Reconstruction of hip stability after proximal and total femur resections

Dislocation is the most common complication after proximal and total femur endoprosthetic reconstruction. The current study describes a surgical techn ique of acetabular preservation and reconstruction of the joint capsule and abductor mechanism that recreates joint stability and avoids dislocation. Between 1980 and 1996, 57 patients underwent proximal or total femur resect ion with endoprosthetic reconstruction. Forty-six patients had primary sarc oma of bone, nine had other bone tumors, and two had metabolic bone disease . The acetabulum was spared and not resurfaced in all patients. Bipolar hem iarthroplasty was performed in 49 patients, and fixed unipolar hemiarthropl asty was performed in eight. Soft tissue reconstruction included Dacron tap e capsulorrhaphy over the prosthetic neck, reattachment of the abductor mec hanism to the prosthesis, and extracortical bone fixation, The average foll owup period was 6.5 years (range, 2-18.2 years), Dislocation occurred in on ly one (1.7%) patient, and aseptic prosthetic loosening occurred in three ( 5.3%) patients. Four patients with primary bone sarcoma had local recurrenc e, of whom one required amputation of the limb. The limb salvage rate was 9 8%. Eighty-one percent of the patients had a good to excellent functional o utcome. Acetabular preservation, capsulorrhaphy, and reconstruction of the abductor mechanism recreate hip stability and avoid dislocation after proxi mal and total femur endoprosthetic reconstruction.