Tumor Resection

  • Eustathios Kenanidis
  • Panagiotis Kakoulidis
  • Eleftherios TsiridisEmail author
  • Anthony Viste
  • Michael J. TauntonEmail author
  • Mathew P. AbdelEmail author
  • Simon Cowie
  • Richard P. Baker


The proximal femur is a usual anatomic location for primary malignant or benign tumors and metastatic disease [1, 2]. The improvement of surgical management of tumors of the proximal femur amalgamated with advances in the field of neo-adjuvant chemotherapy and radiotherapy further improved the patients’ function and quality of life during the last years. Hindquarter amputation remains an option especially for aggressive sarcomas of the proximal femur; however, limb salvage is now more than ever a feasible option [2]. Reconstructive surgery is the method of choice to achieve limb salvage and retention of function [3].


  1. 1.
    Menendez LR, Ahlmann ER, Kermani C, Gotha H. Endoprosthetic reconstruction for neoplasms of the proximal femur. Clin Orthop Relat Res. 2006;450:46–51.CrossRefPubMedGoogle Scholar
  2. 2.
    Potter B, Chow V, Adams S, Letson GD, Temple HT. Endoprosthetic proximal femur replacement: metastatic versus primary tumours. Surg Oncol. 2009;18(4):343.CrossRefPubMedGoogle Scholar
  3. 3.
    Thambapillary S, Dimitriou R, Makridis KG, Fragkakis EM, Bobak P, Giannoudis PV. Implant longevity, complications and functional outcome following proximal femoral Arthroplasty for musculoskeletal tumors: a systematic review. J Arthroplast. 2013;28(8):1381–5.CrossRefGoogle Scholar
  4. 4.
    Fox EJ, Hau MA, Gebhardt MC, Hornicek FJ, Tomford WW, Mankin HJ. Long-term follow-up of proximal femoral allografts. Clin Orthop Relat Res. 2002;397:106–13.CrossRefGoogle Scholar
  5. 5.
    Donati D, Giacomini S, Gozzi E, Mercuri M. Proximal femur reconstruction by an allograft prosthesis composite. Clin Orthop Relat Res. 2002;394:192–200.CrossRefGoogle Scholar
  6. 6.
    Farid Y, Lin PP, Lewis VO, Yasko AW. Endoprosthetic and allograft–prosthetic composite reconstruction of the proximal femur for bone neoplasms. Clin Orthop Relat Res. 2006;442:223–9.CrossRefPubMedGoogle Scholar
  7. 7.
    McGoveran BM, Davis AM, Gross AE, Bell RS. Evaluation of the allograft–prosthesis composite technique for proximal femoral reconstruction after resection of a primary bone tumour. Can J Surg. 1999;42(1):37–45.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Zehr RJ, Enneking WF, Scarborough MT. Allograft–prosthesis composite versus megaprosthesis in proximal femoral reconstruction. Clin Orthop Relat Res. 1996;322:207–23.CrossRefGoogle Scholar
  9. 9.
    Kabukcuoglu Y, Grimer RJ, Tillman RM, Carter SR. Endoprosthetic replacement for primary malignant tumors of the proximal femur. Clin Orthop Relat Res. 1999;358:8–14.CrossRefGoogle Scholar
  10. 10.
    Unwin PS, Cannon SR, Grimer RJ, Kemp HBS, Sneath RS, Walker PS. Aseptic loosening in cemented custom-made prosthetic replacements for bone tumours of the lower limb. J Bone Joint Surg Br. 1996;78(1):5–13.CrossRefPubMedGoogle Scholar
  11. 11.
    Bickels J, Meller I, Henshaw RM, Malawer MM. Reconstruction of hip stability after proximal and total femur resections. Clin Orthop Relat Res. 2000;375:218–30.CrossRefGoogle Scholar
  12. 12.
    Donati D, Zavatta M, Gozzi E, Giacomini S, Campanacci L, Mercuri M. Modular prosthetic replacement of the proximal femur after resection of a bone tumour: a long-term follow-up. J Bone Joint Surg Br. 2001;83(8):1156–60.CrossRefPubMedGoogle Scholar
  13. 13.
    Finstein JL, King JJ, Fox EJ, Ogilvie CM, Lackman RD. Bipolar proximal femoral replacement prostheses for musculoskeletal neoplasms. Clin Orthop Relat Res. 2007;459:66–75.CrossRefPubMedGoogle Scholar
  14. 14.
    Ogilvie CM, Wunder JS, Ferguson PC, Griffin AM, Bell RS. Functional outcome of endoprosthetic proximal femur replacement. Clin Orthop Relat Res. 2004;426:44–8.CrossRefGoogle Scholar
  15. 15.
    Sharma S, Turcotte RE, Isler MH, Wong C. Experience with cemented large segment endoprostheses for tumors. Clin Orthop Relat Res. 2007;459:54–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Zeegin EN, Aponte-Tinao LA, Hornicek FJ, Gebhardt MC, Mankin HJ. Survivorship analysis of 141 modular metallic endoprostheses at early follow-up. Clin Orthop Relat Res. 2004;420:239–50.CrossRefGoogle Scholar
  17. 17.
    Chandrasekar C, Grimer R, Carter S, Tillmann RM, Abudu A, Jeys LM. Unipolar proximal femoral endoprosthetic replacement for tumour. The risk of revision in young patients. J Bone Joint Surg Br. 2009;91:401–4.CrossRefPubMedGoogle Scholar
  18. 18.
    Sokolovski V, Voloshin V, Aliev M, Zubikov VS, Saravanan SA, Martynenko DV, Nisichenko DV, Strelnikov KN. Total hip replacement for proximal femoral tumours: our midterm results. Int Orthop. 2006;30(5):399–402.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Chandrasekar C, Grimer R, Carter S, et al. Modular endoprosthetic replacement for tumours of the proximal femur. J Bone Joint Surg Br. 2009;91(1):108.CrossRefPubMedGoogle Scholar
  20. 20.
    Langlais F, Lambotte J, Colin P, et al. Long-term results of allograft composite total hip prostheses for tumours. Clin Orthop Relat Res. 2003;414:197.CrossRefGoogle Scholar
  21. 21.
    Gosheger G, Hillmann A, Lindner N, et al. Soft tissue reconstruction of megaprosthesis using a trevira tube. Clin Orthop Relat Res. 2001;393:264.CrossRefGoogle Scholar
  22. 22.
    Bruns J, Delling G, Gruber H, et al. Cementless fixation of megaprosthesis using a conical fluted stem in the treatment of bone tumours. J Bone Joint Surg Br. 2007;89(8):1084.CrossRefPubMedGoogle Scholar
  23. 23.
    Holt G, Christie M, Schwartz H. Trabecular metal endoprosthetic limb salvage reconstruction of the lower limb. J Arthroplasty. 2009;24(7):1079.CrossRefPubMedGoogle Scholar
  24. 24.
    Orlic D, Smerdelj M, Kolundzic R, et al. Lower limb salvage surgery: modular endoprosthesis in bone tumour treatment. Int Orthop. 2006;30(6):458.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Hattori H, Mibe J, Matsuoka H, et al. Surgical management of metastatic disease of the proximal femur. J Orthop Surg. 2007;15(3):295.CrossRefGoogle Scholar
  26. 26.
    van Kampen M, Grimer R, Carter S, et al. Replacement of the hip in children with a tumour in the proximal part of the femur. J Bone Joint Surg Am. 2008;90(4):785.CrossRefPubMedGoogle Scholar
  27. 27.
    Graci C, Maccauro G, Mura Torp F, Spinelli MS, Rosa MA, Fabbriciani C. Infection following bone tumor resection and reconstruction with tumoral prostheses: a literature review. Int J Immunopathol Pharmacol. 2010;23(4):1005–13.CrossRefPubMedGoogle Scholar
  28. 28.
    Jacofsky OJ, Haidukewych GJ, Zhang H, Sim FH. Complication and results of arthroplasty for savage of failed treatment of malignant pathologic fractures of the hip. Clin Orthop Relat Res. 2004;427:52–6.CrossRefGoogle Scholar
  29. 29.
    Joglekar SB, Rose PS, Lewallen DG, Sim FH. Tantalum acetabular cups provide secure fixation in THA after pelvic irradiation at minimum 5-year followup. Clin Orthop Relat Res. 2012;470(11):3041–7.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Khan FA, Rose PS, Yanagisawa M, Lewallen DG, Sim FH. Surgical technique: Porous tantalum reconstruction for destructive nonprimary periacetabular tumors. Clin Orthop Relat Res. 2012;470(2):594–601.CrossRefPubMedGoogle Scholar
  31. 31.
    Rose PS, Halasy M, Trousdale RT, Hanssen AD, Sim FH, Berry DJ, Lewallen DG. Preliminary results of tantalum acetabular components for THA after pelvic radiation. Clin Orthop Relat Res. 2006;453:195–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Abudu A, Carter SR, Grimer RJ. The outcome and functional results of diaphyseal endoprostheses after tumour excision. J Bone Joint Surg Br. 1996;78:652–7.CrossRefPubMedGoogle Scholar
  33. 33.
    Aldlyami E, Abudu A, Grimer RJ, Carter SR, Tillman RM. Endoprosthetic replacement of diaphyseal bone defects: long-term results. Int Orthop. 2005;29:25–9.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Ozger H, Akgul T, Yildiz F, Topalan M. Biological reconstruction of the femur using double free vascularized fibular autografts in a vertical array because of a large defect following wide resection of an osteosarcoma: a case report with 7 years of follow-up. J Pediatr Orthop B. 2013;22(1):52–8.CrossRefPubMedGoogle Scholar
  35. 35.
    Alman BA, De Bari A, Krajbich JI. Massive allografts in the treatment of osteosarcoma and Ewing sarcoma in children and adolescents. J Bone Joint Surg Am. 1995;77:54–64.CrossRefPubMedGoogle Scholar
  36. 36.
    Ozaki T, Hillmann A, Bettin D, Wuisman P, Winkelmann W. Intramedullary, 86 antibiotic-loaded cemented, massive allografts for skeletal reconstruction: 26 cases compared with 19 uncemented allografts. Acta Orthop Scand. 1997;68:387–91.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Eustathios Kenanidis
    • 1
  • Panagiotis Kakoulidis
    • 1
  • Eleftherios Tsiridis
    • 2
    Email author
  • Anthony Viste
    • 3
    • 4
  • Michael J. Taunton
    • 5
    Email author
  • Mathew P. Abdel
    • 5
    Email author
  • Simon Cowie
    • 6
  • Richard P. Baker
    • 7
  1. 1.Academic Orthopaedic Unit, Aristotle University Medical SchoolThessalonikiGreece
  2. 2.Academic Orthopaedic UnitPapageorgiou General Hospital, Aristotle University Medical SchoolThessalonikiGreece
  3. 3.Hospices Civils de Lyon, CHU Lyon SudLyonFrance
  4. 4.Service de Chirurgie Orthopédique et TraumatologiqueLyonFrance
  5. 5.Department of Orthopaedic SurgeryMayo Clinic College of Medicine, Mayo ClinicRochesterUSA
  6. 6.Southmead Hospital, North Bristol TrustBristolUK
  7. 7.Avon Orthopaedic Centre, Southmead Hospital, North Bristol NHS TrustBristolUK

Personalised recommendations