[Total femoral prosthesis replacement in management of femoral malignant bone tumor].

OBJECTIVE

To discuss the indications of reconstruction with total femoral prosthesis for the patients with a majority of femur infiltrated by malignant bone tumor, and to evaluate the functional outcome and complication.

METHODS

Between October 1996 and October 2002, 17 patients with malignant bone tumor were treated with total femoral prosthesis replacement. The patients included 8 males and 9 females, whose age was from 12 to 34 years, with the average of 16 years. The lesions were located in the proximal femur metaphysis in 1, the distal femur metaphysis in 6, the femur shaft in 10, pathologic fracture in 2, skip lesions in 3. The extent of lesions was 23-28 cm (a majority of femur infiltrated by malignant bone tumor). Preoperative pathologic diagnosis were established by open biopsy (2 cases) or needle biopsy (15 cases). All patients were osteosarcoma. According to Enneking surgical staging system, the cases were 12 IIB and 5 IIIB. Seventeen cases received preoperative chemotherapy and 15 cases received postoperative chemotherapy.

RESULTS

Seventeen cases were followed up with a mean time of 45 months (range 9-120 months). Local recurrence was observed in 3 (17.6%) after operation 6-14 months. In 12 IIB cases, 4 cases (33%) developed pulmonary metastasis and died. Eight cases remained continuously disease-free for average 75 months (range 50-120 months). In 5 IIIB cases, all with a mean survived term of 13 months (range 9-20 months) died. Fifteen patients (88%) could walk. The patients had maintained average 74% (range 40% - 93%) limb function scores evaluated by ISOLS criteria. Four cases had complications of paralysis of common peroneal nerve (3 cases) and dislocation of hip joint (2 case). No infection took place.

CONCLUSIONS

Total femoral prosthesis replacement could be used in the treatment of the patients with a majority of femur infiltrated by malignant bone tumor and could effectively recover their limb function to a great extent. The procedure can effectively improve the quality of life for the patients with malignant bone tumor staging IIIB.