Femoral Reconstruction Using a Push-Through Prosthesis for Massive Femoral Bone Loss: A Retrospective Case Series and...

Massive femoral bone loss remains one of the greatest challenges in limb salvage and revision orthopedic surgery. The push-through prosthesis was developed as an alternative to total femoral replacement, allowing preservation of the remaining femoral cortex and its associated muscular attachments; however, clinical evidence regarding its use remains limited. We retrospectively reviewed all patients who underwent femoral reconstruction using a push-through prosthesis at a tertiary referral center between 2006 and 2025. Demographic characteristics, surgical indications, previous procedures, postoperative complications, implant survival, and functional outcomes were analyzed, and the current literature was reviewed. Five patients (mean age, 63.4 years) with massive femoral bone loss following complex reconstructive procedures were included. Surgical indications comprised periprosthetic joint infection (n = 2), complex femoral nonunion (n = 1), mechanical failure of a megaprosthesis (n = 1), and failure of revision total hip arthroplasty (n = 1). At a mean follow-up of more than five years, no cases of aseptic loosening, periprosthetic fracture, prosthetic dislocation, or recurrent infection were observed. No patient required revision surgery, resulting in 100% implant and limb survival. All patients remained ambulatory at final follow-up, although most required walking aids. These findings suggest that the push-through prosthesis is a valuable limb-salvage option for carefully selected patients with massive femoral bone loss when conventional reconstructive techniques are no longer feasible, providing durable implant survival, limb preservation, and satisfactory functional outcomes. However, these findings should be interpreted with caution given the small sample size and the absence of standardized functional outcome measures, highlighting the need for larger multicenter studies.