Total femur replacement in sarcoma of the distal end of the femur.

Five patients with sarcoma of the distal end of the femur were treated by a total resection of the femur and its replacement by an endoprosthesis. This was to preserve the body image, prevent mutilation and permit independent ambulation. A chemotherapy program was established with administration of a high dose of methotrexate plus citovorum factor, adriamycin and vincristine. surgical removal of pulmonary metastases and other local recurrences was performed where and when possible. The functional results were excellent in four and poor in the remaining patient. All of the patients rapidly achieved physical rehabilitation and developed a stable and painless gait. This approach to the treatment of osteogenic sarcoma attempts to eliminate the primary tumor, the micrometastases and the overt metastatic disease, leaving the patient to follow as normal a life a possible, which is not the case when a high thigh amputation or a hip disarticulation is performed.