Introduction
Proximal femur tumor resection often necessitates the reconstruction of the hip joint capsule to ensure joint stability and function. An artificial ligament substitute, augmented with polypropylene mesh, can provide the necessary reinforcement. This procedure integrates well with the implantation of a proximal femur megaprosthesis.
Key Steps:
Preoperative Planning:
Conduct thorough imaging studies (MRI, CT scans) to understand the tumor extent and plan the resection.
Select the appropriate size and type of proximal femur megaprosthesis.
Plan the type and dimensions of the artificial ligament substitute and polypropylene mesh required.
1.Tumor Resection:
Administer general anaesthesia and position the patient appropriately.
Make a standard anterolateral or posterior approach incision to access the proximal femur.
Perform en bloc resection of the tumor, ensuring clear margins to reduce recurrence risk.
2.Implantation of Proximal Femur Megaprosthesis:
Prepare the femoral canal and ensure proper fit for the megaprosthesis.
Insert the femoral component of the megaprosthesis and secure it with bone cement if required.
Attach the modular head and ensure proper articulation with the acetabulum.
3.Augmenting Hip Joint Capsule:
Prepare the artificial ligament substitute and polypropylene mesh.
Position the polypropylene mesh around the joint capsule area, ensuring it covers any defects or weak spots.
Fix the mesh to the surrounding soft tissues using non-absorbable sutures to ensure stability and integration.
4.Fixation and Reinforcement:
Attach the artificial ligament substitute to the proximal femur and acetabulum or surrounding structures.
Secure the artificial ligament with appropriate tension to mimic natural ligament stability.
Reinforce the joint capsule by suturing the mesh to the surrounding musculature and remaining capsule tissue.
5.Postoperative Care:
Implement a structured rehabilitation program focusing on gradual weight-bearing and strengthening exercises.
Monitor for any signs of infection, prosthesis loosening, or other complications.
Schedule regular follow-ups with imaging to assess implant stability and integration
Conclusion
Augmenting the hip joint capsule with an artificial ligament substitute and polypropylene mesh following proximal femur tumor resection and implantation of a proximal femur megaprosthesis is an effective method to ensure joint stability. This technique, along with a comprehensive rehabilitation program, can provide good functional outcomes and improved quality of life for patients. Alternative methods, each with their own pros and cons, should be considered based on individual patient needs and clinical scenarios.
27 май 2024
