Restoring the abductor mechanism after proximal femoral resection in orthopedic oncology: trochanter-sparing versus tendon reinsertion techniques
Abstract
Objectives. Reconstruction of the hip abductor mechanism drives gait and function after proximal femoral resection for bone tumors, yet the strategy is debated. We compare soft-tissue reattachment to a modular megaprosthesis with biological tendon-to-tendon reinsertion using an allograft-/autograft-prosthesis composite.
Methods. An AI-assisted (Consensus) plus manual search with full-text verification appraised comparative and cohort studies; function was assessed by MSTS and gait analysis.
Results. Both techniques give reasonable-to-good function (mean MSTS 75-88%). Biological reinsertion gives more efficient gait and active abduction; modular reconstructions more often cause weakness and Trendelenburg gait. Tumor prostheses fail through soft-tissue insufficiency and dislocation, composites through structural failure and infection, although composites show the lowest dislocation rates; limb-salvage is high (97-99%). Synthetic augmentation and posterolateral approach are protective.
Conclusions. Neither technique is superior: biological reinsertion offers the best abductor recovery but more graft complications; modular reconstruction, versatility and durability if soft-tissue repair is optimized. Selection should be individualized to tumor extent, host biology, life expectancy, and clinical experience.
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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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© © Ortopedici Traumatologi Ospedalieri d’Italia (O.T.O.D.i.) , 2026
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