Contemporary Outcomes of Proximal Femoral Replacement as a Salvage Treatment in Nononcologic Severe Bone Loss.
Academic Article
Overview
abstract
BACKGROUND: Severe proximal femoral bone loss remains a challenging problem in revision total hip arthroplasty (rTHA). Proximal femoral replacements (PFRs) are salvage options for severe bone loss in complex rTHA. The purpose of this study was to describe the survivorship and clinical outcomes of PFR for nononcologic indications. METHODS: We performed a retrospective review of 49 patients who underwent 50 PFRs from January 2014 to May 2021 at a single institution. Indications for PFR included periprosthetic femur fracture (n = 20), reimplantation after periprosthetic joint infection (n = 18), aseptic loosening with severe proximal femoral bone loss (n = 10), heterotopic ossification (n = 1), and instability (n = 1). The mean age was 70 years. The mean body mass index was 28 and 25 (50%) patients were women. The mean follow-up was three years. Kaplan-Meier analysis was used to assess survivorship free from reoperation, rerevision, and dislocation. RESULTS: The 2-year survivorship free from all-cause reoperation was 78%, and the 2-year survivorship free from rerevision was 87%. Overall, there were 11 (22%) reoperations, with indications including periprosthetic joint infection (n = 6), aseptic loosening (n = 2), hematoma evacuation (n = 1), instability (n = 1), and delayed wound healing (n = 1). There were eight (16%) patients who dislocated after PFR. The mean Hip Injury and Osteoarthritis Outcome Score for Joint Replacement increased from 48 preoperatively to 77 at two years postoperatively (P < 0.001). CONCLUSIONS: In this series of PFRs performed in complex rTHA, there was low 2-year survivorship free from all-cause reoperation (78%) and rerevision (87%). Furthermore, the dislocation rate was high at 16%. However, only one patient (2%) was revised for femoral component aseptic loosening. This study highlights the complexity of these patients and the utilization of PFR as a salvage option.
