  • Limb Salvage
  • Male
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Recurrence, Local / surgery*
  • Plastic Surgery Procedures*
  • Prognosis
  • Prospective Studies
  • Prostheses and Implants
  • Range of Motion, Articular
  • Retrospective Studies
  • Sarcoma / pathology
  • Sarcoma / surgery*