Objective: To evaluate the clinical outcomes of the wide resection and the functional reconstruction for treating malignant tumors of the proximal femur.
Methods: The clinical data were analysed from 62 patients with malignant tumors of the proximal femur treated between January 1987 and December 2007. There were 29 males and 33 females with a median age of 35 years (range, 14-73 years). In 41 patients with primary malignant tumors having a disease course of 0.5-14.0 months, there were 16 cases of osteosarcoma, 7 cases of fibrosarcoma, 6 cases of chondrosarcoma, 6 cases of malignant fibrous histiocytoma, 4 cases of mesenchymal sarcoma,1 case of Ewing sarcoma, and 1 case of angiosarcoma, including 3 cases of type IB, 2 cases of type IIA, 35 cases of type IIB, and 1 case of type III according to Enneking stage. In 21 patients with metastatic tumors, 16 had a malignant tumor history; the disease course was 0.1-28.0 months (3.4 months on average). Radical resection was performed in 9 cases, extensive resection in 39 cases, and marginal resection in 14 cases. After resection, 39 cases underwent reconstruction with prostheses (prostheses group) and 14 cases underwent reconstruction with allograft-prosthetic composites (APC, APC group).
Results: All incision healed by first intention. Twenty-six cases died of tumor metastasis, their postoperative survive time was 16-56 months (28 months on average). The average follow-up time was 64 months (range, 28-221 months) in 36 survival patients. The local recurrence rate of primary malignant tumors was 4.88% (2/41). In prostheses group, dislocation of femoral head occurred in 2 cases, fracture of prosthetic stem in 1 case, hip pain in 3 cases, acetabular wear in 3 cases, and stem loosening in 5 cases. In APC group, nonunion of APC occurred in 3 cases and acetabular wear in 1 case. At last follow-up, the average Musculoskeletal Tumor Society (MSTS) functional scores were 77.69% +/- 6.50% in prostheses group and 85.71% +/- 7.45% in APC group, showing significant difference (P < 0.001).
Conclusion: When the wide resection is performed for malignant tumors of the proximal femur, better local control could be achieved. Compared with reconstruction of the prosthesis, the APC reconstruction can provide better function.