HEAD AND NECK REPLACEMENT ENDOPROSTHESES FOR PATHOLOGICAL PROXIMAL FEMORAL LESIONS

Records of 28 patients with pathologic lesions in the proximal femur t reated by implantation of a femoral head and neck replacement prosthes is between 1984 and 1995 were reviewed. Mean clinical followup was 47. 8 months in the eight living patients and 15.8 months in the 20 patien ts who had died. The underlying diagnosis was metastatic disease or my eloma in 22 patients. The most frequently occurring indication for imp lantation of this device was a pathologic fracture in 26 patients (18 displaced, eight impending), followed by resection and reconstruction in two patients. All femoral components were cemented: 23 were bipolar hemiarthroplasties and five were total hip arthroplasties, Implant su rvivorship was good (93%), with only two prostheses removed during the followup period, both for infection. However, radiographic analysis r evealed increasing lucencies with time, particularly in the most proxi mal zones, resulting in radiographic failure in an additional case. De ep infection occurred in three cases, leading to resection arthroplast y in two patients, Periprosthetic fractures occurred in three cases, b ut only one occurred intraoperatively, Despite a high complication rat e, the good implant survival during the shortened life span of these p atients supports the continued use of femoral head and neck replacemen t prostheses in this population.