Neoadjuvant chemotherapy, wide resection and custom prosthetic replacement for tumors of the proximal femur

Endoprosthetic reconstruction after bone tumor resection is accepted treatment for femoral tumors. The objective of this study is to evaluate the effectiveness and functional outcomes of custom prosthetic replacement of the proximal femur in patients undergoing oncologic resection. Data of 28 consecutive patients with proximal femur tumors receiving wide resection and prosthetic replacement (16 total hip replacements [THR], 12 bipolar half-hip replacements [HHR]) from January 2005-June 2014 were analyzed retrospectively. Postoperative lower limb function was evaluated using American Musculoskeletal Tumor Society 1993 function scores (MSTS 93). Mean follow-up was 28.6 months (range: 6-138 months). No patients had prosthesis-related complications or revision surgery, 3 had local recurrence of malignancy (8.3%), and 2 had venous thromboembolism resolved with medication. Mean MSTS 93 score was 84.8% (THR 85% vs. HHR 81%, P=0.044). Two patients (10.7%) suffered relapse and 9 (32.1%) died from lung metastasis. Survival rates were 91.7% at 1 year in both groups; 64.8% and 59.4% in THR and HHR groups after 30 months. In conclusions, Neoadjuvant chemotherapy, extended tumorectomy and special prosthetic replacement of proximal femur effectively treated femoral tumors, with minimal local recurrence and satisfactory functional outcomes.