Current concepts in total femoral replacement

Table 1 Types of total femoral replacement prostheses

Feature	Intramedullary TFR system	Tumor-style TFR system
Basic design	Modular hip femoral component; Constrained knee femoral component with customized intercalary segments; May require strut allografts and cerclage cables	Modular and available in multiple lengths
Femoral bone stock	Possibility of preservation; can maintain muscle attachment	Absent
Distal femur resection	Can preserve distal femur or remove femoral component using standard revision techniques	Entire distal femur can be removed by subperiosteal dissection (less bleeding)
Tibial component	Suitable for constrained condylar articulation	Suitable for rotating hinge articulation

TFR: Total femoral replacement.

Table 2 Large case series of total femoral replacement in current literature

Ref.	Publication	n	Age	Indications	Follow-up (mo)	Patients living at time of publication	Survivorship	All-cause revision rate	Complications	Prosthesis used
Ahmed[28]	Arch Orthop Trauma Surg	9	47 (10-74)	Oncologic	51 (8-200)	4/9	No failures	0%	Infection (2), tibial component loosening (1)	Zimmer
Amanatullah et al[3]	J Arthroplasty	20	65 ± 11	Non-oncologic (revision arthroplasty)	73 ± 49	0/20	70% at 5 yr follow-up	30%	Infection (7), hip dislocation (5), limb length discrepancy (2), knee flexion contracture (1)	Biomet, Link Stryker
Berend et al[2]	Clin Orthop Relat Res	59	74 (39-91)	Non-oncologic (end-stage prosthetic disease)	58 (12-156)	14/59	65% at 5 yr follow-up	30.5%	Infection (8), hip dislocation (7), tibial component loosening (2), acetabular component loosening (1)	Biomet, Link
Fountain et al[10]	J Arthroplasty	14	63.7 (48-79)	Non-oncologic (revision arthroplasty)	90 (12-204)	13/14	NA	35.7%	Hip dislocation (5), infection (3)	Link
Friesecke et al[30]	J Bone Joint Surg Am	100	68 (40-94)	Non-oncologic (revision arthroplasty)	59 (1-138)	95/100	NA	21%	Infection (12), hip dislocation (6), prosthesis failure (3), patellar issues (2), hematoma (2), peroneal nerve palsy (1), delayed wound healing (1)	Link
Lombardi et al[12]	J Arthroplasty	75	73 (36-92)	Non-oncologic (end-stage prosthetic disease)	42 (1-158)	50/75	NA	30.7%	Infection (11), hip dislocation (7), tibial component loosening (2), acetabular component loosening (1), hematoma (1), periprosthetic fracture (1)	NA
Mankin et al[14]	Clin Orthop Relat Res	15	52 ± 1 (16-82)	Oncologic, non-oncologic (Paget’ s disease, rheumatoid arthritis)	54 (12-192)	7/15	NA	33.3%	Prosthesis failure (4), infection (1)	NA
Nerubay et al[26]	Clin Orthop Relat Res	19	20	Oncologic	18-96	7/19	NA	-	Wound healing problems (10), infection (1), popliteal vein injury (1), prosthesis failure (1)	NA
Steinbrink et al[33]	J Bone Joint Surg Br	32 (28 patients)	56 (21-81)	Oncologic, non-oncologic (end-stage prosthetic disease, revision arthroplasty, pathologic fractures, osteoporosis)	6-84	23/28	NA	9.4%	Infection (2), hip dislocation (1), prosthesis failure (1), patellar pain (1)	Custom
Ward et al[34]	Clin Orthop Relat Res	21	44.6 (11-91)	Oncologic, non-oncologic (revision arthroplasty, end-stage prosthetic disease)	31 (1-125)	11/21	NA	2.4%	Infection (3), hip dislocation (2), patellar pain (1)	Custom

NA: Information was not available in article.