Proximal femoral reconstructions: A European "italian" experience. A case series

Background: The aim of the study was to analyze our experience with a single system of modular proximal femoral replacement, evaluating oncologic results, complications, and functional results. Methods: We reviewed data on 38 patients (21 men and 17 women; mean age 59 y) treated with proximal femoral reconstructions by two orthopaedic surgeons. Reconstruction was performed in all patients using a MUTARS® modular proximal femoral prosthesis, and an acetabular reconstruction in eight patients. Diagnoses included primary bone sarcomas (21), bone metastases (15), and radioinduced osteonecrosis (2). The stem was press fit in 11 patients and cemented in 27. Results: At a mean follow-up of 1.9 yr, 12 patients were alive with no evidence of disease, three have no evidence of disease after treatment of a recurrence or metastasis, 12 were alive with disease, and nine had died. The two with osteonecrosis were not included in this analysis. Complications occurred in seven patients: four type I (wound dehiscence in one and dislocation in three), one type II, one type IV, and one type V failures, while type III failures did not occur. At last follow-up, 89% of patients (34/38) had retained their implant. The mean Musculoskeletal Tumor Society (MSTS) score was 24.7 (14-30), with excellent or good results in all patients except one. Conclusion: The overall survival of this prosthesis was satisfactory with good implant survival in proximal femoral reconstruction. The most frequent cause of failure was dislocation. The incidence of infection was low. Functional results were good or excellent. Level of Evidence: IV; case series