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Single-Institution Experience With Nononcologic Total Femoral Replacement.

Ryan Ouillette1, Kevin Chen1, Matthew Dipane1

  • 1Department of Orthopedic Surgery, University of California, Los Angeles, Santa Monica, CA, USA.

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PubMed
Summary

Total femur replacement (TFR) is a vital limb-salvage surgery for extensive bone loss during revision hip and knee arthroplasty. While TFR has a high revision rate, most patients regain ambulatory function, preserving limb use.

Keywords:
Periprosthetic fractureProsthetic joint infectionRevision arthroplastyTotal femur replacement

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Area of Science:

  • Orthopedic Surgery
  • Arthroplasty
  • Limb Salvage Procedures

Background:

  • Revision hip and knee arthroplasty volume is increasing.
  • Total femur replacement (TFR) is a critical salvage option for extensive bone loss.
  • Prior TFR outcomes have shown mixed results.

Purpose of the Study:

  • To characterize outcomes of nononcologic TFR in a large, single-center series.
  • To evaluate revision rates and indications for TFR.
  • To assess complications, ambulatory status, and reoperation rates.

Main Methods:

  • Retrospective analysis of 23 nononcologic TFR procedures (2012-2021).
  • Primary outcomes: TFR revision rate and indication.
  • Secondary outcomes: reoperation rate, complications, ambulatory status, assistive device use.

Main Results:

  • Predominant indications for TFR: periprosthetic fracture (65.2%) and infection (34.8%).
  • Over half of patients (52.2%) required TFR revision, mainly for infection (75.0%).
  • 63.6% of patients achieved ambulation; low rates of amputation (1) and mortality (1).

Conclusions:

  • Nononcologic TFR is a viable limb-salvage option for extensive bone loss in revision arthroplasty.
  • Despite high revision and infection risks, TFR preserves limb function for most patients.
  • Careful patient counseling regarding potential complications is essential for TFR consideration.