25dkou343 10.3205/25dkou343 urn:nbn:de:0183-25dkou3436 Meeting Abstract Meißner Meißner Nils N

Department of Orthopedic Surgery, Mayo Clinic, Rochester, USA Klinik für Operative Orthopädie, Sana Kliniken Sommerfeld, Kremmen, Deutschland

author Carstens Carstens Mason M

Department of Orthopedic Surgery, Mayo Clinic, Rochester, USA

author Larson Larson Dirk D

Department of Orthopedic Surgery, Mayo Clinic, Rochester, USA

author Bedard Bedard Nicholas N

Department of Orthopedic Surgery, Mayo Clinic, Rochester, USA

author Hannon Hannon Charles C

Department of Orthopedic Surgery, Mayo Clinic, Rochester, USA

author Abdel Abdel Matthew M

Department of Orthopedic Surgery, Mayo Clinic, Rochester, USA

author German Medical Science GMS Publishing House

Düsseldorf

610 20251031 engl This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). M0634 343 Deutsche Gesellschaft für Orthopädie und Unfallchirurgie Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie Deutsche Gesellschaft für Unfallchirurgie Berufsverband für Orthopädie und Unfallchirurgie Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2025) Abstracts | AG Evidenzbasierte Medizin | Primär- und Revisionsendoprothetik – perioperativer Verlauf Berlin 20251028 20251031 AB52-4101 TextObjectives and questions: Proximal femoral replacement (PFR) is a salvage procedure in revision total hip arthroplasty (THA) for extensive femoral bone loss. This study aimed to evaluate implant survivorship and clinical outcomes of PFR for non-oncologic indications at midterm follow-up.Material and methods: Sixty-one consecutive PFRs for non-oncologic indications performed between 2000 and 2022 at a single academic institution were reviewed. The most common indication was periprosthetic fracture and reimplantation after periprosthetic joint infection (each 33%), followed by aseptic loosening (31%) and dislocation (3%). Femoral bone loss was severe in all patients, with 49% Paprosky type IIIb defects and 51% Paprosky type IV defects. The majority of PFRs were cemented (98%). Constrained liners were used in 26 patients (43%), while standard head-liner constructs were used in 25 patients (41%) and dual-mobility constructs in 10 patients (16%). Outcomes of interest included implant survivorship, mortality rates, and clinical outcomes. Revision, reoperation, dislocation, and aseptic failures were considered as time-to-event outcomes, and were analyzed using the cumulative incidence function, accounting for the competing risk of death. The mean patient age was 77 years, with 67% being female. Mean follow-up was 5 years. Results: The 5-year cumulative incidence of any revision and any revision of the femoral component was 24% and 8%, respectively (Figure 1 ). The 5-year cumulative incidence of any reoperation was 30%. Dislocation was the most common reason for revision (n=8), with a 5-year cumulative incidence of 15%, followed by periprosthetic joint infection (n=4), periprosthetic fracture (n=2), and aseptic loosening (n=1). Among the 10 patients who dislocated, 8 patients (80%) underwent revision to a constrained liner at a mean of 2 years. The 5-year cumulative incidence of revision for aseptic loosening of the PFR was 2%. The 2- and 5-year mortality rates were 14% and 42%, respectively.Discussion and conclusions: In this complex cohort of 61 PFRs for non-oncologic revision THA, revision and reoperation rates were modest, with dislocation as the predominant failure mode. Although aseptic loosening was rare, mortality remained high. 0

1 1 Figure 1: Cumulative incidence of revision with death as a competing risk factor.

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