Revision of THR to Adler Pantheon proximal femoral EPR for metastatic bone disease progression


Subscribe to get full access to this operation and the extensive Hip Surgery Atlas.


Professional Guidelines Included

Learn the Revision of THR to Adler Pantheon proximal femoral EPR for metastatic bone disease progression surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Revision of THR to Adler Pantheon proximal femoral EPR for metastatic bone disease progression surgical procedure.

Metastatic bone disease commonly presents to the orthopaedic surgeon, bone being the most common site of metastasis. There are various Skeletal Related Events, or “SREs”, related to malignant bone disease most commonly pathological or impending fracture, hypercalcaemia, spinal cord compression and severe pain. These may require surgery and/or radiotherapy to palliate pain and also to maintain both the capacity to walk and quality of life.

Due to advances in the holistic management of common malignancies, particularly breast and prostate carcinoma, patient survival has been extended to the point that these are now considered  chronic diseases rather than terminal diseases. Consequently, the prevalence of metastatic bone disease continues to escalate.

The goals of surgical intervention for solitary metastases are to resect the tumour en-bloc and reconstruct with curative intent but as a minimum to extend life. To reconstruct segmental bone defects after en-bloc excision endoprosthetic replacements are commonly used. Other options include allograft or allograft-prosthetic composites, but these would not typically be appropriate in metastatic bone disease. Such cases should be referred to a centre specialising in orthopaedic oncology.

With multiple sites of disease a cure is not possible surgically, therefore the treatment intent is to palliate pain, allow early weight-bearing and minimise the risk of mechanical failure, necessitating revision surgery. Carefully planning the right operation to achieve these goals is imperative. Reconstructions should aim to last the lifetime of the patient and therefore a revision procedure such as this case should be avoided. These are the guiding principles described in the British Orthopaedic Oncology Society guidelines 2015, which are also navigable from the guidelines section associated with this technique.

In this case none of those clear principles were adhered to. This patient had a solitary femoral  metastasis treated intra-lesionally with a cemented total hip replacement which failed due to tumour progression within six months necessitating revision surgery for limb-salvage.

The Adler Pantheon endoprosthetic replacement utilises the latest technologies to avoid the commonest causes of failure and revision in proximal femoral endoprostheses: a 3D printed bridging collar encourages both periosteal and endosteal ingrowth and ongrowth to prevent aseptic loosening; Agluna (silver) surface treatment is now available to prevent early prosthetic joint infection.

Author:Jonathan Stevenson FRCS(Tr & Orth)

Institution: Royal Orthopaedic Hospital, Birmingham, UK

  • Each operation and the questions associated become a named course in the CPD section
  • The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
  • You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
  • The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
  • There are four possible answers of which one is correct (or on occasion more correct) than the others.
  • There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
  • The course is completed once all the lessons are read and quizzes submitted and passed.
  • On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
  • Your dashboard also will contain a record of the time you have spent logged onto and using the site.
  • The timer suspends after 5 minutes though if there is no activity.
  • When you restart you will resume at the same point in the module.
  • Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
    The pass mark is 75%.
  • If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
  • Once these have been read you can re-do just the questions you failed on.
  • Once you have passed the quiz you can return at a future stage & resit .

CPD Points:

  • Operation Quiz – 1 CPD point
  • Surgical steps Quiz – 1/4 CPD point
  • Implants Quiz – 1/4 CPD point
  • Problem case Quiz – 1/2 CPD point

One CPD point equates to one hour of academic activity


Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.

Our content is designed for both Surgeons in independent practice and Surgeons in training.


  • Did you find this technique helpful?
  • YesNo


Logo Logo Logo Logo Logo Logo Logo

Associates & Partners

Logo Logo Logo Logo Logo Logo