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2015 ; 6
(11
): 919-26
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Current concepts in total femoral replacement
#MMPMID26716087
Ramanathan D
; Siqueira MB
; Klika AK
; Higuera CA
; Barsoum WK
; Joyce MJ
World J Orthop
2015[Dec]; 6
(11
): 919-26
PMID26716087
show ga
Total femoral replacement (TFR) is a salvage arthroplasty procedure used as an
alternative to lower limb amputation. Since its initial description in the
mid-20(th) century, this procedure has been used in a variety of oncologic and
non-oncologic indications. The most compelling advantage of TFR is the
achievement of immediate fixation which permits early mobilization. It is
anticipated that TFR will be increasingly performed as the rate of revision
arthroplasty rises worldwide. The existing literature is mainly composed of a
rather heterogeneous mix of retrospective case series and a wide assortment of
case reports. Numerous TFR prostheses are currently available and the surgeon
must understand the unique implications of each implant design. Long-term
functional outcomes are dependent on adherence to proper technique and an
appropriate physical therapy program for postoperative rehabilitation. Revision
TFR is mainly performed for periprosthetic infection and the severe femoral bone
loss associated with aseptic revisions. Depending on the likelihood of attaining
infection clearance, it may sometimes be advisable to proceed directly to hip
disarticulation without attempting salvage of the TFR. Other reported
complications of TFR include hip joint instability, limb length discrepancy,
device failure, component loosening, patellar maltracking and delayed wound
healing. Further research is needed to better characterize the long-term
functional outcomes and complications associated with this complex procedure.