Endoprosthetic and allograft-prosthetic composite reconstruction of the proximal femur for bone neoplasms

Reconstruction of the proximal femur after tumor resection can be achieved with either an endoprosthesis or an allograft-prosthetic composite. We compared the two modalities for complications, functional outcome, and construct survival. We retrospectively analyzed 52 patients with endoprostheses and 20 with allograft-prosthetic composite reconstructions between 1974 and 2002. Median followup was 146 months and 76 months, respectively. Both methods were associated with low rates of early complications. Infections occurred in two patients with endoprostheses and one patient with an allograft-prosthetic composite reconstruction. Aseptic loosening was the most common (10%) late complication for patients with endoprostheses. Nonunion was the most common (10%) complication for patients with allograft-prosthetic composite reconstructions. All host-allograft junctions eventually healed after bone-grafting. The Musculoskeletal Tumor Society scores were similar for patients with endoprostheses (70%) and allograft-prosthetic composites (82%). The median hip abductor strength was greater for patients with allograft-prosthetic composite reconstructions (4.6 of 5) than for patients with endoprostheses (2.8 of 5). Kaplan-Meier survivorship of the implant was 86% for both groups at 10 years. The consistent restoration of abductor muscle strength combined with the low morbidity and high durability support the use of allograft-prosthetic composite reconstruction in patients with long life expectancy.