Prosthetic reconstruction of the proximal femur after resection for bone tumors

Thirty-one cases of endoprosthetic proximal femoral reconstruction after resection for bone tumors are reported. The minimum follow-up period was 2 years (average, 63 months). There were two local recurrences, two deaths from pulmonary metastases, two postoperative infections (1 superficial and 1 deep), both responding to therapy, one postoperative dislocation of a bipolar endoprosthesis, and two cases of loosening of acetabular cups on the same patient. Clinical results (Enneking grade) showed 27% E, 56% G, 14% F, and 3% P. Diaphyseal remodeling results (Rizzoli grade) were 29% A, 6% B, 49% C, 10% D, and 6% E. Anchorage (International Society of Limb Salvage grade) was assessed as 97% E and 3% F, whereas interface (International Society of Limb Salvage grade) was 100% E. Hip (bipolar) articulation was graded as 30% E, 56% G, 11% F, and 3% P. Initial rigid stabilization of the stem with cross-fixation screws allows for excellent bone ingrowth, but presents the problem of proximal cortical atrophy. Bipolar hip components are easy to insert and offer greater inherent stability and so are to be recommended for use in tumor surgery. The results suggest good medium- to long-term results with respect to wear. A new radiographic grading system is presented for bipolar arthroplasty. Survivorship of the femoral component in this series is 100% at a maximum follow-up period of 8 years.