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Proximal Femur Replacements for an Oncologic Indication Offer a Durable Endoprosthetic Reconstruction Option: A
Rishi Trikha1, Danielle E Greig1, Thomas E Olson1
1Department of Orthopaedic Surgery at the University of California, Los Angeles, Los Angeles, CA, USA.
Clinical Orthopaedics and Related Research
|July 17, 2023
Summary
Proximal femur replacements (PFRs) demonstrate good long-term durability for oncologic indications. These implants offer a durable reconstruction, with survival rates exceeding patient survival in some cases, making them a viable option for limb salvage surgery.
Area of Science:
- Orthopedic surgery
- Oncology
- Biomaterials science
Background:
- Proximal femur replacements (PFRs) are crucial for treating large bony defects caused by proximal femur tumors.
- Limited patient volumes and short follow-up periods characterize existing research on PFRs for oncologic cases.
- Improved systemic therapies necessitate understanding the long-term durability of endoprosthetic reconstructions for musculoskeletal tumors.
Purpose of the Study:
- To compare long-term survival of cemented bipolar PFRs with patient survival across tumor types (benign, aggressive, metastatic).
- To identify common reasons for PFR revisions.
- To determine factors associated with primary PFR survival and survivorship free from conversion to total hip arthroplasty (THA).
Main Methods:
- A retrospective study of 122 patients who underwent primary PFR for oncologic indications between 1980 and 2020.
- Analysis of demographic, oncologic, procedural, and outcome data, including prosthesis survival, patient survival, complication rates, and THA conversion.
- Patient, prosthesis, and limb salvage survival rates were calculated using revision as the endpoint and death as a competing risk.
Main Results:
- Patient survival varied significantly by disease stage; 100% survival at 30 years for benign/low-grade disease versus 6.2% at 5 years for metastatic disease.
- Implant survival at 5, 10, 20, and 30 years was 97%, 81%, 69%, and 51%, respectively.
- Revision rates were 8%, with aseptic loosening and infection being the most common causes. Follow-up time was the only factor associated with revision.
Conclusions:
- Cemented bipolar PFRs are a durable reconstruction technique for oncologic indications.
- PFRs demonstrate longevity, particularly in high-grade or metastatic disease, where implant survival can exceed patient survival.
- Further multi-institutional collaborations are needed due to the rarity of these cases to enhance prognostic accuracy.
