Outcomes of Proximal Femoral Replacement for Nononcologic Indications in Australia

Proximal femoral replacement (PFR) is commonly used to reconstruct the proximal femur following oncologic resection. A PFR may also be used for nononcologic indications; however, there is limited literature on outcomes following these procedures. The aim of this study was to investigate usage, implant survivorship, and patient mortality following primary and first revision PFR in Australia.

Data from the Australian Orthopaedic Association National Joint Replacement Registry were obtained for primary and first revision PFR procedures performed for nononcologic indications from September 1, 1999, to December 31, 2023. There were seven PFR prostheses identified. Kaplan-Meier estimates of implant survival were used to determine cumulative percent revision (CPR), and reasons for revision were examined. A 1-year patient mortality was determined.

There were 199 primary PFR procedures identified, including 58 hemiarthroplasties and 141 total conventional procedures. The most common indications were fractured neck of femur (46.2%) and failed internal fixation (29.1%). At three years, the cumulative percent revision was 11.5% for total conventional PFR. Common reasons for revision included instability (55.6%) and infection (33.3%). The 1-year patient mortality was 15.7%. There were 161 first revision PFR procedures identified. The most common indication for revision was fracture (47.8%). At three years, the cumulative percent of second revision was 20.2%. Common reasons for the second revision included infection (37.0%) and instability (37.0%). The 1-year patient mortality was 20.0%.

The use of PFR for nononcologic indications is increasing. Although PFR offers an attractive salvage option for complex proximal femoral pathology, surgeons need to be mindful of the high revision and mortality rates associated with this procedure. Hemiarthroplasty should be considered where possible to reduce the risk of instability.

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