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[Total femoral replacement. Three case reports and literature review]
C Rivera1, V Ilizaliturri-Sánchez1, J Camacho-Galindo1
1Servicio de Reconstrucción Articular de Cadera y Rodilla del Instituto Nacional de Rehabilitación, Calz. México-Xochimilco Núm. 289, Col. Arenal de Guadalupe, CP 14389, Del. Tlalpan, México, D.F.
Insights
Total femoral replacement is a complex salvage surgery for hip and knee arthroplasty revisions. This procedure significantly improves patient pain and function, offering an alternative to limb disarticulation.
Area of Science:
- Orthopedic Surgery
- Arthroplasty Revision
- Biomaterials Science
Background:
- Hip and knee replacements are common but require revision due to limited implant lifespan.
- Revision arthroplasty often involves complications such as bone loss, compromising implant stability.
- End-stage prosthetic joint disease necessitates complex surgical interventions.
Purpose of the Study:
- To describe the experience with total femoral and joint replacement in three revision arthroplasty cases.
- To evaluate the efficacy of total femoral replacement as a salvage procedure.
- To assess functional outcomes and pain reduction following this complex surgery.
Main Methods:
- Retrospective case series of three patients undergoing total femoral and hip/knee arthroplasty revision between 2006-2011.
- Standardized postoperative management including debridement and antibiotic therapy.
- Assessment of pain using the Visual Analog Scale (VAS) and function using the WOMAC score.
Main Results:
- Significant improvement in pain scores (VAS: 8 to 2.3, p<0.05).
- Significant improvement in functional scores (WOMAC: 21.6 to 55, p<0.05).
- Successful management of bone loss and implant instability in complex revision cases.
Conclusions:
- Total femoral replacement is a demanding but feasible salvage surgery for end-stage prosthetic joint disease.
- This procedure offers an alternative to limb disarticulation, improving patient functionality.
- It enhances the capacity for independent activities in patients with compromised joint replacements.
Introduction:
Currently hip and knee joint replacement were performed frequently at orthopedic centers. However, these surgeries do not last forever and thus revision procedures are required. The latter usually involve complications like bone loss that may compromise implant stability.
Methods:
Three hip and knee arthroplasty revisions were performed from 2006 to 2011, which warranted the total replacement of the femur and the joints involved. The purpose of this paper is to describe our experience with these implants used in arthroplasty revision surgery.
Results:
A standardized postoperative management protocol was used in all patients. They required debridement and specific antibiotic therapy. They had a significant improvement in the pain visual analog scale (VAS) (the score went from 8 to 2.3, p ‹ 0.05) and in function, measured with the WOMAC score (from a preoperative score of 21.6 to 55, p ‹ 0.05).
Conclusions:
Total femoral replacement is an infrequent, demanding and complex salvage surgery that represents an alternative to the disarticulation of the pelvic limb at the end stage of prosthetic disease. This is a feasible option used to improve patient functionality and decrease residual capacity for performing activities independently.
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