The push-through total femoral prosthesis offers a functional alternative to total femoral replacement: a case series

• Published in: International orthopaedics Vol. 41; no. 11; pp. 2237 - 2244
• Main Authors: Gorter, Jelle, Ploegmakers, Joris J. W., ten Have, Bas L. E. F., Schreuder, Hendrik W. B., Jutte, Paul C.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.11.2017
• Subjects: Adult; Aged; Female; Femoral Neoplasms - mortality; Femoral Neoplasms - surgery; Femur - surgery; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Original Paper; Orthopedics; Patient Satisfaction; Postoperative Complications - epidemiology; Prosthesis Design - adverse effects; Prosthesis Failure; Prosthesis Implantation - adverse effects; Prosthesis Implantation - methods; Replantation; Retrospective Studies; Survival Analysis; Time Factors; Treatment Outcome; Limb salvaging; Arthroplasty; Push-through; Total femoral prosthesis; Functional outcome
• ISSN: 0341-2695; 1432-5195
• DOI: 10.1007/s00264-017-3467-5

Purpose Oncologic resections or complications of segmental femoral prostheses can result in severe bone loss of the femur for which a total femoral prosthesis (TFP) is required. This study assesses whether the loss of stability and function caused by the loss of muscle attachments can be improved by using a push-through total femoral endoprosthesis (PTTF), because it saves parts of the femur and its muscle attachments. Methods In this retrospective case series, ten patients aged 25–77 (mean 54) who received a PTTF between 2005 and 2014 were included for baseline, complications and survival analysis with a mean follow-up of 5.3 (1.1–9.6) years. Functional outcome was assessed in six patients using the Musculoskeletal Tumor Society (MSTS) score, WHO performance scale, Toronto Extremity Salvage Score (TESS), SF36, EQ-5D, NRS pain score, fatigue score and satisfaction score. Results The mean MSTS score was 64% (23–93%). Five patients had a WHO performance scale of 1, one patient of 3. Mean TESS was 69% (13–90%). SF36 was most notably limited by physical functioning (mean 48), vitality (68) and general health (67). NRS score was 1.9, 1.8 and 8.3 for pain, fatigue and satisfaction, respectively. There were four failures: two infections (one resulting in amputation and one in a minor revision) and two mechanical failures (which required one revision to a TFP and one minor revision). Patient survival was 100%, limb survival 90%, and prosthesis survival 80%. Conclusion The push-through total femoral endoprosthesis allows preservation of muscle attachments and offers a good alternative to total femoral prostheses.