[Replacement of proximal end of the femur (author's transl)].

The article reports on replacement of the proximal end of the femur, including the acetabulum, by means of special endoprostheses in a total of 49 hips. Besides treatment of pertrochanteral and subtrochanteral fractures of the femur in individual cases, and an increasing field of application within the framework of prosthetic exchange operations, resection and replacement of the coxal femur are mainly employed in tumour processes. Primary malignant tumours require pre-treatment and after-treatment by chemotherapy (with the exception of chondrosarcoma) in order to meet the demand of oncological radicality. Tendency to luxation, which is the most frequent component, can be reduced by employing a sophisticated surgical technique, good physiotherapy, appropriate training of the patients, and application of a Hohmann's bandage. The radiological course indicates that all the complications involved in endoprostheses, especially loosening, may be expected, even though they may occur with a certain delay of time. Besides general osseous atrophy of the prosthesis-bearing diaphysis, it is mainly the lateral "traction" side which is affected. Sintering of the prosthesis can temporarily delay breakdown of the anchoring. Prosthesis fractures are possible. Hence, the special endoprosthesis proximal to the hip joint is a recommended alternative to surgery of a crippling nature. In view of the fact that it is hardly possible to retract one's steps at a later date, indications towards special endoprosthesis must continue to be highly differentiated and closely adapted to each individual case.