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dc.contributor.authorThaler, Martin
dc.contributor.authorManson, Theodore T
dc.contributor.authorHolzapfel, Boris Michael
dc.contributor.authorMoskal, Joseph
dc.date.accessioned2022-06-21T14:32:56Z
dc.date.available2022-06-21T14:32:56Z
dc.date.issued2022-05-31
dc.identifier.urihttp://hdl.handle.net/10713/19217
dc.description.abstractObjective: Proximal femoral replacement (PFR) is a salvage procedure originally developed for reconstruction after resection of sarcomas and metastatic cancer. These techniques can also be adapted for the treatment of non-oncologic reconstruction for cases involving massive proximal bone loss. The direct anterior approach (DAA) is readily utilized for revision total hip arthroplasty (THA), but there have been few reports of its use for proximal femoral replacement. Indications: Aseptic, septic femoral implant loosening, periprosthetic femoral fracture, oncologic lesions of the proximal femur. The most common indication for non-oncologic proximal femoral placement is a severe femoral defect Paprosky IIIB or IV. Contraindications: Infection. Surgical technique: In contrast to conventional DAA approaches and extensions, we recommend starting the approach 3 cm lateral to the anterior superior iliac spine and performing a straight incision directed towards the fibular head. After identification and incision of the tensor fasciae lata proximally and the lateral mobilization of the iliotibial tract distally, the vastus lateralis muscle can be retracted medially as far as needed. Special care should be taken to avoid injuries to the branches of the femoral nerve innervating the vastus lateralis muscle. If required, the distal extension of the DAA can continue all the way to the knee to allow implantation of a total femoral replacement. The level of the femoral resection is detected with an x‑ray. In accordance with preoperative planning, the proximal femur is resected. Ream and broach the distal femoral fragment to the femoral canal. With trial implants in place, leg length, anteversion of the implant and hip stability are evaluated. It is crucial to provide robust reattachment of the abductor muscles to the PFR prosthesis. Mesh reinforcement can be used to reinforce the muscular attachment if necessary. Postoperative management: We typically use no hip precautions other than to limit combined external rotation and extension for 6 weeks. In most cases, full weight bearing is possible after surgery. Results: A PFR was performed in 16 patients (mean age: 55.1 years; range 17-84 years) using an extension of the DAA. The indication was primary bone sarcoma in 7 patients, metastatic lesion in 6 patients and massive periprosthetic femoral bone loss in 3 patients. Complications related to the surgery occurred in 2 patients (both were dislocation). Overall, 1 patient required reoperation and 1 patient died because of his disease. Mean follow-up was 34.5 months.en_US
dc.description.urihttps://doi.org/10.1007/s00064-022-00770-xen_US
dc.description.urihttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9197819/en_US
dc.language.isoenen_US
dc.publisherSpringer Natureen_US
dc.relation.ispartofOperative Orthopadie und Traumatologieen_US
dc.rights© 2022. The Author(s).en_US
dc.subjectFemoral revisionen_US
dc.subjectMassive bone lossen_US
dc.subjectMetastatic bone diseaseen_US
dc.subjectRevision total hip arthroplastyen_US
dc.subjectSarcomaen_US
dc.titleProximal femoral replacement using the direct anterior approach to the hip.en_US
dc.typeArticleen_US
dc.identifier.doi10.1007/s00064-022-00770-x
dc.identifier.pmid35641789
dc.source.journaltitleOperative Orthopadie und Traumatologie
dc.source.volume34
dc.source.issue3
dc.source.beginpage218
dc.source.endpage230
dc.source.countryGermany


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