Abstract
Introduction
Total femur implantation is a rare and challenging procedure in final revision surgery of hip and knee arthroplasties. Reports of this operation technique are even rare in literature. In this study we retrospectively analyse our patients with total femur implants.
Material and Methods
Between October 2002 and February 2009 we implanted 27 total femurs in hip and knee revision surgery cases. We used the modular prosthesis system–Megasystem C® by Waldemar Link–in all cases. Our 22 female and 5 male patients had a mean age of 76 years (range 45–88). Indications for the procedure were loosening of megaprosthesis of the hip in 12 cases; 2 with massive distal migration, 1 with penetration into the knee joint and 1 after two step revision procedure. In 13 cases a periprosthetic indicated a total femur implanatation due to massive bone loss; 1 breakage of a long femoral stem, 5 fracture of osteosynthesis materials, 3 after prosthesis revisions and 1 pseudoarhrosis of femur and tibia after knee arthroplasty. We analysed perioperative complications, clinical status and result and further revision within follow up time.
Results
We were able to examine 16 patients at follow up time. Eight patients were lost to follow up and 2 have been died; 1 after fulminant pulmonal embolia after operation and 1 four years postoperatively. One total femur had to be exchanged due to infection after 1 year. Perioperative complications occurred as follows: 1 massive blood transfusion, 1 peroneal palsy, 1 ulcus ventriculis bleeding, 1 thrombosis of vena suclavia and vena jugularis, 1 sigmaresection due to diverticulosis, 1 luxations of the hip, and 2 wound necrosis. In 3 caese a revision operation swas performed; 1multiple luxtion of the hip and due to infection of the total femur implant. The range of motion of the hip was 85 degrees (range 30–90) and knee 92 degrees (range 30–110). In nearly all cases we found a lengthening of the revised limb. The general outcome of the patients was. Ten patient were very satisfied, 2 statisfied and 2 fair due to pain persistence. Two patient were mobile with one crutch, 3 used two crutches and one was able to walk with a rollator. One patient was unable to walk due to diplegia after spine fracture.
Conclusion
Total femur procedure in final revision arthroplasty has a high potential of perioperative risks but has shown good clinical and mobility results in our patient group. With the Megasystem C® by Link we had a save and good performance while operation of this difficult patient group
