Which Factors Associate With Implant Revision and Hip Disarticulation After Total Femur Replacement? A Retrospective...

Area of Science:

• Orthopaedic Oncology
• Revision Arthroplasty Surgery
• Musculoskeletal Oncology

Background:

• Total femur replacements (TFRs) are complex procedures with a high complication rate, often due to infection.
• Understanding revision risks and associated factors in high-risk populations is crucial for TFR outcomes.

Purpose of the Study:

• To determine the cumulative incidence of implant revision and hip disarticulation after TFR.
• To identify patient- and procedure-related factors associated with revision and hip disarticulation.
• To assess overall mortality, oncologic outcomes, and complications in TFR patients.

Main Methods:

• Retrospective, multicenter study of 143 patients undergoing TFR across 14 European centers.
• Data collected on complications, revisions, amputations, and clinical/surgical details.
• Competing risk analysis used to evaluate major complications and hip disarticulation, with death as a competing event.

Main Results:

• Cumulative incidence of TFR revision was 24% at 2 years and 35% at 5 years.
• Cumulative incidence of hip disarticulation was 4% at 2 years and 10% at 5 years.
• Advanced patient age was linked to increased risk of major complications and hip disarticulation; mesh grafts showed a protective effect against hip disarticulation.

Conclusions:

• Patients must be informed of the significant revision and hip disarticulation risks associated with TFR.
• Identified risk factors, including advanced age and mesh graft use, should guide patient counseling and surgical decisions.
• Careful consideration of TFR indications is advised, especially for older patients, given the complexity and potential for secondary hip disarticulation.