Bipolar proximal femoral replacement prostheses for musculoskeletal neoplasms

While bipolar proximal femoral replacement prostheses (PFRP) have become a common treatment for tumors of the proximal femur, long-term results are not specified in the literature. The objective was to determine the complication and revision rates of bipolar PFRP and compare them to historical controls of bipolar hemiarthroplasties for nontumor indications. Information was retrospectively collected on 62 patients who received bipolar PFRP with cemented diaphyseal stems for primary or metastatic disease of the proximal femur from 1981 to 2003. Mean followup was 5 years. Twelve of 62 (19%) bipolar PFRPs underwent revision. Aseptic loosening was the most common complication with six (10%) undergoing revision. None were converted to THA due to acetabular erosion. Three patients (5%) had problems with dislocation and three (5%) had deep infections. Mean MSTS functional rating was 71% of normal function. The limb salvage rate was 98% and the 5-year event-free prosthetic survival was 79%. Bipolar PFRPs were found to have higher revision, dislocation, and deep infection rates compared to bipolar hemiarthroplasty for nontumor indications, but a lower rate of conversion to THA due to acetabular erosion. Bipolar PFRPs have good long-term durability with some complications, but are able to preserve the limb and provide good function for patients.