title: Intramedullary total femoral replacement for salvage of the compromised femur associated with hip and knee arthroplasty.
abstract: Severely compromised femora because of prosthetic loosening, osteolysis, or periprosthetic fracture around total hip and knee arthroplasties are increasing. Two approaches that create an intramedullary total femoral (IMTF) replacement are reported. Twenty-three IMTF replacements in 22 patients were performed at 2 institutions. Seven revision total knee arthroplasties with a stemmed component were linked to a well-fixed hip stem with a custom intramedullary sleeve. Sixteen IMTF replacements involved revision of both hip and knee arthroplasties which were connected via an intercalary segment with morse taper junctions. Follow-up averaged 36 months. Complications included 2 dislocations, 2 deep infections, and 2 knee revisions for tibial loosening. Advantages over conventional total femoral replacement or ORIF include less dissection, maintenance of soft tissue attachments, and immediate component stability to allow for early mobilization.
authors.affiliation: Department of Orthopedics, University of Utah, Salt Lake City, UT 84108, USA.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Peters
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Hickman
authors.forename: Jill
authors.initials: J
authors.lastname: Erickson
authors.forename: Adolph V
authors.initials: AV
authors.lastname: Lombardi
authors.forename: Keith R
authors.initials: KR
authors.lastname: Berend
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Mallory
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D005264:Femoral Fractures / Q000209:etiology / Q000601:surgery; D005269:Femur / Q000601:surgery*; D006801:Humans; D008297:Male; D010014:Osteolysis / Q000209:etiology / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology / Q000601:surgery