Mechanical evaluation of six types of reconstruction following 25, 50, and 75% resection of the proximal femur.

The structural stiffness and the stiffness of the osteotomy site after six types of reconstruction of the proximal femur were compared by testing in axial compression, mediolateral bending, and axial torsion in a canine model. An osteotomy was carried out for 25, 50, or 75% of the length of each femur, and the proximal portion was replaced by one of five allograft/endoprosthetic composites or a segmental replacement. The reconstructions included (a) a composite press-fit proximally and cemented distally, (b) a composite cemented proximally and distally, (c) a composite cemented proximally and fixed with two plates at the allograft-host bone interface, (d) a composite cemented proximally and secured distally with bicortical screws, (e) a composite secured proximally and distally with bicortical screws, and (f) a segmental prosthesis cemented into the distal femur. The results showed that the segmental reconstruction and the reconstruction with double-plate fixation and a cemented endoprosthesis were structurally stiffer and had greater stiffness of the osteotomy site than the other reconstructions. In comparison, reconstructions that involved cement alone or cement and press-fit techniques generally were more compliant than the others, both structurally and at the osteotomy site.