[Proximal femoral resection with endoprosthetic reconstruction for malignant bone tumors : Surgical technique via the anterior hip approach].

Abstract

Objective of the surgery: Proximal femur resection with EPR aims to achieve oncological tumor removal while preserving surrounding soft tissue and neurovascular structures, ensuring functional restoration of hip joint stability.

Indications: Malignant bone tumors of the proximal femur, pathological fractures due to tumor involvement, recurrent tumors after previous resection, extensive destruction of the proximal femur due to metastases.

Contraindications: Extensive soft tissue infiltration with inadequate reconstruction potential, generalized metastases without curative treatment options, severe infections in the surgical area, critical general condition prohibiting major surgery.

Surgical technique: A longitudinal skin incision is made, incorporating the biopsy scar. After sequential soft tissue preparation and preservation of neurovascular structures, femoral osteotomy is performed according to preoperative planning. The hip capsule is preserved and reconstructed. The tumor resection is followed by endoprosthetic reconstruction with a modular tumor prosthesis and subsequent soft tissue reconstruction to ensure optimal stability.

Follow-up: Postoperative management includes early functional mobilization with partial weight-bearing. Adjuvant therapy is planned individually based on tumor staging. Regular radiological follow-up is essential for long-term success.

Evidence: EPR following tumor resection is an established procedure with good functional outcomes and oncological safety. Long-term studies demonstrate satisfactory functional results and acceptable complication rates.