[Implantation technique of tumor and crutch prostheses].

Using anatomic specimens from 58 fixed femurs, we analyzed the point of insertion and junctional variations of the gluteus medius, minimus and vastus lateralis over the greater trochanter. On six specimens the physiological muscle cross-section Q was determined for the muscles inserting at the greater trochanter. The results showed that the gluteus medius and minimus, as well as the vastus lateralis generally insert at the lateral and ventral surfaces of the greater trochanter. In 59.6% of all cases these muscles form a joint tendon junction. In 21.1% the gluteus medius inserts autonomously and with 13.5% the gluteus minimus inserts independently. In 5.8% of all specimens all three muscles insert autonomously. The average physiological muscle cross-section of the gluteus medius and minimus added up to 37.83 cm2 and that of the vastus lateralis and the fibrously connected vastus intermedius came to 36.14 cm2. Accordingly the extensor muscles of the knee, together with the counteracting gluteus medius und minimus, form a muscle sling that puts a pressure load on the greater trochanter from the lateral cranial direction. An operating technique for the implantation of tumor prostheses using this muscle sling is introduced. Hereby the greater trochanter and inserted musculature remain intact and are placed hoodlike on the implanted tumor prosthesis. Postoperatively, the procedure results in good muscle function with early exercise tolerance.