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Long-term results of proximal femoral replacement for non-neoplastic disorders
A L Malkani1, J J Settecerri, F H Sim
1Mayo Graduate School of Medicine, Rochester, Minnesota, USA.
Insights
Proximal femoral replacement prostheses offer hip salvage for massive bone loss, but longer follow-up reveals a higher failure rate, with dislocation and aseptic loosening being common complications.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
Background:
- Massive bone loss in the proximal femur presents significant reconstructive challenges.
- Revision hip arthroplasty often involves complex cases with prior surgical history.
Purpose of the Study:
- To evaluate the long-term outcomes and survivorship of total hip arthroplasty using proximal femoral replacement prostheses in patients with massive bone loss.
- To identify the complication rates and functional outcomes associated with this reconstructive technique.
Main Methods:
- Retrospective review of 50 consecutive total hip arthroplasties utilizing proximal femoral replacement prostheses in 49 patients.
- Assessment of clinical and radiographic outcomes, including Harris hip scores and prosthesis survivorship, over a mean follow-up of 11.1 years.
Main Results:
- Preoperative Harris hip scores improved significantly postoperatively, from an average of 46 to 80 at one year and 76 at latest follow-up.
- The most frequent complication was dislocation (11 hips), followed by aseptic loosening requiring revision of femoral (4) and acetabular (7) components.
- Predicted 12-year survivorship, with revision as the endpoint, was 64%.
Conclusions:
- While proximal femoral replacement prostheses can salvage hips in cases of massive bone loss, preliminary encouraging results are tempered by a higher-than-anticipated long-term failure rate.
- Dislocation and aseptic loosening represent significant challenges impacting the longevity of these prostheses.
Abstract:
We reviewed retrospectively 50 consecutive total hip arthroplasties with proximal femoral replacement prostheses in 49 patients. All the patients had massive bone loss. There were 31 women and 18 men who had undergone a mean of 3.1 hip operations. At the last review, 15 patients had died and two had been lost to follow-up, so that 32 patients (33 hips) were available for assessment. The mean age of the patients at the time of the operation was 60.6 years. The mean length of clinical follow-up was 11.1 +/- 4 years, and mean radiographic follow-up was 7.6 +/- 3.2 years. The average preoperative Harris hip score was 46 +/- 13 points, which improved to 80 +/- 10 points after one year and to 76 +/- 16 points at the latest follow-up. The most frequent complication was dislocation, which occurred in 11 hips. Four femoral components and seven acetabular prostheses were revised because of aseptic loosening. With revision at the end point, survivorship after total hip arthroplasty with a proximal femoral replacement prosthesis was predicted to be 64% at 12 years. Although our preliminary results of hip salvage with a proximal femoral replacement prosthesis were encouraging, a longer follow-up has shown a higher rate of failure.