The modular Italian Megaprosthesis R.O.M.A.-Lepine for reconstruction after resection
of tumors located in the proximal femur: multicentric preliminary experience
Authors: Roberto Biagini, Alessandro Luzzati, Gennaro Scotto, Nicola Salducca, Umberto
Prencipe, Giuseppe Costanzo, Virginia Ferraresi, Carmine Zoccali
Introduction: proximal femur is a frequent site for primitive e secondary tumors. For primitive
bone tumors the mainstay of treatment is wide resection and reconstruction with a megaprosthesis; for secondary tumors we can identify the previous reported treatment and the
endomedullary locked nail. The choice depends on several factors as the histology, the site of
metastasis, the time from the extirpation of the primary tumor, the life expectance and the
presence of other effective therapies. Because of the improvement of survival, resection and
reconstruction with mega-prosthesis is more and more widespread. We report the
preliminary results of a new prosthesis particularly adapted for metastatic patients but also
applicable in primitive tumors.
Patients and methods: from February 2013 to January 2015, 43 patients underwent surgeries
for tumors located at the proximal or medial third of the femur. The cohort was composed by
20 males and 23 females with a median age of 65,5 years (min 41-max 82). Ten out of 43
patients were affected by primitive tumors, the remaining part by metastases;
chondrosarcoma was the most frequent primitive tumor (4 out of 10) whereas breast cancer
was the most frequent origin of metastasis (13 out of 32).
Indications for surgery were in 20 cases pathological fracture (whereof 3 cases of rupture of a
previous inserted intramedullary nail), in 11 cases impending fractures whereas in 12 cases
indication was oncological.
A further group with the same epidemiological and clinical characteristics where other
prosthetic reconstruction systems were used was build for comparison.
The prosthesis was chosen looking for a system able to reconstruct the femur even after
minimal resection and able to stabilize with an endomedullary stem the most of the segment.
Inpatient time, complications and residual function after six months from surgeries were
considered primary endpoints.
Results: no statistical differences were found in the results of the two different groups.
Discussion: the ROMA prosthesis is an efficient system for reconstruction after resection of
tumors located in the proximal femur. It is easy to implant and, to our knowledge, it is the only
which allow to perform little reconstruction (the lesser hap is 30mm of height) and to
stabilize the entire femur because the intramedullary stem measures from 140 to 240.
Conclusion: The Roma prosthesis can be considered a valid alternative for reconstruction after
resection of tumors located in the proximal third of the femur. The cost of quite the half of the
other prosthesis commercially available suggests that it can be particularly suitable also from
an economic point of view. The proximal availability of hap of 200mm of length and a stem of
300 will increase indications.