RU2819998C2 - Method for reconstruction of proximal part of femur for exoprosthesis with hip joint and implant (versions) for its implementation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: according to the first version, a reconstruction implant of a proximal femoral stump with a hip joint is made on the basis of computed tomography and X-ray imaging results and comprises a tubular housing made with external concentric projections for the possibility of fixing the prolene mesh with cerclage threads and with a cone, spherical head for connection with cone of tubular housing, bipolar head for fixation on the spherical head, made in accordance with the size of the cotyloid cavity, distal end plug to give the stump support ability, screw for fixing between each other the tubular housing and the distal end plug to give the stump support ability, and a proximal end plug for closing and locking the screw. A reconstruction implant of a proximal femoral stump with a hip joint for exoprosthesis replacement according to the second version is based on the results of computed tomography and X-ray imaging and comprises a tubular body housing with external concentric projections for the possibility of fixing the prolene mesh with cerclage threads and with a cone, spherical head for connection with cone of tubular housing, bipolar head for fixation on the spherical head, made in accordance with the size of the cotyloid cavity, extending component with concentric projections for the possibility of fixing the prolene mesh by cerclage threads with an internal thread for the screw and made of two variable cylinders, wherein the small cylinder has the possibility of entering the tubular housing, the distal end plug to give the stump support ability, screw for fixation between each other of tubular housing, elongating component and distal end plug to give the stump support ability, proximal end plug for screw closing and locking. Method for reconstruction of proximal part of femur with hip joint for exoprosthesis replacement using one of said implants, consisting in the fact that exarticulation of an extremity in a hip joint is performed, solving intraoperatively, depending on the volume of soft tissues of the hip, which can be preserved, the possibility of using one of the above implants, prolene mesh is fixed to concentric projections with cerclage sutures and muscles and soft tissues are fixed to it, after that an extremity stump with preserved soft tissues and muscles is formed, the wound is closed tightly in layers.

EFFECT: inventions enable to reduce the probability of developing pathological processes and complications when replacing the supporting end of the bone stump with the implant.

3 cl, 16 dwg, 2 ex

Description

The invention relates to medicine, namely to oncology, traumatology (gunshot and mine-explosive injuries) and orthopedics, in particular to devices for surgical treatment of amputation or reamputation, disarticulation of a limb in the hip joint.

In industrialized countries, lower limb amputations are performed in 80-90% of cases for occlusive arterial disease. Amputations due to malignant tumors account for approximately 5.0%. If we analyze the data on the level of amputations, the picture is as follows: in the area of the hip joint and pelvis, amputations in more than 50.0% of cases are caused by malignant tumors (at a young age about 10.0%) (Malawer M.M. et al., 1997). Among the oncology centers of the CIS countries, the N.N. Russian Cancer Research Center has the greatest experience in treating bone tumors. Blokhin RAMS. As an example, in the department of general oncology of the Russian Cancer Research Center named after. N.N. Blokhin RAMS annually performs about 100 amputations of the lower extremities due to malignant neoplasms. Moreover, 50.0% of patients are young people (under 20 years old). In 47.0% of cases, the cause of amputation is osteogenic sarcoma. In 13.0% of patients, amputation is performed at the level of the lower leg (N.N. Trapeznikov et al., 1998; M.D. Aliev et al., 2004). Amputation can be used both as part of radical treatment and for palliative purposes in case of an advanced tumor process, for example, in a pathological fracture complicated by infection and intoxication. It should be remembered that even palliative tumor removal can significantly improve the patient’s condition and quality of life (Merimsky O., Kollender Y., Inbar M. et al., 1997).

Amputation is also indicated for extensive traumatic crush injuries of the limb, for gas phlegmon and gangrene, severe fistulas, tuberculosis and other purulent processes, as well as sometimes for congenital anomalies and orthopedic diseases [Boychev B., Conforti B., Chokanov K. Operative orthopedics and traumatology. Sofia. State Ed. "Medicine and physical education." 1961. P. 550]. In England and Scotland, the cause of amputations in 70% were vascular diseases and diabetes [Pitkin M.R. Biomechanics of construction of lower limb prostheses. S-P. 2006, p. 8]. We observed 4% of disabled people with amputation stumps after electrical trauma and 3% as a result of frostbite [Sytin L.V., Zoloeva G.K. Vasilchenko E.M. Rehabilitation of disabled people with impaired support and movement functions. Novosibirsk. 2003. P. 225]. In conditions of hostilities, especially when anti-personnel mines are used, their frequency increases sharply. In a military field situation or during amputation due to vascular diseases, the end of the bone is not closed, which remains exposed after muscle contraction, which contributes to the development of osteomyelitis, then indications for reamputation appear [Boychev B., Conforti B., Chokanov K. Operative orthopedics and traumatology . Sofia. State Ed. "Medicine and physical education." 1961, p. 553]. For stump defects in combination with painful scars, chronic ulcers, painful osteophytes and neuromas, amputation is indicated.

However, even after processing the bone sawdust using the aperiosteal method, osteophytes on the femoral stumps occur in 83.5% of cases.

In some cases, due to the prevalence of the tumor process, it is impossible to amputate a limb, and in these cases, according to indications, an operation involving disarticulation of the lower limb at the hip joint (disarticulation) is performed. After surgical treatment for disarticulation of the limb in the hip joint, subsequent exoprosthetics for the purpose of functional rehabilitation of the limb is practically impossible.

A known autograft from the calcaneus is used for osteoplastic amputation according to N.I. Pirogov. It is used so that the cut of the calcaneus is adjacent to the cut of the tibia. Since the heel bone graft is prone to displacement, they resort to dissection of the Achilles tendon or fixation of the graft with a nail [Shevkunenko V.N. A short course in operative surgery with topographic anatomy. M.: Publishing house. second. State ed. medical literature "Medgiz". 1947. pp. 174-175].

The disadvantage of an autograft from the calcaneus is the possibility of its displacement and bone resorption, as well as the lack of signs in it of improving the quality of surgical treatment and reducing complications when replacing the supporting end of the bone stump with an endoprosthesis through more reliable fixation of the endoprosthesis rod in the medullary canal and more accurate placement of its supporting plate on cortical layer of the end of the tubular bone stump.

A lining under the bone stump formed during low intercondylar amputation of the femur is known, made in the form of a plate from the dissected patella, creating a good fulcrum [Boychev B., Conforti B., Chokanov K. Operative orthopedics and traumatology. Sofia. State Ed. "Medicine and physical education." 1961, p. 549]. During osteoplastic amputation of the femur according to Gritty-Szymanowski, the cartilaginous surface of the patella is cut off from the cartilaginous surface of the patella, and the patella is fixed to the sawdust of the femur with three catgut sutures drawn through holes drilled along the edges of the femur, then the anterior tendon-aponeurotic flap is sutured with catgut sutures to the posterior one. flap [Movshovich I.A. Operative orthopedics. Moscow.”Medicine” 1983, pp. 388-389].

The disadvantage of an autograft from a dissected patella is the possibility of its resorption and weakening of the strength of the transplanted bone, unreliability of graft attachment with possible displacement and the development of complications. There are no signs of improving the quality of treatment and reducing complications after surgical replacement of the supporting end of the bone stump with an endoprosthesis by more reliable fixation of the endoprosthesis rod in the medullary canal and more accurate placement of its supporting plate on the cortical layer of the end of the tubular bone stump.

There is a known method for endoprosthetics of the joints of the fingers (A.S. USSR No. 439277, published on August 15, 1974). The method is carried out by resection of the articular ends of the articulating phalanges, modeling the bone marrow canals in accordance with the shape and size of the legs of the endoprosthesis and introducing an implant into the site of the resected joint.

The disadvantage of this method is that when endoprosthetics is performed with an elastic implant on a joint damaged as a result of trauma in the presence of dislocation, deviation, the deformation that existed before the operation is preserved due to scarred soft tissues, which cause deformation of the endoprosthesis. Curvature of the endoprosthesis leads to a sharp decrease in the range of motion in the joint.

There is a known method for endoprosthetics of finger joints (RU2069543C1). Resection of the damaged articular ends is performed, expansion of the bone marrow canals and installation of an endoprosthesis, while the anatomical relationships are first restored and soft tissues are prepared using an external fixation device, and after correlation of the deformation, the endoprosthesis itself is carried out, and if there is deviation during resection, two opposing triangular ones are cut out from the joint capsule flap, with the flap of a larger area with its base facing the side opposite to the deviation, followed by mutual movement of the flaps after the implantation of the endoprosthesis.

The disadvantage of this method is long-term fixation in the external fixation apparatus and, therefore, an increased risk of infection of the endoprosthesis during subsequent operations.

The closest (prototype) is a support device for limb amputations (FR 1046920 A), containing a smooth-walled rod with a support plate with the ability to insert the rod into the medullary canal and place the support plate on the cut end of the bone stump.

The disadvantage of this endoprosthesis is the smooth surface of the rod, the unreliability of attachment of the endoprosthesis to the bone stump with the possibility of rotational displacement and migration from the bone marrow canal. There are no signs of improving the quality of surgical replacement of the supporting end of the bone stump with an endoprosthesis and reducing complications by more reliable fixation of the endoprosthesis rod in the medullary canal and more accurate placement of its supporting plate on the cortical layer of the end of the tubular bone stump.

The method of stump endoprosthetics we propose is aimed at subsequently making it possible to replace the lower limb with a functional exoprosthesis.

The technical solution is to develop a method for reconstructing the stump of the proximal segment of the femur and hip joint for defects of the femur and manufacturing a modular implant for reconstructing segmental defects of the proximal segment of the femur according to anthropometric data, ensuring optimal anatomical compliance with the geometry of the defect, providing the ability to intraoperatively change the length of the implant, providing flexion -extension movements, supportability of the stump in order to create conditions for the further manufacture of an exoprosthesis of the lower limb and thereby create conditions for the physical and social rehabilitation of patients, reduce the preparation time and the total operation time, reduce the volume of surgical trauma, reduce the time for implementing a personalized approach to treatment patients with defects of the proximal segments of the femur and hip joint.

The reconstruction implant of the stump of the proximal part of the femur with the hip joint for exoprosthetics according to the first option is made on the basis of the results of computed tomography and radiography and contains a tubular body made with external concentric protrusions for the possibility of fixing the prolene mesh with cerclage threads and with a cone, a spherical head for connection with the tubular cone housing, a bipolar head for fixation on the spherical head, made in accordance with the size of the acetabulum, a distal end cap to provide support for the stump, a screw for fixing the tubular body and the distal end cap together to provide support for the stump, and a proximal end cap for closing and locking screw The reconstruction implant of the stump of the proximal part of the femur with the hip joint for exoprosthetics according to the second option is made on the basis of the results of computed tomography and radiography and contains a tubular body made with external concentric protrusions for the possibility of fixing the prolene mesh with cerclage threads and with a cone, a spherical head for connection with the tubular cone housing, a bipolar head for fixation on the spherical head, made in accordance with the size of the acetabulum, an extension component with concentric protrusions for the possibility of fixing the prolene mesh with cerclage threads with internal threads for the screw and made of two variable cylinders, while the small cylinder has the ability to fit into a tubular body, a distal end cap to make the stump supportable, a screw to secure the tubular body, extension component and a distal end cap to each other to make the stump bearable, a proximal end cap to close and lock the screw.

When implementing a method for reconstructing the proximal part of the femur with a hip joint for exoprosthetics using an implant according to the first option or the second option, the limb is disarticulated in the hip joint, and it is decided intraoperatively, depending on the volume of soft tissues of the hip that can be preserved, the possibility of using an implant according to In the first option or in the second option, a prolene mesh is fixed to the concentric protrusions of the implant with cerclage threads and muscles and soft tissues are fixed to it, after which a limb stump is formed with preserved soft tissues and muscles, the wound is sutured tightly in layers.

The invention is illustrated by a detailed description, a clinical example and illustrations, which show:

Fig. 1 - diagram of the stump implant: 1 - tubular body; 2 - conical neck; 3- proximal end plug; 4 - distal end plug; 5 - fixing screw; 6 - spherical head of the hip joint endoprosthesis, 8 - concentric protrusions.

Fig. 2 - fragment of the diagram: 1 - tubular body; 2 - conical neck for fixing the spherical head of the hip joint endoprosthesis; 3 - proximal end plug.

Fig. 3 - diagram: 9 - extension component; 8 - concentric protrusions.

Fig. 4 - diagram of a fragment of the lower part of the distal part of the implant: 1 - tubular body; 4-distal end cap; 5 - fixing screw.

Fig. 5 - diagram: 5 - fixing screw.

Fig. 6 - diagram: 6 - spherical head of the hip joint endoprosthesis.

Fig. 7 - diagram: 7 - bipolar head fixing the endoprosthesis in the acetabulum.

Fig. 8 - photo illustration of the assembled stump implant.

Fig. 9 - photo illustration of patient G., before surgery: multiple fistulas of the limb with purulent discharge.

Fig. 10 - radiograph of the femur of patient G., before surgery: periprosthetic osteomyelitis of the proximal segment of the femur.

Fig. 11 is a photo illustration of the intraoperative formation of a femoral stump with installation of a stump implant.

Fig. 12 - photo illustration of the finally formed femoral stump.

Fig. 13 - radiograph of patient G., after endoprosthetics of the femoral stump.

Fig. 14 - X-ray of patient A., lower half of the right thigh: recurrence of paraosteal sarcoma in the soft tissues.

Fig. 15 - X-ray of patient A., upper half of the right thigh: periprosthetic fracture of the right femur.

Fig. 16 - radiograph of patient A., after surgery: reconstructed stump.

The method is carried out as follows.

Indications for stump endoprosthetics are cases of oncological and traumatic lesions of the proximal segment of the femur, when disarticulation of the limb in the hip joint is indicated, but there are conditions for preserving soft tissues in order to form a stump and cover the stump endoprosthesis.

Based on the results of computed tomography and radiography, an implant is made by milling from a titanium alloy (for example, TiAl6V4) (Figure 1).

The implant (Fig. 1-7) is made of titanium alloy (for example, TiAl6V4) and consists of: a tubular body 1 with concentric protrusions 8 and a cone 2 (Fig. 1) with a spherical head 6 (Fig. 6), a bipolar head 7 (Fig. 7), made of medical alloy for fixing the implant to the acetabulum, in accordance with its size, in the lower pole of the implant there is a distal end plug 4 (Fig. 4), designed to provide support to the stump, and in the upper pole there is a proximal end plug plug 3 (Fig.2) for blocking screw 5 (Fig.5). All parts: tubular body 1, distal end cap 4 and proximal end cap 3 are fixed together with screw 5.

The implant is equipped with an additional extension component 9, with concentric protrusions 8 (Figure 3), made in the form of two alternating cylinders with internal threads for a screw, the small cylinder being designed to fit into the tubular body 1 of the implant.

In the operating room, with the patient lying on his back, a skin incision is made from the center of the Poupart ligament vertically down 10 cm and, going around the thigh at this level, it is connected to the beginning of the incision. The femoral vein and artery below the Poupartian ligament are identified, ligated and divided. At the same level, after preliminary treatment, the femoral nerve is crossed. The thigh is externally rotated and the adductor muscles are crossed. Then the limb is rotated medially and the muscles are cut in the anterior and posterior sections. The sciatic nerve is exposed and isolated, and after appropriate treatment it is transected. The hip joint is opened by transversely dissecting its bursa at the neck of the femur. The round ligament is transected, after which the head of the femur is dislocated from the acetabulum. The posterior wall of the hip joint capsule is incised and the limb is removed. Produce thorough hemostasis.

The implant is collected outside the wound (Figure 1).

A tubular body 1 with a cone 2 (Fig. 1, Fig. 2) is connected to a spherical head 6 (Fig. 6) and, if necessary (this is decided intraoperatively, depending on the volume of soft tissue of the thigh that can be preserved) - an extension component 9 ( Fig.3). The distal end cap 4 (Fig. 4) is attached with a screw 5 to the body 1, and the screw 5 is closed with a proximal end cap 3 (Fig. 2), in order to lock the screw 5. The bipolar head 7 (Fig. 7), which is created in accordance with the size of the patient's acetabulum, is fixed on the spherical head 6 (Fig. 1, Fig. 6). The assembled implant (Figure 8) is inserted into the acetabulum (Figure 11).

From the outside of the implant, a prolene mesh is fixed to concentric protrusions 8 (Fig. 1) with cerclage threads and muscles and soft tissues are fixed to it.

The limb stump is finally formed (Fig. 12) with preserved soft tissues and muscles. The wound is sutured tightly in layers and drained with a rubber or PVC tube for 4-6 days.

Thus, the use of the claimed stump implant during limb disarticulation provides more reliable fixation in the acetabulum and soft tissues. As a result, the likelihood of developing pathological processes and complications when replacing the supporting end of the bone stump with an implant is reduced.

A significant difference between the claimed device and the prototype is that the implant is made of a homogeneous, neutral, durable material for the body (titanium alloy TiAl6V4), which ensures replacement of the removed proximal segment of the femur and does not cause negative reactions of body tissues and complications.

Clinical example 1.

Patient G., 39 years old. Diagnosed with: C40.2 osteosarcoma of the distal right femur urT2N0M0 G3 IIBst. Combined treatment in 1995-1996 (PCT + surgery). Aseptic instability of the femoral leg of the endoprosthesis in 1996. Revision arthroplasty in 1996. Periprosthetic infection in 2006. Two-stage revision arthroplasty of the right knee joint 2014-2015. Periprosthetic infection 02.2019. Surgical treatment (05.22.2020. Disarticulation of the right limb in the femoral joint with simultaneous endoprosthetics of the stump of the right femur with an oncological implant).

History: according to the patient, she dates back to 1995, when she noted the appearance of pain and swelling in the area of the right knee joint. Sent to the Russian Cancer Research Center named after. N.N. Blokhina. The diagnosis of osteosarcoma was morphologically verified. 7 courses of PCT were conducted. In 1996, an operation involving resection of the distal part of the right femur was performed with replacement of the defect with a Sivash endoprosthesis. In 2006, an abscess was opened along the m/f, after which a fistula opened (Fig. 9). Received antibacterial therapy. The patient had a spacer installed on August 8, 2014. On June 18, 2015, the patient underwent revision arthroplasty. In February 2019, suppuration of the endoprosthesis and the appearance of fistula tracts (Fig. 10). Sowing on flora at the place of residence. St. aureus. Treatment tactics were discussed at the Russian Cancer Research Center. It is recommended to perform amputation of the right hip at the place of residence. The patient was consulted at the MRRC named after. Tsyba. Treatment tactics were discussed at the consultation.

Taking into account the examination data, a decision was made to conduct surgical treatment involving amputation of the right lower limb at the level of the border of the middle third and lower third of the thigh with simultaneous endoprosthetics of the right hip joint with an implant.

The implant was manufactured by milling from a titanium alloy (TiAl6V4). Bipolar head, made of medical alloy (CoCrMo) in accordance with the size of the patient's acetabulum - 44 mm in diameter.

On May 21, 2020, a surgical operation was performed - disarticulation of the right lower limb in the hip joint with simultaneous endoprosthesis replacement of the stump of the right hip with an implant.

Progress of the operation.

In the operating room, the patient, lying on her back, made an incision in the skin of the right thigh from the center of the Poupart ligament vertically down 10 cm and, going around the thigh at this level, connected it to the beginning of the incision. The femoral vein and artery below the Poupartian ligament were identified, ligated and transected. At the same level, after preliminary treatment, the femoral nerve was crossed. The hip was externally rotated and the adductors were divided. Then the limb was rotated medially and the muscles were cut in the anterior and posterior sections. The sciatic nerve was exposed and isolated, and after appropriate treatment it was transected. The hip joint was opened by transversely dissecting its bursa at the neck of the femur. They cut the round ligament and then dislocated the head of the femur from the acetabulum. The posterior wall of the hip joint capsule was incised and the limb was removed. Careful hemostasis was performed.

Outside the wound, the stump implant of the upper third of the thigh is assembled (Fig. 8).

The bipolar head was inserted into the acetabulum of the ilium. And the stump implant collected outside the wound was fixed to the bipolar head (Fig. 11). From the outside, to the concentric protrusions of the implant, the prolene mesh was fixed with cerclage threads and soft tissues were fixed to it.

A femoral stump was formed with soft tissue fixation. Two doses of Gentacoll 10x10 are installed in the endoprosthesis bed. Soft tissues were sutured around the endoprosthesis to form a cylindrical stump (Fig. 12). The wound was sutured in layers. Stitches on the skin. Aseptic dressing.

The next day after the operation, R-control of the implant installation was carried out (Fig. 13).

Clinical example 2.

Patient A., 33 years old. Diagnosed: C40.2; Paraosteal osteosarcoma n/3 of the right femur; рT2N0M0 G1 Ib. Surgery. Segmental resection of n/2 of the right femur. Endoprosthesis replacement of the right knee joint, 2013. Periprosthetic inflammation. Revision arthroplasty of the right knee joint, 2014. Instability of the femoral component of the endoprosthesis (after a car accident), 2017. Revision arthroplasty of the right knee joint, 2017. Periprosthetic fracture in third of the right femur. Local tumor recurrence, 2023. Disarticulation of the right lower limb in the hip joint with simultaneous endoprosthetics of the stump of the right femur with an oncological implant, 01/20/23.

History: In February 2013, swelling appeared in the right popliteal region. Complaints of pain in the right thigh for 1.5 months. Sent to MRRC Obninsk. The diagnosis has been verified. Surgical treatment: 08.28.13. Segmental resection of n/3 of the right femur. Endoprosthetics of the right knee joint. During control in April 2014, inflammation of the endoprosthesis bed occurred. Outpatient conservative treatment was carried out without success. Surgical treatment 08/25/14. Revision of the endoprosthesis. Removal of the endoprosthesis. Installation of a cement spacer. The second stage involved revision endoprosthetics of the right knee joint. 07/06/17 as a result of a car injury - lateral rotation of the limb by 45 degrees. Clinically - instability of the femoral component of the endoprosthesis. 07/19/07 - Re-endoprosthetics of the right knee joint. In 2023 - repeated periprosthetic fracture in third of the right femur. Upon further examination (Fig. 14, Fig. 15), a relapse of parosteal osteosarcoma was revealed in the soft tissues of n/3 of the right thigh (histologically verified). At the consultation, a decision was made to carry out surgical treatment of disarticulation of the right lower limb at the level of the right hip joint with reconstruction of the stump with an individual implant in order to create conditions for further exoprosthetics.

Progress of the operation.

In the operating room, with the patient lying on his back, a skin incision was made along the outer surface of the right thigh from the hip joint to the middle third of the thigh. Bluntly and sharply separated soft tissues in layers in the projection of the proximal segment of the femur. The proximal bone segment is isolated up to the intertrochanteric fracture line, the bone segment above the fracture line is isolated, isolated from scar tissue, and dislocated from the acetabulum. The limb was amputated at the level of the upper third - middle third of the thigh with the formation of opposing full-thickness flaps. The limb has been removed. The femoral artery and vein were isolated, ligated and stitched separately. The sciatic nerve was isolated, sharply transected, and ligated. Outside the wound, the stump implant of the upper third of the thigh is assembled (Fig. 8), using a tubular body (Fig. 3) and an extension component (Fig. 4), which are connected to each other with a screw (Fig. 5). The bipolar head was inserted into the acetabulum of the ilium. The stump implant assembled outside the wound was fixed to the bipolar head (Fig. 11). From the outside, to the concentric protrusions of the implant, the prolene mesh was fixed with cerclage threads and soft tissues were fixed to it.

A femoral stump was formed with soft tissue fixation. The soft tissues were sutured around the endoprosthesis to form a cylindrical stump. The wound was sutured in layers. Stitches on the skin. Aseptic dressing.

The next day after the operation, R-control of the implant installation was carried out (Fig. 16). X-ray after surgery).

The proposed method made it possible to design the implant in such a way that, after its installation and fastening, the geometric parameters maximally corresponded to the shape and symmetry of the healthy bone, and the area of fixation and attachment of the device to the acetabulum and thigh muscles made it possible to form a supportable stump of a cylindrical shape, which ensured a tight anatomical fit of the implant to the underlying tissues.

The proposed method allows:

- to produce a modular device for the reconstruction of segmental defects of the proximal segment of the femur according to anthropometric data, ensuring optimal anatomical compliance with the geometry of the defect;

- provide the ability to intraoperatively change the length of the implant;

- ensure flexion-extension movements and supportability of the stump in order to create conditions for the further manufacture of an exoprosthesis of the lower limb;

- create conditions for physical and social rehabilitation of patients;

- reduce preparation time and total operation time;

- reduce the volume of surgical trauma;

- reduce the time for implementing a personalized approach in the treatment of patients with defects of the proximal segments of the femur and hip joint.

Also, the advantage of the proposed method of replacement with endoprosthetics of the stump is that it is cost-effective, production and delivery times are minimal. And most importantly, the proposed method is aimed at subsequently making it possible to replace the lower limb with a functional exoprosthesis.

Another positive aspect is that there is a direct connection between the clinician installing the implant and production engineers.

Claims (3)

1. Reconstruction implant of the stump of the proximal part of the femur with a hip joint for exoprosthetics, made on the basis of the results of computed tomography and radiography and containing a tubular body made with external concentric protrusions for the possibility of fixing the prolene mesh with cerclage threads and with a cone, a spherical head for connection with the cone tubular body, a bipolar head for fixation on the spherical head, made in accordance with the size of the acetabulum, a distal end cap to give support to the stump, a screw to fix the tubular body and the distal end cap to give support to the stump, and a proximal end cap to close and locking the screw. 2. Reconstruction implant of the stump of the proximal part of the femur with a hip joint for exoprosthetics, made on the basis of the results of computed tomography and radiography and containing a tubular body made with external concentric protrusions for the possibility of fixing the prolene mesh with cerclage threads and with a cone, a spherical head for connection with the cone tubular body, bipolar head for fixation on the spherical head, made in accordance with the size of the acetabulum, extension component with concentric projections for the possibility of fixing the prolene mesh with cerclage threads with internal threads for the screw and made of two variable cylinders, while the small cylinder has the ability to fit into the tubular body, a distal end plug to make the stump supportable, a screw to secure the tubular body, extension component and distal end plug to each other to make the stump supportable, a proximal end plug to close and lock the screw. 3. A method for reconstructing the proximal part of the femur with a hip joint for exoprosthetics using an implant according to claim 1 or 2, disarticulation of the limb in the hip joint is performed, it is decided intraoperatively, depending on the volume of soft tissues of the hip that can be preserved, the possibility of using an implant according to claim 1 or 2, a prolene mesh is fixed to the concentric protrusions of the implant with cerclage threads and muscles and soft tissues are fixed to it, after which a limb stump is formed with preserved soft tissues and muscles, the wound is sutured tightly in layers.