The Journal of Bone and Joint Surgery, Vol 70, Issue 4 507-516, Copyright © 1988 by Journal of Bone and Joint Surgery, Inc
Reconstruction for defects of the proximal part of the femur using allograft arthroplasty
MH Jofe, MC Gebhardt, WW Tomford and HJ Mankin
Orthopaedic Oncology Unit, Massachusetts General Hospital, Boston 02114.
One of the most difficult problems in orthopaedic oncology is
reconstruction after resection of a tumor of the proximal end of the femur.
In order to achieve a wide margin about a primary or secondary malignant
neoplasm of bone, it is often necessary to resect not only the hip joint
and fifteen or more centimeters of the proximal part of the femur, but also
the surrounding envelope of soft tissue. In some patients, little is left
but the sciatic and femoral nerves and vessels. Since 1971, we have done
reconstructions in forty-four patients, using an allograft and an implant
or else an osteoarticular graft alone to replace the proximal end of the
femur. Twenty-eight of these reconstructions were performed in patients who
had had a malignant tumor and were followed for two to fifteen years
postoperatively. Fifteen of the patients had only an osteoarticular graft,
and thirteen had an allograft and a prosthesis (nine Austin Moore, two
bipolar, and two long-stem total hip replacements). The average length of
the femoral segment was 18.4 centimeters; the longest one measured
thirty-one centimeters. Using an evaluation system of functional
end-results that includes failures as a result of recurrence of the tumor,
we recorded approximately 70 per cent excellent and good results for both
groups. When the two failures that were due to recurrence of the tumor were
omitted from the statistics (in order to evaluate the allograft procedure
more fully), the successful results increased to about 80 per cent. In
general, the patients who had an osteoarticular reconstruction fared less
well than did those who had an allograft and a prosthesis, but the series
were not quite comparable. The major complications were metastases in nine
patients (five of whom died), infection in five, and fracture of the
allograft in six. Restoration of the reconstruction was possible for most
of the patients who had a problem that was not related to the tumor, and
only one patient required an amputation for recurrent tumor. Despite the
many difficulties, we think that an allograft, with or without a prosthetic
implant, should be given primary consideration as a means of reconstruction
of the limb when resection of a tumor necessitates resection of a long
segment of the proximal end of the femur.
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