Proximal Femoral Replacement Outcomes for Oncologic versus Nononcologic Indications: A Systematic Review and...

Proximal femoral replacement (PFR) is a modular endoprosthetic reconstruction technique traditionally used for oncologic resections, but increasingly applied to nononcologic conditions. This systematic review and meta-analysis aimed to compare complications, revision and amputation rates, implant survivorship, and patient survival between oncologic and nononcologic PFR cases.

A systematic search of PubMed, Embase, and Scopus was conducted through September 2025. Studies were included if they reported clinical outcomes of PFR with separate data for oncologic and nononcologic indications. Outcomes such as the overall complication rate, dislocation, periprosthetic fracture, and infection rate were collected. Data were pooled using random-effects models, and heterogeneity was quantified with the I² statistic. There were 42 studies that met inclusion criteria, encompassing 2,804 PFR cases (2,081 oncologic and 723 nononcologic). The patient mean age was higher in nononcologic cohorts (72 versus 54 years, P < 0.001).

The pooled overall complication rate was 27% (95% confidence interval (CI) [0.21 to 0.32]), without significant difference between groups (P = 0.93). Dislocation or instability occurred more frequently in nononcologic PFR (9 versus 5%; P = 0.04), whereas rates of infection, aseptic loosening, and periprosthetic fracture were similar. Revision rates were significantly higher in nononcologic cases (13% [0.08 to 0.18]) than in oncologic cases (6% [0.04 to 0.09]; P = 0.03). Amputation was rare overall but more common in oncologic series (1 versus 0%; P = 0.02). Overall implant survival rate was 90.8, 89.4, and 77.1% at one, five, and 10 years, respectively. The five-year patient survival was markedly lower in oncologic cohorts (46 versus 67%; P < 0.001).

The PFR demonstrates acceptable complication and survivorship rates across indications. Although oncologic patients experience higher mortality, nononcologic cases have a greater revision risk. However, given the substantial heterogeneity across included studies, results should be interpreted with caution and underscore the need for future standardized, prospective investigations.