Current concepts in total femoral replacement

Figure 1 Total femoral replacement with intercalary body to connect proximal femoral replacement with distal rotating hinge knee implant. A: Composite radiographic images of our patient who underwent revision arthroplasty with TFR after periprosthetic infection necessitated removal of distal femoral replacement rotating hinge component and en bloc resection saucerization excision of remnant native proximal femur; B: Reconstruction was accomplished with intercalary body connecting proximal femoral replacement component with rotating hinge knee implant. Extensor mechanism was reconstructed and the greater trochanter repaired with a long claw cable fixation and Mersilene tapes. TFR: Total femoral replacement.

Figure 2 Total femoral replacements with constrained acetabular component and rotating hinge knee implant. A: Composite radiographic images of our patient who underwent TFR after multiplerevisions of total hip arthroplasty; B: TFR was done with constrained acetabular component, rotating hinge knee arthroplasty and patellar resurfacing. Abductor muscle repair was done by using a locking suture technique sewing into holes in the proximal femoral replacement component. Somatosensory evoked potentials were used intraoperatively to monitor sciatic nerve function during correction of a 4 cm limb length discrepancy. Potentials remained normal throughout. TFR: Total femoral replacement.