The femur is the long bone of your thigh and is important for proper function of the hip and knee joints. The entire femur is a relatively common site for primary sarcomas and metastatic disease. Some of these tumors include osteosarcoma, chondrosarcoma, and Ewing’s sarcoma. The common muscles of your femur (thigh bone) include your hamstrings and quadriceps. A total femur prosthetic replacement involves a radical resection of the femur containing the sarcoma and replacing the bone with a prosthesis. A total femur prosthetic replacement is considered a limb-sparing surgery. Limb-sparing surgery can be performed for approximately 95% of tumors arising from the upper femur. Adjuvant (additional) therapies, such as chemotherapy and/or radiation, may be used in conjunction with this procedure as treatment for various bone sarcomas. In some instances, the extremity cannot be saved and an amputation is performed.
Contraindications for saving the limb may include neurovascular invasion, infection, pathological fracture, invasion of the pelvis, extensive disease, contamination from a poorly performed biopsy, recurrent disease.
An incision is made, containing the marked biopsy site, along with margins so no tumor remains once removed.
Separating all major arteries, veins, and nerves from the tumor. In rare cases a nerve (s) may need to be removed if it is involved by the bone sarcoma. For this procedure, it is vital that the sciatic nerve and femoral artery and vein are properly identified and mobilized away from the tumor. Once the blood vessels and nerves are separated, they can be retracted (moved away from the tumor) and protected throughout the procedure.
Developing surgical planes (margins that are tumor free) and separating muscles that can be preserved and leaving those in continuity with the tumor that should be removed. This is based on preoperative MRI and intraoperative findings as well as the type of tumor.
Removal of tumor and reconstruction with a tumor prosthesis. Reconstruction of the leg (femur bone) utilizing a specialized tumor prosthesis is the most common limb-sparing technique for bone sarcomas, soft-tissue sarcomas, or large benign aggressive tumors that have destroyed the bone arising in this area. This prosthesis is sized and built during the surgical procedure then implanted and secured in place using cement. The length of bone removed is based on preoperative X-rays and MRI.
Shown are the components of the total femur prosthesis, including the acetabular cup, liner, femoral head, femoral stem, and...
Soft tissue coverage of the prosthesis. Multiple muscle rotation flaps are used to restore function and stability of the limb. The goal is to provide a stable hip and knee so the extremity can function well. Preserving the vastus lateralis (quadricep muscle) and utilizing it for soft tissue coverage of the prosthesis is most important for achieving optimal functional outcomes and for protecting the prosthesis from infection.
We then close your incision with sutures and cover the surgical site with bandages. Multiple large drains may also be used to drain the surgical site and prevent a seroma (buildup of fluid).
This is a total femur prosthesis replacement on an x-ray. Notice the femur is removed and replaced by a prosthesis the length of the entire femur.
Shown is the marked incision used for a total femur prosthesis replacement.
Shown is the specimen (the femur bone containing the bone sarcoma) and the prosthesis, which will replace the femur bone.
Shown is the femur prosthesis. Once inserted, soft tissue coverage of the prosthesis occurs prior to closure.
Shown is soft tissue coverage of the prosthesis prior to closure.
After your surgery you will spend a few nights in the hospital and then will be recuperating at home. Various pain protocols and nerve blocks are used to minimize pain. Mostly all patients are very comfortable after the surgery. For the first few days you will ice the area and keep it elevated to reduce swelling. You will return to the office 2 weeks after surgery. Patients are usually kept in a hip abductor brace for 6 weeks to allow the muscles to heal and prevent dislocation of the hip by stabilizing the prosthesis. Once cleared, you will subsequently start physical therapy. We usually prescribe specific physical therapy protocols 3 times a week for 12 weeks after surgery to gradually strengthen muscles. Strengthening with significant resistance after sufficient range of motion is achieved as determined by Dr. Wittig. There may be an ultimate weight limit imposed upon you depending on various factors.
You will be monitored periodically with X-ray and MRI imaging over the course of 5 years to ensure there are no signs of recurrence. You will have follow up appointments every 4 months for the first 2 years, then every 6 months for the next 2 years, and then once a year. Since the integrity of the limb has been restored to full or almost full, recovery is anticipated provided the patient adheres to strict physical therapy.