{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T22:12:58Z","timestamp":1761948778801},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2022,5,31]],"date-time":"2022-05-31T00:00:00Z","timestamp":1653955200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,5,31]],"date-time":"2022-05-31T00:00:00Z","timestamp":1653955200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"University of Innsbruck and Medical University of Innsbruck"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Oper Orthop Traumatol"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Objective<\/jats:title>\n                <jats:p>Proximal femoral replacement (PFR) is a\u00a0salvage procedure originally developed for reconstruction after resection of sarcomas and metastatic cancer. These techniques can also be adapted for the treatment of non-oncologic reconstruction for cases involving massive proximal bone loss. The direct anterior approach (DAA) is readily utilized for revision total hip arthroplasty (THA), but there have been few reports of its use for proximal femoral replacement.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Indications<\/jats:title>\n                <jats:p>Aseptic, septic femoral implant loosening, periprosthetic femoral fracture, oncologic lesions of the proximal femur. The most common indication for non-oncologic proximal femoral placement is a\u00a0severe femoral defect Paprosky IIIB or\u00a0IV.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Contraindications<\/jats:title>\n                <jats:p>Infection.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Surgical technique<\/jats:title>\n                <jats:p>In contrast to conventional DAA approaches and extensions, we recommend starting the approach 3\u202fcm lateral to the anterior superior iliac spine and performing a\u00a0straight incision directed towards the fibular head. After identification and incision of the tensor fasciae lata proximally and the lateral mobilization of the iliotibial tract distally, the vastus lateralis muscle can be retracted medially as far as needed. Special care should be taken to avoid injuries to the branches of the femoral nerve innervating the vastus lateralis muscle. If required, the distal extension of the DAA can continue all the way to the knee to allow implantation of a\u00a0total femoral replacement. The level of the femoral resection is detected with an x\u2011ray. In accordance with preoperative planning, the proximal femur is resected. Ream and broach the distal femoral fragment to the femoral canal. With trial implants in place, leg length, anteversion of the implant and hip stability are evaluated. It is crucial to provide robust reattachment of the abductor muscles to the PFR prosthesis. Mesh reinforcement can be used to reinforce the muscular attachment if necessary.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Postoperative management<\/jats:title>\n                <jats:p>We typically use no hip precautions other than to limit combined external rotation and extension for 6\u00a0weeks. In most cases, full weight bearing is possible after surgery.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A\u00a0PFR was performed in 16\u00a0patients (mean age: 55.1\u00a0years; range 17\u201384\u00a0years) using an extension of the DAA. The indication was primary bone sarcoma in 7\u00a0patients, metastatic lesion in 6\u00a0patients and massive periprosthetic femoral bone loss in 3\u00a0patients. Complications related to the surgery occurred in 2\u00a0patients (both were dislocation). Overall, 1\u00a0patient required reoperation and 1\u00a0patient died because of his disease. Mean follow-up was 34.5\u00a0months.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00064-022-00770-x","type":"journal-article","created":{"date-parts":[[2022,5,31]],"date-time":"2022-05-31T20:02:50Z","timestamp":1654027370000},"page":"218-230","update-policy":"http:\/\/dx.doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Proximal femoral replacement using the direct anterior approach to the hip"],"prefix":"10.1007","volume":"34","author":[{"given":"Martin","family":"Thaler","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Theodore T.","family":"Manson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Boris Michael","family":"Holzapfel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Moskal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,5,31]]},"reference":[{"issue":"Suppl 6","key":"770_CR1","doi-asserted-by":"publisher","first-page":"S105","DOI":"10.1016\/j.injury.2014.10.032","volume":"45","author":"GM Calori","year":"2014","unstructured":"Calori\u00a0GM, Colombo\u00a0M, Malagoli\u00a0E et al (2014) Megaprosthesis in post-traumatic and periprosthetic large bone defects: Issues to consider. 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Informed consent was obtained from all patients included in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}