German Congress of Orthopaedics and Traumatology (DKOU 2025)
Retrospective evaluation of outcomes and complications following proximal femoral replacement for various indications
2St. Vincenz-Kliniken, Paderborn-Salzkotten, Deutschland
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Objectives and questions: Proximal femoral replacement (PFR) is a limb-salvage procedure indicated for tumor resection, periprosthetic fractures, and revision surgeries for septic or aseptic loosening. While outcomes following tumor resection are well documented, data on PFR for other indications remain limited. This study evaluates PFR outcomes across various indications and compares them to tumor-related procedures.
Material and methods: A retrospective analysis was performed on patients who underwent PFR between October 2009 and August 2023 at our Level I trauma center. A total of 81 patients received 84 PFRs, including 42 primary and 42 revision procedures. Indications included tumor resection (n = 43), infection (n = 20), and other causes (n = 21), such as periprosthetic fractures and mechanical complications. Outcomes assessed included revision rates, operative time, and perioperative complications classified by Henderson.
Results: The mean follow-up was 23.4 ± 37.8 months, with an overall complication rate of 43%. Revision rates were higher for revision surgeries (57%) compared to primary surgeries (29%). The mean operative time was 250 minutes for primary surgeries and 201 minutes for revisions. Complications varied by Henderson classification: primary surgeries had 5 Type I, 1 Type III, 1 Type IV, and 5 Type V cases, while revisions had 4 Type I, 6 Type III, and 6 Type IV cases.
Revision rates were 12% for tumor surgeries, 75% for infection-related cases, and 43% for other causes. Mean operative times were 260 minutes for tumor surgeries, 188 minutes for infections, and 191 minutes for other indications. Complications varied: tumor surgeries had 5 Type I, 1 Type III, 1 Type IV, and 5 Type V cases; infection-related surgeries had 1 Type I, 2 Type III, and 12 Type V; other causes had 3 Type I, 4 Type III, and 2 Type IV.
Tumor recurrence was observed in 12% (n = 5) of cases. No cases of aseptic implant failure were observed as a complication.
Discussion and conclusion: In this cohort, primary PFRs had lower complication and revision rates compared to revisions. Tumor recurrence and soft tissue failure were common in primary surgeries, while infection predominated in revisions. Despite longer operative times, tumor-related PFRs had lower complication rates.PFR remains a viable limb-salvage option, but revision surgeries, especially those due to infection, carry significantly higher risks, being the most challenging complication.
