• A Bertani, M Helix, M L Louis, A Rochwerger, and G Curvale.
• Orthopedic Surgery Department, Laveran Military Teaching Hospital, Boulevard Laveran, 13013 Marseille, France. antoine bertani@yahoo.fr
• Orthop Traumatol Sur. 2009 Nov 1;95(7):491-7.

BackgroundManagement of extensive proximal femur bone loss secondary to tumor resection or major osteolysis remains controversial. The possible options include a composite allograft/stem prosthesis, a modular type megaprosthesis or a custom-made megaprosthesis. Modularity allows versatility at reconstruction and avoids the delay required manufacturing a custom-made implant. Hypothesis and type of study: A retrospective radiological and clinical study investigated whether a special reconstruction modular stem design (JVC IX) would provide medium term success in the treatment of severe proximal femur bone loss.Material And MethodsBetween 1995 and 2005, 23 JVC IX hip replacements were performed for severe segmental proximal femur bone loss. Etiology was: 13 cases of tumor resection, eight of extensive osteolysis secondary to femoral implant loosening, and two traumatic situations. Follow-up was annual. Functional assessment used the Musculo-Skeletal Tumor Score (MSTS), and implant survival rates underwent Kaplan-Meier analysis, with surgical revision (to replace or remove the implant) as the end point.ResultsAll 23 patients (23 hips) were followed up for a mean 5.4 years (+/-3.7 yrs). Mean MSTS was 16.2 (max.=30). All stems demonstrated good fixation at radiological assessment, except for one case of probable loosening in contact with a metastatic osteolysis. Four implants had to be revised: two for non-controlled infection, one for tumor extension, and one for stem fatigue fracture. At 10 years' follow-up, implant survivorship was 81.5% (range: 62% to 100%).DiscussionSevere proximal femur bone loss is a difficult situation to deal with, offering no ideal treatment option. Modular megaprostheses are salvage procedures. Their results at a mean 5.4 years' follow-up are encouraging, and appear comparable to the ones obtained with alternative solutions (composite allograft/stem prostheses).Type Of StudyLevel IV retrospective, therapeutic study.2009 Published by Elsevier Masson SAS.

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