Page 20 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

Chapter 1
endoprosthetic reconstruction was performed for a tumor of the distal femur, using an implant designed by professor Scales and manufactured by Stanmore (Stanmore Implants Worldwide, Elstree, United Kingdom)75. Endoprostheses at that time were custom-made, based on calculations made from radiographs of the a ected bone(s), and it generally took six to eight weeks before the nal endoprosthesis was ready for implantation ( gure 10)22, 74, 75.
Figure 9: Reconstruction of the proximal femur with a “metal hip joint”, performed in 1942 by Moore and Bohlmann74.
To ensure ready availability of endoprostheses and to allow for intraoperative exibility, Kotz from Vienna (Austria) introduced the concept of a modular implant for reconstruction of large osseous defects in 1975. Professor Kotz later developed an entire modular implant system for reconstruction of various tumor sites, the Kotz Modular Femur and Tibia Reconstruction (KMFTR) system, which relied on uncemented stem xation with two additional plates, and had a xed hinge for reconstructions around the knee76. Despite several changes in endoprosthetic design over the years that followed, the basic idea behind the modern modular endoprosthetic systems is still comparable with the KMFTR system73.
A few years later, Kotz and Salzer published on their early experiences with rotationplasty as an alternative method of reconstruction for patients with a tumor of the distal femur77. With this technique, that had earlier been described by Borggreve78 and Van Nes79 for treatment of femoral deformities, the ankle acts as a knee following resection of the knee and 180° rotation of the remaining lower limb80. Although patients have to use an external prosthesis and the cosmetic
18