Total hip arthroplasty in severe segmental femoral bone loss situations: use of a reconstruction modular stem design (JVC IX). Retrospective study of 23 cases

A Bertani, M Helix, M L Louis, A Rochwerger, G Curvale
Orthopaedics & Traumatology, Surgery & Research: OTSR 2009, 95 (7): 491-7

BACKGROUND: Management of extensive proximal femur bone loss secondary to tumor resection or major osteolysis remains controversial. The possible options include a composite allograft/stem prosthesis, a modular type megaprosthesis or a custom-made megaprosthesis. Modularity allows versatility at reconstruction and avoids the delay required manufacturing a custom-made implant. Hypothesis and type of study: A retrospective radiological and clinical study investigated whether a special reconstruction modular stem design (JVC IX) would provide medium term success in the treatment of severe proximal femur bone loss.

MATERIAL AND METHODS: Between 1995 and 2005, 23 JVC IX hip replacements were performed for severe segmental proximal femur bone loss. Etiology was: 13 cases of tumor resection, eight of extensive osteolysis secondary to femoral implant loosening, and two traumatic situations. Follow-up was annual. Functional assessment used the Musculo-Skeletal Tumor Score (MSTS), and implant survival rates underwent Kaplan-Meier analysis, with surgical revision (to replace or remove the implant) as the end point.

RESULTS: All 23 patients (23 hips) were followed up for a mean 5.4 years (+/-3.7 yrs). Mean MSTS was 16.2 (max.=30). All stems demonstrated good fixation at radiological assessment, except for one case of probable loosening in contact with a metastatic osteolysis. Four implants had to be revised: two for non-controlled infection, one for tumor extension, and one for stem fatigue fracture. At 10 years' follow-up, implant survivorship was 81.5% (range: 62% to 100%).

DISCUSSION: Severe proximal femur bone loss is a difficult situation to deal with, offering no ideal treatment option. Modular megaprostheses are salvage procedures. Their results at a mean 5.4 years' follow-up are encouraging, and appear comparable to the ones obtained with alternative solutions (composite allograft/stem prostheses).

TYPE OF STUDY: Level IV retrospective, therapeutic study.

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