title: The push-through total femoral prosthesis offers a functional alternative to total femoral replacement: a case series.
abstract: Oncologic resections or complications of segmental femoral prostheses can result in severe bone loss of the femur for which a total femoral prosthesis (TFP) is required. This study assesses whether the loss of stability and function caused by the loss of muscle attachments can be improved by using a push-through total femoral endoprosthesis (PTTF), because it saves parts of the femur and its muscle attachments.
  
  
  
  In this retrospective case series, ten patients aged 25-77 (mean 54) who received a PTTF between 2005 and 2014 were included for baseline, complications and survival analysis with a mean follow-up of 5.3 (1.1-9.6) years. Functional outcome was assessed in six patients using the Musculoskeletal Tumor Society (MSTS) score, WHO performance scale, Toronto Extremity Salvage Score (TESS), SF36, EQ-5D, NRS pain score, fatigue score and satisfaction score.
  
  
  
  The mean MSTS score was 64% (23-93%). Five patients had a WHO performance scale of 1, one patient of 3. Mean TESS was 69% (13-90%). SF36 was most notably limited by physical functioning (mean 48), vitality (68) and general health (67). NRS score was 1.9, 1.8 and 8.3 for pain, fatigue and satisfaction, respectively. There were four failures: two infections (one resulting in amputation and one in a minor revision) and two mechanical failures (which required one revision to a TFP and one minor revision). Patient survival was 100%, limb survival 90%, and prosthesis survival 80%.
  
  
  
  The push-through total femoral endoprosthesis allows preservation of muscle attachments and offers a good alternative to total femoral prostheses.
authors.affiliation: Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30001, 9700 RB, Groningen, The Netherlands. jellegorter@gmail.com.
authors.forename: Jelle
authors.identifier: 0000-0003-0063-2318
authors.initials: J
authors.lastname: Gorter
authors.affiliation: Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30001, 9700 RB, Groningen, The Netherlands.
authors.forename: Joris J W
authors.initials: JJW
authors.lastname: Ploegmakers
authors.affiliation: Department of Orthopaedic Surgery, Martini Hospital, P.O. Box 30033, 9700 RM, Groningen, The Netherlands.
authors.forename: Bas L E F
authors.initials: BLEF
authors.lastname: Ten Have
authors.affiliation: Department of Orthopaedic Surgery, Radboud University, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Hendrik W B
authors.initials: HWB
authors.lastname: Schreuder
authors.affiliation: Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30001, 9700 RB, Groningen, The Netherlands.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Jutte
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005266:Femoral Neoplasms / Q000401:mortality / Q000601:surgery*; D005269:Femur / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology; D011474:Prosthesis Design / Q000009:adverse effects; D011475:Prosthesis Failure; D019919:Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D012092:Replantation; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
keywords: Arthroplasty; Functional outcome; Limb salvaging; Push-through; Total femoral prosthesis