title: Patient-oriented functional results of total femoral endoprosthetic reconstruction following oncologic resection.
abstract: OBJECTIVE
  Functional outcomes following oncologic total femoral endoprosthetic reconstruction (TFR) are lacking. We compared patient-oriented functional results of TFRs to proximal femur and distal femur reconstructions (PFR and DFR). We also compared function and complications with regard to knee and hip componentry.
  
  
  METHODS
  Fifty-four TFR patients were identified from three institutional prospective databases. Forty-one had fixed- and 13 had rotating-hinge knees, 37 hemiarthroplasty and 17 total hip arthroplasty componentry. Toronto Extremity Salvage Scores (TESS) for n = 27 were compared between groups and to cohorts of PFR (n = 31) and DFR (n = 85) patients using the Mann-Whitney U-test.
  
  
  RESULTS
  Follow-up averaged 4 years. Mechanical complications included five hip dislocations and one femoral malrotation. Four dislocations were in fixed-hinge implants, all in those lacking abductor reattachment. TESS averaged 69.3 ± 17.8, statistically decreased from DFR (P = 0.002) and PFR patients (P = 0.036). No significant differences were detected between patients in the fixed-hinge (n = 18) and rotating-hinge (n = 9) groups (P = 0.944), or total hip (n = 8) and hemiarthroplasty (n = 19) groups (P = 0.633).
  
  
  CONCLUSIONS
  TFR is reserved for extreme cases of limb salvage, portending a poor prognosis overall. Function reflects additive impairments from PFR and DFR. TFR outcomes differ little with rotating- or fixed-hinge, total hip or hemiarthroplasty implants.
authors.affiliation: The Department of Orthopaedics, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA. kevin.jones@hci.utah.edu
authors.forename: Kevin B
authors.initials: KB
authors.lastname: Jones
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Griffin
authors.forename: Coonoor R
authors.initials: CR
authors.lastname: Chandrasekar
authors.forename: David
authors.initials: D
authors.lastname: Biau
authors.forename: Antoine
authors.initials: A
authors.lastname: Babinet
authors.forename: Benjamin
authors.initials: B
authors.lastname: Deheshi
authors.forename: Robert S
authors.initials: RS
authors.lastname: Bell
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Grimer
authors.forename: Jay S
authors.initials: JS
authors.lastname: Wunder
authors.forename: Peter C
authors.initials: PC
authors.lastname: Ferguson
mesh_terms: D000328:Adult; D001859:Bone Neoplasms / Q000556:secondary / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005266:Femoral Neoplasms / Q000601:surgery*; D005269:Femur / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D007720:Knee Prosthesis; D023821:Limb Salvage; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D011446:Prospective Studies; D019736:Prostheses and Implants; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012509:Sarcoma / Q000473:pathology / Q000601:surgery*