Proximal Femoral Replacement With Tumor Prosthesis; Total Femur Replacement

Proximal Femoral Replacement With Tumor Prosthesis; Total Femur Replacement

Kevin I. Perry

Key Concepts

  • Massive bone loss of the femur after total hip arthroplasty (THA) can occur secondary to osteolysis, stress shielding, mechanical loosening, infection (Figure 34.1A-D), periprosthetic fracture, tumor resection, and multiple previous reconstructive procedures.

  • Salvage of the abductors and reattachment to the prosthesis whenever possible can help with patient function in this difficult cohort of patients.

  • Complications following these procedures can be high. Dislocation and infection are two of the most common complications.

  • Constrained or dual-mobility acetabular implants should be considered to mitigate the risk of dislocation.

  • Patients often ambulate with a significant limp and require some form of gait aid after proximal or total femoral replacement.

Sterile Instruments and Implants


  • Routine hip and knee (for total femur) retractors, including a Charnley retractor, and assortment of blunt and sharp Hohman retractors

  • 2.5- or 3.2-mm drill

  • Blunt or sharp bone hook


  • Proximal femoral replacement and/or total femoral replacement systems


  • Lateral decubitus position for proximal femoral replacement or a sloppy lateral decubitus position on a bean bag for total femoral replacement

  • Two hip bolsters

  • Operative leg draped free for ease of acetabular and femoral exposure for the hip and for adequate femoral and tibial exposure for the knee

Figure 34.1 ▪ A-D, Preoperative radiographs of an infected total hip with substantial bone loss, infected strut grafts, plates, and cables. Planned proximal femoral resection and antibiotic spacer placement was planned for eventual total femoral replacement.

Surgical Approaches

  • Removal of the hip implants can be accomplished from either an anterolateral or posterolateral approach depending on surgeon preference.

  • For total femoral replacement, often a combination of a laterally based approach to the hip and an anterior-based approach to the knee is needed. Alternatively, total femoral replacement can be accomplished from an extensive lateral approach to the leg.

Preoperative Planning

Dec 14, 2019 | Posted by in ORTHOPEDIC | Comments Off on Proximal Femoral Replacement With Tumor Prosthesis; Total Femur Replacement

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