Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Dec 18, 2015; 6(11): 919-926
Published online Dec 18, 2015. doi: 10.5312/wjo.v6.i11.919
Current concepts in total femoral replacement
Deepak Ramanathan, Marcelo BP Siqueira, Alison K Klika, Carlos A Higuera, Wael K Barsoum, Michael J Joyce
Deepak Ramanathan, Marcelo BP Siqueira, Alison K Klika, Carlos A Higuera, Wael K Barsoum, Michael J Joyce, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
Author contributions: Ramanathan D and Siqueira MBP reviewed the literature for this minireview; Ramanathan D and Joyce MJ wrote the manuscript; Klika AK, Higuera CA and Barsoum WK reviewed and revised the manuscript.
Conflict-of-interest statement: No financial support was received for this study. Dr. Carlos A Higuera has received research funding from Zimmer. Dr. Wael K Barsoum has received research funding and royalties from Stryker and Zimmer. He is also a consultant for Stryker. Dr. Michael J Joyce is a Medical Board Trustee of the Musculoskeletal Transplant Foundation. None of the other authors have any relevant disclosures to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CCBY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Alison K Klika, MS, Research Program Manager, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, United States.
Telephone: +1-216-4444954 Fax: +1-216-4456255
Received: May 29, 2015
Peer-review started: June 3, 2015
First decision: July 3, 2015
Revised: July 31, 2015
Accepted: September 29, 2015
Article in press: September 30, 2015
Published online: December 18, 2015

Total femoral replacement (TFR) is a salvage arthroplasty procedure used as an alternative to lower limb amputation. Since its initial description in the mid-20th century, this procedure has been used in a variety of oncologic and non-oncologic indications. The most compelling advantage of TFR is the achievement of immediate fixation which permits early mobilization. It is anticipated that TFR will be increasingly performed as the rate of revision arthroplasty rises worldwide. The existing literature is mainly composed of a rather heterogeneous mix of retrospective case series and a wide assortment of case reports. Numerous TFR prostheses are currently available and the surgeon must understand the unique implications of each implant design. Long-term functional outcomes are dependent on adherence to proper technique and an appropriate physical therapy program for postoperative rehabilitation. Revision TFR is mainly performed for periprosthetic infection and the severe femoral bone loss associated with aseptic revisions. Depending on the likelihood of attaining infection clearance, it may sometimes be advisable to proceed directly to hip disarticulation without attempting salvage of the TFR. Other reported complications of TFR include hip joint instability, limb length discrepancy, device failure, component loosening, patellar maltracking and delayed wound healing. Further research is needed to better characterize the long-term functional outcomes and complications associated with this complex procedure.

Keywords: Hip disarticulation, Limb salvage, Revision arthroplasty, Total femur arthroplasty, Total femoral arthroplasty, Total femoral replacement, Total femur replacement, Salvage arthroplasty

Core tip: The inherent mechanical limitations of the total femoral replacement implant, the complexities of the associated surgical technique and the typically poor condition of the host soft tissue bed have contributed to the mixed outcomes and high complication rates which are reported in the literature. Although this procedure could provide satisfactory long-term ambulatory outcomes by salvaging the extremity for weight bearing, prudent selection and management of the well-evaluated surgical candidate is essential to ensuring the successful achievement of this goal.