Taylor Adam J, Gililland Jeremy M, Anderson Lucas A
Department of Orthopaedics, UC Davis Medical Center, University of California, Sacramento, CA, USA.
Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA.
Arthroplast Today. 2024 Aug 2;28:101474. doi: 10.1016/j.artd.2024.101474. eCollection 2024 Aug.
Total femur replacement is a well-recognized salvage procedure and an alternative to hip disarticulation in patients with massive femoral bone loss. Compared to conventional total femur replacement, intramedullary total femur (IMTF) requires less soft tissue dissection and preserves femoral bone stock and soft-tissue attachments. Despite these advantages, patients can still anticipate compromised functional outcomes and high complication rates following IMTF. Prior studies describe IMTF with the patient positioned laterally and utilizing posterior or anterolateral approaches to the hip. We describe our IMTF technique performed via the direct anterior approach in the supine position. In our experience, this is an effective method, with potential benefits including intraoperative limb length and rotational assessment, use of fluoroscopy, more convenient exposure of the knee, and potential lower rates of hip instability.
全股骨置换是一种公认的挽救性手术，是股骨大量骨丢失患者髋关节离断术的替代方案。与传统全股骨置换相比，髓内全股骨（IMTF）置换所需的软组织分离较少，可保留股骨骨量和软组织附着。尽管有这些优点，但患者仍可能预期IMTF置换后功能结果不佳且并发症发生率高。先前的研究描述了患者侧卧位并采用髋关节后外侧或前外侧入路进行IMTF置换。我们描述了通过仰卧位直接前路进行IMTF置换的技术。根据我们的经验，这是一种有效的方法，潜在益处包括术中肢体长度和旋转评估、使用透视、更方便地暴露膝关节以及可能降低髋关节不稳定的发生率。
