Proximal and Total Femur Resection with Endoprosthetic Reconstruction

  • Jacob Bickels
  • Isaac Meller
  • Robert Henshaw
  • Martin Malawer


Proximal and total femur resections are limb-sparing options for most primary bone sarcomas, metastatic lesions, and a variety of nononcologic indications of the proximal and midfemur that were traditionally treated with a major amputation. However, proximal and total femur resections are highly complex surgical procedures. Meticulous surgical technique and proper postoperative management are mandatory for local tumor control and acceptable functional outcome. This chapter emphasizes the indications for surgery, preoperative evaluation, and surgical concepts and technique.


Proximal Femur Total Femur Femur Resection Endoprosthetic Reconstruction Profundus Femoral Artery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Unni KK. Ewing tumor. In: Unni KK, editor. Dahlin’s Bone Tumors. General Aspects and Data on 11,087 Cases. Philadelphia: JB Lippincott; 1996:249–61.Google Scholar
  2. 2.
    Unni KK. Chondrosarcoma (primary, secondary, dedifferentiated, and clear cell). In: Unni KK, editor. Dahlin’s Bone Tumors. General Aspects and Data on 11,087 Cases. Philadelphia: JB Lippincott; 1996:71–108.Google Scholar
  3. 3.
    Unni KK. Osteosarcoma. In: Unni KK, editor. Dahlin’s Bone Tumors. General Aspects and Data on 11,087 Cases. Philadelphia: JB Lippincott; 1996:143–83.Google Scholar
  4. 4.
    Capanna R, Guerra A, Ruggieri P, Biagini R, Campanacci M. The Kotz prosthesis in massive osteoarticular resections for bone tumors: preliminary results in 27 cases. Ital J Orthop Traumatol. 1985;11:271–81.PubMedGoogle Scholar
  5. 5.
    Johnson ME, Mankin HJ. Reconstructions after resections of tumors involving the proximal femur. Orthop Clin N Am. 1991;22:87–103.Google Scholar
  6. 6.
    Lewis MM, Chekofsky KM. Proximal femoral replacement for neoplastic disease. Clin Orthop. 1982;171:72–9.PubMedGoogle Scholar
  7. 7.
    Marcove RC, Lewis MM, Rosen G, Huvos AG. Total femur replacement. Compr Ther. 1977;3:13–19.PubMedGoogle Scholar
  8. 8.
    Chandler H, Clark J, Murphy S et al. Reconstruction of major segmental loss of the proximal femur in revision total hip arthroplasty. Clin Orthop. 1994;298:67–74.PubMedGoogle Scholar
  9. 9.
    Freedman EL, Eckardt JJ. A modular endoprosthetic system for tumor and non-tumor reconstructions: preliminary experience. Orthopedics. 1997;20:27–35.PubMedGoogle Scholar
  10. 10.
    Malkani AL, Settecerri JJ, Sim FH, Chao EYS, Wallrichs SL. Long-term results of proximal femoral replacement for nonneoplastic disorders. J Bone Joint Surg. 1977;77B:351–6.Google Scholar
  11. 11.
    Enneking WF, Shirley PD. Resection-arthrodesis for malignant and potentially malignant lesions about the knee using an intramedullary rod and local bone graft. J Bone Joint Surg. 1977;59A:223–35.Google Scholar
  12. 12.
    Mankin HJ, Fogelson FS, Thrasher AZ et al. Massive resection and allograft transplantation in the treatment of malignant bone tumors. N Engl J Med. 1976;294:1247–55.PubMedGoogle Scholar
  13. 13.
    Horowitz SM, Glasser DB, Lane JM, Healey JH. Prosthetic and extremity survivorship after limb salvage for sarcoma. How long do the reconstructions last? Clin Orthop. 1993; 293:280–6.PubMedGoogle Scholar
  14. 14.
    Malawer MM, Chou LB. Prosthetic survival and clinical results with use of large-segment replacements in the treatment of high-grade bone sarcomas. J Bone Joint Surg. 1995;77A:1154–65.Google Scholar
  15. 15.
    Henja MJ, Gitelis S. Allograft prosthetic composite reconstruction for bone tumors. Sem Surg Oncol. 1997;13: 18–24.Google Scholar
  16. 16.
    Mankin HJ, Gebhardt MC, Jennings LC, Springfield DS, Tomford WW. Long-term results of allograft replacement in the management of bone tumors. Clin Orthop. 1996; 324:86–97.PubMedGoogle Scholar
  17. 17.
    Zehr RJ, Enneking WF, Scarborough MT. Allograft-prosthetic composite versus megaprosthesis in proximal femoral reconstruction. Clin Orthop. 1996;322:207–23.PubMedGoogle Scholar
  18. 18.
    Khong KS, Chao EYS, Sim FH. Long-term performance of custom prosthetic replacement for neoplastic diseases of the proximal femur. In: Yamamuro T, editor. New Developments for Limb Salvage in Musculoskeletal Tumors. Tokyo: Springer-Verlag; 1989:403–11.Google Scholar
  19. 19.
    Campanacci M, Capanna R, Cervellati C, Guerra A, Calderoni P. Modular rotatory endoprosthesis for segmental resections of the proximal humerus: experience with thirty three cases. In: Chao EYS, Ivins JC, editors. Tumor Prostheses for Bone and Joint Reconstruction: The Design and Application. New-York: Thieme-Stratton; 1983:127–39.Google Scholar
  20. 20.
    Dorfman HD, Czerniak B. Metastatic tumors in bone. In: Dorfman HD, Czerniak B, editors. Bone Tumors. St Louis: CV Mosby; 1998;1009–40.Google Scholar
  21. 21.
    Ward WG, Dorey F, Eckardt JJ. Total femoral endoprosthetic reconstruction. Clin Orthop. 1995;316: 195–206.PubMedGoogle Scholar
  22. 22.
    Aboulafia AJ, Buch R, Mathews J, Li W, Malawer MM. Reconstruction using a saddle prosthesis following excision of primary and metastatic periacetabular tumors. Clin Orthop. 1995;314:203–13.PubMedGoogle Scholar
  23. 23.
    Barrack RL, Wolfe MW, Waldman DA et al. Resurfacing of the patella in total knee arthroplasty. A prospective, randomized, double-blind study. J Bone Joint Surg. 1997; 79A:1121–31.Google Scholar
  24. 24.
    Bourne RB, Rorabeck CH, Vas M, Kramer J, Hardie R, Robertson D. Resurfacing versus not resurfacing the patella during total knee replacement. Clin Orthop. 1995; 321:156–61.PubMedGoogle Scholar
  25. 25.
    Oishi CS, Walker RH, Colwell CW. The femoral component in total hip arthroplasty. Six to eight-year follow-up of one hundred consecutive patients after use of a third-generation cementing technique. J Bone Joint Surg. 1994;76A:1130–6.Google Scholar
  26. 26.
    Malawer MM, Meller I. Experience with extracortical fixation of large segmental prostheses and description of a modular segmental replacement system (MSRS). In: Langlais F, Tomeno B, editors. Limb Salvage. Major Reconstructions in Oncology and Nontumoral Conditions. Berlin: Springer-Verlag; 1991:345–54.Google Scholar
  27. 27.
    Ward WG, Johnston KS, Dorey FJ, Eckardt JJ. Extra-medullary porous coating to prevent diaphyseal osteolysis and radiolucent lines around proximal tibial replacements. A preliminary report. J Bone Joint Surg. 1993;75B:976–87.Google Scholar
  28. 28.
    Malawer MM, Price WM. Gastrocnemius transposition flap in conjunction with limb-sparing surgery for primary bone sarcomas around the knee. Plast Reconstr Surg. 1984;73:741–9.PubMedGoogle Scholar
  29. 29.
    Capanna R, Ruggieri P, De Cristofaro R et al. Complications, their treatment and outcome in 257 cementless megaprostheses. In: Brown KLB, editor. Complications of Limb Salvage. Prevention, Management, and Outcome. Montreal: ISOLS; 1991:147–50.Google Scholar
  30. 30.
    Wippermann B, Zwipp H, Sturm J, Tscherne H. Complications of endoprosthetic proximal femoral replacement. In: Brown KLB, editor. Complications of Limb Salvage. Prevention, Management, and Outcome. Montreal: ISOLS; 1991:143–6.Google Scholar
  31. 31.
    Johnsson R, Carlsson A, Kisch K, Moritz U, Zetterstrom R, Persson BM. Function following mega total hip arthroplasty compared with total hip arthroplasty and healthy matched controls. Clin Orthop. 1985;192:159–67.PubMedGoogle Scholar
  32. 32.
    Kabukcuoglu Y, Grimer RJ, Tillman RM, Carter SR. Endoprosthetic replacement for primary malignant tumors of the proximal femur. Clin Orthop. 1999;358:8–14.PubMedGoogle Scholar
  33. 33.
    Bickels J, Meller I, Henshaw RM, Malawer MM. Reconstruction of hip stability after proximal and total femur resections. Clin Orthop 2000;375:218–230.PubMedGoogle Scholar
  34. 34.
    Dobbs HS, Scales JT, Wilson JN et al. Endoprosthetic replacement of the proximal femur and acetabulum. J Bone Joint Surg. 1981;63B:219–24.Google Scholar
  35. 35.
    Unwin PS, Cannon SR, Grimer RJ et al. Aseptic loosening in cemented custom-made prosthetic replacement for bone tumours of the lower limb. J Bone Joint Surg. 1996;78B:5–13.Google Scholar

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© Kluwer Academic Publishers 2004

Authors and Affiliations

  • Jacob Bickels
  • Isaac Meller
  • Robert Henshaw
  • Martin Malawer

There are no affiliations available

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