[Tumour prosthesis in the treatment of metastases, loosening of prosthesis and fractures at the proximal femur (author's transl)]

Proximal femoral replacement prosthesis for salvage of failed hip arthroplasty: complications in a 2-11 year follow-up study in 19 elderly patients

We reviewed 19 elderly patients who underwent revision total hip arthroplasty with a proximal femoral replacement prosthesis for aseptic loosening and severe proximal femoral bone loss. The mean interval from initial hip replacement to revision arthroplasty was 8 (2-20) years. The mean age of the patients was 78 (63-87) years. 2 patients died within 2 years postoperatively and 1 patient was lost for follow-up evaluation. The remaining 16 patients were assessed clinically and radiographically after a mean follow-up period of 5 (2-11) years. All patients had local pain relief, but they all needed a crutch or another walking aid. According to the Merle d'Aubigne hip-rating scale there were no excellent results, 1 very good, 8 good, 5 fair, 2 poor and no bad results. 4 patients had an intraoperative fracture, 7 had a dislocation, 2 had a deep infection, and 3 patients had progressive loosening of the screws fixing the greater trochanter to the femoral component. Our series demonstrates that revision of a failed hip prosthesis, using a proximal femoral replacement prosthesis, presents complex problems.

[Hip tumor prosthesis--indication in a trauma center and results]

This is a report about six cases of replacement of the proximal femur by a cementless special prosthesis in modular system done in the Unfallkrankenhaus Wien-Meidling. One of the patients suffered by a lymphoma, three others had fractures caused by bone metastasis. One was a pertrochanteric fracture complicated by osteoporosis, and finally one fracture of the femur preceded by an insufficient implantation of a semitotal hip replacement. The hipsocket was supplied four times by a cementfree Polyäthylensocket, in one case a CLW-ring was implanted. Investigation showed that after a little more than two months the stump of femur became porous and by an average of eleven months the prosthesis was covered by bone. The complications were in one case an incomplete fracture of the diaphysis and in another case a luxation for three times. There are several indications for a tumor prosthesis: 1. Primary and secondary malignant tumors. 2. Bone metastasis with or without fractures. 3. Comminuted fractures complicated by various factors, e.g. osteoporosis. 4. Loosening of prosthesis with poor bone conditions or failed implantation of a standard prosthesis. Although the successes seem to be quite promisingly, this method should be applied in a quite differentiated way, as any retreat is nearly impossible, once started.

Internal fixation technique in pathological fractures of the extremities

More often than not, the standard methods of internal fixation are insufficient to meet the demands of treatment of pathological fractures. In malignant diseases with improved survival rates, durability of the osteosynthesis is needed. The seemingly convenient prosthetic replacement therefore has to be regarded with caution. Good results without complications cannot be expected unless the fixation of the components is in healthy bone. In the younger patient with a curable disease, late complications have to be considered. We describe methods of internal fixation that satisfy these particular requirements, and pertinent clinical examples elucidate the techniques.