Intramedullary and total femur replacement in revision arthroplasty as a last limb-saving option: IS THERE ANY BENEFIT FROM THE LESS INVASIVE INTRAMEDULLARY REPLACEMENT?

• Published in: Journal of bone and joint surgery. British volume Vol. 93; no. 11; pp. 1545 - 1549
• Main Authors: HOELL, S, BUTSCHEK, S, GOSHEGER, G, DEDY, N, DIECKMANN, R, HENRICHS, M, DANIILIDIS, K, HARDES, J
• Format: Journal Article
• Language: English
• Published: London British Editorial Society of Bone and Joint Surgery 01.11.2011
• Subjects: Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Hip - methods; Arthroplasty, Replacement, Knee - adverse effects; Arthroplasty, Replacement, Knee - methods; Biological and medical sciences; Diseases of the osteoarticular system; Female; Femur - surgery; Follow-Up Studies; Hip Prosthesis; Humans; Knee Prosthesis; Limb Salvage - adverse effects; Limb Salvage - methods; Male; Medical sciences; Middle Aged; Orthopedic surgery; Prostheses and Implants; Prosthesis Design; Prosthesis Failure; Reoperation - adverse effects; Reoperation - methods; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Reoperation; Femur; Orthopedic surgery; Treatment; Medullary cavity; Prosthesis; Limb; Bone
• ISSN: 0301-620X; 2044-5377
• DOI: 10.1302/0301-620X.93B11.27309

There has been a substantial increase in the number of hip and knee prostheses implanted in recent years, with a consequent increase in the number of revisions required. Total femur replacement (TFR) following destruction of the entire femur, usually after several previous revision operations, is a rare procedure but is the only way of avoiding amputation. Intramedullary femur replacement (IFR) with preservation of the femoral diaphysis is a modification of TFR. Between 1999 and 2010, 27 patients with non-oncological conditions underwent surgery in our department with either IFR (n = 15) or TFR (n = 12) and were included in this study retrospectively. The aim of the study was to assess the indications, complications and outcomes of IFR and TFR in revision cases. The mean follow-up period was 31.3 months (6 to 90). Complications developed in 37% of cases, 33% in the IFR group and 4% in the TFR group. Despite a trend towards a slightly better functional outcome compared with TFR, the indication for intramedullary femur replacement should be established on a very strict basis in view of the procedure's much higher complication rate.