Fig. 1 762 THE JOURNAL OF BONE AND JOINT SURGERY PROSTHETIC REPLACEMENT OF THE DISTAL FEMUR FOR PRIMARY

Over a 16-year period, 135 custom-made distal femoral prostheses, based on a fully constrained Stanmore-type knee replacement, were used in the treatment of primary malignant or aggressive benign tumours. Survivorship analysis showed a cumulative success rate of 72 % at five years and 64 % at seven years. Intact prostheses in 91 % of the surviving patients gave good or excellent functional results. Deep infection was the major complication, occurring in 6.8 % of cases; clinical aseptic loosening occurred in 6.0%. Revision surgery was carried out for loosening and infection, and the early results are encouraging. We conclude that prosthetic replacement of the distal femur can meet the objectives of limb salvage surgery. Limb salvage surgery for malignant bone tumours has become accepted practice due largely to the improvement in tumour control with modern chemotherapy (Rosen et a! 1983; Link et a! 1986; Simon and Nachman 1986; Eilber et a! 1987), and also to progress in surgical reconstruction. The most commonly used replacement