Total femoral reconstruction with custom prosthesis for osteosarcoma

BACKGROUND The aim of this study was to assess total femur replacement for the treatment of femoral osteosarcomas. METHODS Between January 1995 and January 2012, 21 patients with a mean age of 21.8 years old were treated for femoral osteosarcomas with total femur replacement. All tumors were staged according to Enneking's criteria with one stage IIA case and 20 stage IIB cases. RESULTS The survival of patients with osteosarcoma without metastases was 66.7% at 5 years. Twelve patients were alive with an overall mean follow-up of 71.2 months, and the mean postoperative functional score was 72.5% at their last follow-up. Superficial infection occurred in two patients, which were resolved by changing dressing and intravenous antibiotics. Deep infection occurred in one patient, which was an amputation by hip disarticulation. Patella fracture occurred in one patient, which was treated by open reduction and tension band fixation. Local recurrence was seen in one patient, which was an amputation by hip disarticulation. Pulmonary metastases were observed in nine patients and all the patients subsequently died of disease within 12 months. Aseptic loosening in tibial stem occurred in three patients, whose whole prosthesis was revised. CONCLUSIONS Total femur replacement is a reliable method to restore mechanical and functional results after extensive resection of the femur.