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Proximal femoral replacement for non-oncologic reconstruction: functional outcomes and survivorship in 30 patients
Edgar Manuel Bodu Lamberti1, Gary Monclou2, Camila Karduss Preciado1
1University of La Sabana, Chía, Colombia.
Background:
Proximal femoral replacement (PFR) is a useful salvage option for reconstruction after massive proximal femoral bone loss. However, functional outcomes in non-oncologic cases remain underreported. The purpose of this study was to evaluate postoperative function, complications, and implant survival after PFR performed for non-oncologic indications.
Methods:
We retrospectively reviewed 63 consecutive non-oncologic PFRs performed between 2018 and 2023. After applying exclusion criteria and accounting for duplicates and patients lost to follow-up, 30 participants were available for final evaluation. The primary outcome was the postoperative modified Harris Hip Score (mHHS). Secondary outcomes included postoperative complications, infection-free survival, and revision-free arthroplasty survival. Univariate linear regression analyses were performed to identify factors associated with postoperative mHHS.
Results:
The study cohort included 30 patients (63.3% female) with a mean age of 64.4 ± 13.6 years and mean follow-up of 31.4 months. The mean postoperative mHHS was 54.0 ± 22.4. Male patients demonstrated higher unadjusted mHHS than females (69.2 ± 18.5 vs. 45.2 ± 19.8; p = 0.003). The Kaplan-Meier estimated infection-free survival was 96.4% (95% CI, 89.8-100%) at 12 months, 91.4% (95% CI, 80.4-100%) at 24 months, and 73.1% (95% CI, 46.3-100%) at 60 months. Revision arthroplasty survival was 85.1% (95% CI, 68%, 100%) at 12 and 24 months, and 49.7% (95% CI, 25.6-96.3%) at 60 months. Overall complications occurred in 15 patients (50%), with periprosthetic joint infection being the most frequent (n = 4, 13.3%).
Conclusions:
PFR for non-oncologic indications provides modest limb salvage and functional outcomes, although complications remain common. Functional recovery appears multifactorial and not solely dependent on implant design or fixation method. These findings may support the use of PFR as a salvage option in carefully selected non-oncologic cases, while emphasizing the need for larger prospective studies to improve patient selection and outcomes.