Restoration of bone stock after aseptic loosening of a distal post-resections femoral prosthesis.

Background. The aseptic loosening of the stem is a frequent complication of post-resection endoprosthesis. Material and methods. Twenty-one patients were operated for primary neoplasm of the distal femoral epiphysis. In 3 cases (14.3%) loosening of the endoprosthesis stem appeared 4 to 8 years after the resection-reconstruction procedure. In all cases the endoprosthesis was reinserted with reconstruction of the femoral shaft, using cancellous femoral impaction grafting with cement (Exeter technique). Results. The early results of revision surgery were good in all 3 cases. Subtrochanteric fracture appeared at the site where the cortex of the femoral shaft cortex was perforated by the endoprosthesis stem tip, ca. 18 months after reinsertion. Loosening of the reinserted endoprosthesis appeared in another female patient. The outcomes of revision surgery were good 2 to 3.5 years post surgery in both patients. Conclusions. The outcome of revision surgery for loosening of the femoral component of a post-resection endoprosthesis is good if there is no perforation of the femoral cortex.