{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T11:48:31Z","timestamp":1793533711964,"version":"4.5.0"},"reference-count":17,"publisher":"British Editorial Society of Bone & Joint Surgery","issue":"1","license":[{"start":{"date-parts":[[2009,1,1]],"date-time":"2009-01-01T00:00:00Z","timestamp":1230768000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/online.boneandjoint.org.uk\/TDM"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery. British volume"],"published-print":{"date-parts":[[2009,1]]},"abstract":"<jats:p> Endoprosthetic replacement of the proximal femur may be required to treat primary bone tumours or destructive metastases either with impending or established pathological fracture. Modular prostheses are available off the shelf and can be adapted to most reconstructive situations for this purpose. We have assessed the clinical and functional outcome of using the METS (Stanmore Implants Worldwide) modular tumour prosthesis to reconstruct the proximal femur in 100 consecutive patients between 2001 and 2006. We compared the results with the published series for patients managed with modular and custom-made endoprosthetic replacements for the same conditions. <\/jats:p><jats:p> There were 52 males and 48 females with a mean age of 56.3 years (16 to 84) and a mean follow-up of 24.6 months (0 to 60). In 65 patients the procedure was undertaken for metastases, in 25 for a primary bone tumour, and in ten for other malignant conditions. A total of 46 patients presented with a pathological fracture, and 19 presented with failed fixation of a previous pathological fracture. The overall patient survival was 63.6% at one year and 23.1% at five years, and was significantly better for patients with a primary bone tumour than for those with metastatic tumour (82.3% vs 53.3%, respectively at one year (p = 0.003)). There were six early dislocations of which five could be treated by closed reduction. No patient needed revision surgery for dislocation. Revision surgery was required by six (6%) patients, five for pain caused by acetabular wear and one for tumour progression. Amputation was needed in four patients for local recurrence or infection. <\/jats:p><jats:p> The estimated five-year implant survival with revision as the endpoint was 90.7%. The mean Toronto Extremity Salvage score was 61% (51% to 95%). The implant survival and complications resulting from the use of the modular system were comparable to the published series of both custom-made and other modular proximal femoral implants. <\/jats:p><jats:p> We conclude that at intermediate follow-up the modular tumour prosthesis for proximal femur replacement provides versatility, a low incidence of implant-related complications and acceptable function for patients with metastatic tumours, pathological fractures and failed fixation of the proximal femur. It also functions as well as a custom-made endoprosthetic replacement. <\/jats:p>","DOI":"10.1302\/0301-620x.91b1.20448","type":"journal-article","created":{"date-parts":[[2008,12,17]],"date-time":"2008-12-17T18:07:46Z","timestamp":1229537266000},"page":"108-112","source":"Crossref","is-referenced-by-count":119,"title":["Modular endoprosthetic replacement for tumours of the proximal femur"],"prefix":"10.1302","volume":"91-B","author":[{"given":"C. R.","family":"Chandrasekar","sequence":"first","affiliation":[{"name":"The Royal Orthopaedic Hospital Oncology Service, Bristol Road South, Birmingham B31 2AP, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. J.","family":"Grimer","sequence":"additional","affiliation":[{"name":"The Royal Orthopaedic Hospital Oncology Service, Bristol Road South, Birmingham B31 2AP, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. R.","family":"Carter","sequence":"additional","affiliation":[{"name":"The Royal Orthopaedic Hospital Oncology Service, Bristol Road South, Birmingham B31 2AP, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. M.","family":"Tillman","sequence":"additional","affiliation":[{"name":"The Royal Orthopaedic Hospital Oncology Service, Bristol Road South, Birmingham B31 2AP, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Abudu","sequence":"additional","affiliation":[{"name":"The Royal Orthopaedic Hospital Oncology Service, Bristol Road South, Birmingham B31 2AP, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Buckley","sequence":"additional","affiliation":[{"name":"Cancer Research UK Clinical Trials Unit University of Birmingham, Vincent Drive, Edgbaston, Birmingham B15 2TT, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"42","reference":[{"key":"R1","unstructured":"Damron TA, Sim FH. Surgical treatment for metastatic disease of the pelvis and the proximal end of the femur. Instr Course Lect 2000;49:461\u201370."},{"key":"R2","unstructured":"No authors listed. British Orthopaedic Association and the British Orthopaedic Oncology Society. Metastatic Bone Disease: a guide to good practice. 2001: http\/\/www.boa.ac.uk\/site\/showpublications.aspx?ID=59 (date last accessed 7 August 2008)."},{"key":"R3","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.81B1.0810001"},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.78B1.0780005"},{"key":"R5","doi-asserted-by":"crossref","unstructured":"Jeys LM, Grimer RJ, Carter SR, Tillman RM. Risk of amputation following limb salvage surgery with endoprosthetic replacement, in a consecutive series of 1261 patients. Int Orthop 2003;27:160\u20133.","DOI":"10.1007\/s00264-003-0429-x"},{"key":"R6","doi-asserted-by":"crossref","unstructured":"Jeys LM, Grimer RJ, Carter SR, Tillman RM. Periprosthetic infection in patients treated for an orthopaedic oncological condition. J Bone Joint Surg [Am] 2005;87-A:842\u20139.","DOI":"10.2106\/JBJS.C.01222"},{"key":"R7","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000229332.91158.05"},{"key":"R8","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-199808000-00024"},{"key":"R9","doi-asserted-by":"crossref","unstructured":"Freedman EL, Eckardt JJ. A modular endoprosthetic system for tumor and non-tumor reconstruction: preliminary experience. Orthopedics 1997;20:27\u201336.","DOI":"10.3928\/0147-7447-19970101-06"},{"key":"R10","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-200403000-00034"},{"key":"R11","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000223978.36831.39"},{"key":"R12","doi-asserted-by":"crossref","unstructured":"Kabukcuoglu Y, Grimer RJ, Tillman RM, Carter SR. Endoprosthetic replacement for primary malignant tumours of the proximal femur. Clin Orthop 1999;358:8\u201314.","DOI":"10.1097\/00003086-199901000-00003"},{"key":"R13","unstructured":"No authors listed. ISOLS Implant radiological evaluation protocol http:\/\/www.isols.org\/files\/protocols.cfm; (date last accessed 5 October 2007)."},{"key":"R14","doi-asserted-by":"publisher","DOI":"10.1007\/BF00540024"},{"key":"R15","doi-asserted-by":"crossref","unstructured":"van Kampen M, Grimer RJ, Carter SR, Tillman RM, Abudu A. Replacement of the hip in children with a tumor in the proximal part of the femur. J Bone Joint Surg [Am] 2008;90-A:785\u201395.","DOI":"10.2106\/JBJS.F.01182"},{"key":"R16","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.89B4.18631"},{"key":"R17","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.89B12.19481"}],"container-title":["The Journal of Bone and Joint Surgery. 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