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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.
Arthroplasty Today
|January 24, 2025
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.
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.
