Experiences with total femur replacement for malignant bone and soft tissue tumors

Background: Reasonable function can be restored after total femur replacement after massive resection of bone and soft tissue sarcomas of the thigh. The type of femoral prosthesis and surgical approach are tailored to the clinical characteristics of individual patients and to tumor anatomy. Though the complication rate is high, total femur replacement offers the patient limb salvage and a chance at functional ambulation.

Objective: We described the function and complications of total femur replacement performed at the institution as well as relevant literature reviews.

Methods: Seven patients underwent total femur replacement for the treatment of malignant bone and soft tissue tumors of the lower extremities between 1992 and 2010 at our institute. Ages ranged from 12 to 68 (mean=34) years. The tumor was pathologically diagnosed as osteosarcoma in two patients, Ewing’s sarcoma in two, chondrosarcoma (grade 3) in one, soft tissue malignant fibrous histiocytoma in one, and bone metastasis from renal cancer in one. Follow-up periods ranged from 1 to 17 years (mean = six years three months). All patients underwent wide resection, using the Howmedica Modular and Reconstruction System in five cases and the Kyocera Limb Salvage System in two cases. Function, complications and outcomes were evaluated in these patients, and the usefulness of the operative procedures is discussed herein.

Results: The mean functional score was 60%. X-ray examination revealed migration in only one case. Complications were infection (n=2), bipolar head dislocation (n=1) and patellar fracture (n=2). The outcomes were DOD (died of disease) in three cases, NED (no evidence of disease) in two, AWD (alive with disease) in one, and CDF (continuous disease free) in one.

Conclusion: The results suggest that total femur replacement is useful as a means of reconstructing affected limbs in patients with malignant bone and soft tissue tumors, but that latissimus dorsi muscle transplantation, as well as other procedures, must also be considered in cases requiring extensive soft tissue resection to prevent infection. Furthermore, early one-stage revision is advisable in cases showing signs of infection.