Total femoral replacement for oncologic indications: Functional outcomes, complications, and implant survival rates

Total femoral replacements for oncological indications are a rare indication, and there is limited data on functional outcomes, complications, and implant survival rates. The purpose of this study was to investigate functional outcomes, the rate and nature of com plications associated with this technique, and the survival rates of the implant used.

This is a retrospective case series from a single subspeciality orthopedic oncology unit in an urban referral center that evalu ated patients treated between January 2000 and May 2023. A total of 27 patients were included in the final analyses. The Musculoskeletal Tumor Society (MSTS) scoring system was used for functional evaluation. The received adjuvant-neoadjuvant chemotherapies and radio therapies, resected soft tissues during index surgery, complications, the number and extent of secondary surgical interventions, and data on local recurrence were recorded through chart review. Data on implant loss for any reason was also recorded. Complication-freesurvival rate and implant- loss-free survival rate were calculated using the Kaplan-Meier estimator at 60 months. The Henderson clas sification system was used to categorize failure modes.

The median MSTS score at the most recent follow-up was 21 (range: 17-23). A total of 16 complications occurred in 13 patients. Only one of these complications was an intraoperative issue. Ten of the 16 complications necessitated one or more secondary surgical interventions. The most common complication was infection, occurring in 8 patients. Other complications included hip pain that neces sitated total hip arthroplasty, leg-length discrepancy, and spontaneous patella fractures, each occurring in 2 patients. At 60 months, 10 patients (37%) experienced complications. The mean estimated complication-free survival was 39 months (95% CI: 29-49). There were 6 patients in total who experienced implant loss. Infection was the sole cause of implant loss in 4 patients. Implant loss occurred in 1 patient due to recurrence and in another patient due to a combination of recurrence and infection, which led to amputation in both cases. The mean estimated implant-loss-free survival was 50 months (95% CI: 42-58).

Total femoral replacement is reserved for distinctly specific oncological indications, where other more biological reconstruction methods are not feasible. This technique could yield satisfactory functional outcomes, along with a favorable implant survival rate and complication-free survival rate at mid-term. Infection remains the most common complication associated with this technique, while the main causes of implant failure are infection and local recurrence. Future studies focusing on strategies to prevent such complications and define clearer patient selection criteria may substantially improve the overall success of this technique.   Cite this article as: Kaya H, Vahabi A, Daştan AE, Çolak TS, Keçeci B, Sabah D. Total femoral replacement for oncologic indications: Functional outcomes, complications, and implant survival rates. Acta Orthop Traumatol Turc., 2025;59(6):477-484.