Total femoral replacement for treating femur malignant tumor_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WU Fan ^1,2 , FANG Xiang ¹ , LANG Zhigang ^1,3 , LIU Hongyuan ⁴ , XIONG Yan ¹ , ZHANG Wenli ¹ , LUO Yi ¹ , TU Chongqi ¹ ,  DUAN Hong ¹

1. Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;
2. SectionⅠDepartment of Orthopedics, the Fourth People’s Hospital of Zigong City, Zigong Sichuan, 643000, P.R.China;
3. Department of Osteopathy, Sichuan Provincial Orthopedic Hospital, Chengdu Sichuan, 610041, P.R.China;
4. Department of Orthopedics, Sichuan Provincial Fifth People’s Hospital, Chengdu Sichuan, 610031, P.R.China;

Corresponding?author：

DUAN Hong, Email: duanhong1970@126.com

Keywords：

Total femoral replacement; femur malignant tumor; limb salvage

DOI：

10.7507/1002-1892.201807052

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Objective To investigate the procedure and effectiveness of total femoral replacement for treating femur malignant tumor.Methods The clinical data of 9 patients with femoral malignant tumors who underwent total femoral replacement between July 2013 and March 2017 were retrospectively analyzed. There were 5 males and 4 females, aged 16-75 years with an average of 44.8 years. The disease duration ranged from 2 to 6 months with an average of 3.5 months. There were 5 cases of osteosarcoma (3 cases were staged as Enneking ⅡB, 2 cases were staged as Enneking Ⅲ), 1 case of malignant fibrosarcoma (staged as Enneking ⅡB), 1 case of chondrosarcoma (staged as Enneking ⅠB), 2 cases of femoral muti-metastasis of lung cancer with pathological fracture. The visual analogue scale (VAS) score and the quality of life (QOL) score of the tumor patients were evaluated before operation and at 3 months after operation. The Musculoskeletal Tumor Society (MSTS) score and Harris hip score (HHS) were evaluated at last follow-up.Results Nine patients were followed up 11-58 months, with an average of 21 months. No complication such as wound infection, joint dislocation, and nerve injury occurred. One patient developed popliteal vein thrombosis, and 2 patients with osteosarcoma died of tumor progression. The VAS score and QOL score at 3 months after operation were 3.2±1.2 and 40.6±5.4 respectively, which were significantly improved when compared with preoperative ones (5.9±0.8 and 22.3±4.2 respectively) (t=11.314, P=0.000; t=–7.794, P=0.000). At last follow-up, the MSTS score was 15-29 with an average of 21.1, and the HHS score was 44-90 with an average of 66.5.Conclusion Total femoral replacement is an effective limb salvage procedure for the treatment of femoral malignant tumors, which can effectively restore the weight-bearing and walking function, relieve pain, and improve the quality of life.

Citation： WU Fan, FANG Xiang, LANG Zhigang, LIU Hongyuan, XIONG Yan, ZHANG Wenli, LUO Yi, TU Chongqi, DUAN Hong. Total femoral replacement for treating femur malignant tumor. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(1): 18-22. doi: 10.7507/1002-1892.201807052 Copy

1.	Kalra S, Abudu A, Murata H, et al. Total femur replacement: primary procedure for treatment of malignant tumours of the femur. Eur J Surg Oncol, 2010, 36(4): 378-383.
2.	張清, 牛曉輝, 蔡槱伯, 等. 人工全股骨關節置換治療股骨骨肉瘤. 中華外科雜志, 2007, 45(10): 661-664.
3.	孫燕. 癌癥疼痛的綜合治療. 實用腫瘤雜志, 1992, 7(2): 119-121.
4.	Buchman J. Total femur and knee joint replacement with a vitallium endoprosthesis. Bull Hosp Joint Dis, 1965, 26: 21-34.
5.	Present DA, Kuschner SH. Total femur replacement. A case report with 35-year follow-up study. Clin Orthop Relat Res, 1990, (251): 166-167.
6.	姜鴻志, 段德生, 李柱田, 等. 氮化鈦全股骨置換一例報告. 白求恩醫科大學學報, 1982, (5): 25-27.
7.	Pan K, Chan W, Shanmugam P, et al. Large volume osteosarcomas of the femur treated with total femoral replacement. Malays Orthop J, 2014, 8(1): 32-36.
8.	Liu T, Zhang X, Zhang Q, et al. Total femoral reconstruction with custom prosthesis for osteosarcoma. World J Surg Oncol, 2016, 14: 93.
9.	Sewell MD, Spiegelberg BG, Hanna SA, et al. Total femoral endoprosthetic replacement following excision of bone tumours. J Bone Joint Surg (Br), 2009, 91(11): 1513-1520.
10.	Ahmed AR. Total femur replacement. Arch Orthop Trauma Surg, 2010, 130(2): 171-176.
11.	Yoshida Y, Kojima T, Taniguchia M, et al. Experiences with total femur replacement for malignant bone and soft tissue tumors. Asian Biomedicine, 2012, 6(1): 123-127.
12.	郭春, 甘林, 屠重棋. 全股骨人工假體置換治療復發性骨肉瘤. 華西醫學, 2003, 18(1): 86-87.
13.	Sanz-Ruiz P, Villanueva-Martinez M, Calvo-Haro JA, et al. Total femur arthroplasty for revision hip failure in osteogenesis imperfecta: limits of biology. Arthroplast Today, 2017, 3(3): 154-159.
14.	Buchowski JM, Cascio BM, Streiff MB, et al. Resection and reconstruction of a massive femoral hemophilic pseudotumor. Clin Orthop Relat Res, 2005, (430): 237-242.
15.	Lombardi AV Jr, Berend KR. The shattered femur: radical solution options. J Arthroplasty, 2006, 21(4 Suppl 1): 107-111.
16.	Sherman SL, Cunneen KP, Walcott-Sapp S, et al. Custom total femur spacer and second-stage total femur arthroplasty as a novel approach to infection and periprosthetic fracture. J Arthroplasty, 2008, 23(5): 781-786.
17.	Natarajan MV, Balasubramanian N, Jayasankar V, et al. Endoprosthetic reconstruction using total femoral custom mega prosthesis in malignant bone tumours. Int Orthop, 2009, 33(5): 1359-1363.
18.	Ruggieri P, Bosco G, Pala E, et al. Local recurrence, survival and function after total femur resection and megaprosthetic reconstruction for bone sarcomas. Clin Orthop Relat Res, 2010, 468(11): 2860-2866.
19.	Henderson ER, Groundland JS, Pala E, et al. Failure mode classification for tumor endoprostheses: retrospective review of five institutions and a literature review. J Bone Joint Surg (Am), 2011, 93(5): 418-429.
20.	Henderson ER, O’Connor MI, Ruggieri P, et al. Classification of failure of limb salvage after reconstructive surgery for bone tumours : a modified system Including biological and expandable reconstructions. Bone Joint J, 2014, 96-B(11): 1436-1440.
21.	Friesecke C, Plutat J, Block A. Revision arthroplasty with use of a total femur prosthesis. J Bone Joint Surg (Am), 2005, 87(12): 2693-2701.
22.	Du Z, Tang S, Yang R, et al. Use of an artificial ligament decreases hip dislocation and improves limb function after total femoral prosthetic replacement following femoral tumor resection. J Arthroplasty, 2018, 33(5): 1507-1514.

1. Kalra S, Abudu A, Murata H, et al. Total femur replacement: primary procedure for treatment of malignant tumours of the femur. Eur J Surg Oncol, 2010, 36(4): 378-383.
2. 張清, 牛曉輝, 蔡槱伯, 等. 人工全股骨關節置換治療股骨骨肉瘤. 中華外科雜志, 2007, 45(10): 661-664.
3. 孫燕. 癌癥疼痛的綜合治療. 實用腫瘤雜志, 1992, 7(2): 119-121.
4. Buchman J. Total femur and knee joint replacement with a vitallium endoprosthesis. Bull Hosp Joint Dis, 1965, 26: 21-34.
5. Present DA, Kuschner SH. Total femur replacement. A case report with 35-year follow-up study. Clin Orthop Relat Res, 1990, (251): 166-167.
6. 姜鴻志, 段德生, 李柱田, 等. 氮化鈦全股骨置換一例報告. 白求恩醫科大學學報, 1982, (5): 25-27.
7. Pan K, Chan W, Shanmugam P, et al. Large volume osteosarcomas of the femur treated with total femoral replacement. Malays Orthop J, 2014, 8(1): 32-36.
8. Liu T, Zhang X, Zhang Q, et al. Total femoral reconstruction with custom prosthesis for osteosarcoma. World J Surg Oncol, 2016, 14: 93.
9. Sewell MD, Spiegelberg BG, Hanna SA, et al. Total femoral endoprosthetic replacement following excision of bone tumours. J Bone Joint Surg (Br), 2009, 91(11): 1513-1520.
10. Ahmed AR. Total femur replacement. Arch Orthop Trauma Surg, 2010, 130(2): 171-176.
11. Yoshida Y, Kojima T, Taniguchia M, et al. Experiences with total femur replacement for malignant bone and soft tissue tumors. Asian Biomedicine, 2012, 6(1): 123-127.
12. 郭春, 甘林, 屠重棋. 全股骨人工假體置換治療復發性骨肉瘤. 華西醫學, 2003, 18(1): 86-87.
13. Sanz-Ruiz P, Villanueva-Martinez M, Calvo-Haro JA, et al. Total femur arthroplasty for revision hip failure in osteogenesis imperfecta: limits of biology. Arthroplast Today, 2017, 3(3): 154-159.
14. Buchowski JM, Cascio BM, Streiff MB, et al. Resection and reconstruction of a massive femoral hemophilic pseudotumor. Clin Orthop Relat Res, 2005, (430): 237-242.
15. Lombardi AV Jr, Berend KR. The shattered femur: radical solution options. J Arthroplasty, 2006, 21(4 Suppl 1): 107-111.
16. Sherman SL, Cunneen KP, Walcott-Sapp S, et al. Custom total femur spacer and second-stage total femur arthroplasty as a novel approach to infection and periprosthetic fracture. J Arthroplasty, 2008, 23(5): 781-786.
17. Natarajan MV, Balasubramanian N, Jayasankar V, et al. Endoprosthetic reconstruction using total femoral custom mega prosthesis in malignant bone tumours. Int Orthop, 2009, 33(5): 1359-1363.
18. Ruggieri P, Bosco G, Pala E, et al. Local recurrence, survival and function after total femur resection and megaprosthetic reconstruction for bone sarcomas. Clin Orthop Relat Res, 2010, 468(11): 2860-2866.
19. Henderson ER, Groundland JS, Pala E, et al. Failure mode classification for tumor endoprostheses: retrospective review of five institutions and a literature review. J Bone Joint Surg (Am), 2011, 93(5): 418-429.
20. Henderson ER, O’Connor MI, Ruggieri P, et al. Classification of failure of limb salvage after reconstructive surgery for bone tumours : a modified system Including biological and expandable reconstructions. Bone Joint J, 2014, 96-B(11): 1436-1440.
21. Friesecke C, Plutat J, Block A. Revision arthroplasty with use of a total femur prosthesis. J Bone Joint Surg (Am), 2005, 87(12): 2693-2701.
22. Du Z, Tang S, Yang R, et al. Use of an artificial ligament decreases hip dislocation and improves limb function after total femoral prosthetic replacement following femoral tumor resection. J Arthroplasty, 2018, 33(5): 1507-1514.

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