Reconstructions majeures de la hanche par association de prothèses et d’allogreffes (résultats à long terme de 34 prothèses composites)

Reconstruction after major resections of malignant tumors can be achieved by association of prostheses and of massive allografts. In 34 patients, we could reconstruct: the proximal femur in 21 cases, after an average resection of 180 mm, with a "composite" allograft prosthesis (with a bone graft around the stem) or a "composite and combined" allograft prosthesis (in which the femur allograft was associated with the trochanteric tendons, to facilitate the reinsertion of the glutei muscles); 10 hemipelvis in which the cup was inserted in an hemipelvic allograft; 3 proximal femurs and acetabulum (with composite cups and stems). In comparison with metallic reconstruction prostheses, composite prostheses improved function, limited complications, and increased longevity. The association of allografts and prostheses not only allows reconstructions which could be hardly achieved with only prostheses (especially for the pelvis), but also improves functional result and longevity, thanks to the biological fixation of the osseous and tendinous allografts. Considering our 15 years follow up in oncology, we have now extended these procedures to the major bone losses of the femur and pelvis following iterative revisions of standard prostheses for arthritis.