26dkou243 10.3205/26dkou243 urn:nbn:de:0183-26dkou2434 Meeting Abstract Valentini Valentini Marisa M

Orthopaedics and Trauma, Medical University of Graz, Graz, Österreich

author Svehlik Svehlik Martin M

Orthopaedics and Trauma, Medical University of Graz, Graz, Österreich

author Leithner Leithner Andreas A

Orthopaedics and Trauma, Medical University of Graz, Graz, Österreich

author Bergovec Bergovec Marko M

Orthopaedics and Trauma, Diakonissen Schladming Clinic, Schladming, Österreich

author EMSOS TFR Study Group

Multiple, Italy, Turkey, Italy, Germany, South Africa, Israel, Finland, France, Portugal, Slovenja, Poland, Österreich

author Smolle Smolle Maria Anna MA

Orthopaedics and Trauma, Medical University of Graz, Graz, Österreich

author German Medical Science GMS Publishing House

Düsseldorf

610 20261020 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). M0659 243 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 2026) Abstracts | Tumorchirurgie 1 Berlin 20261020 20261023 DKOU26_Abs_2052 TextObjectives and questions: Total femur replacements (TFRs) are rarely performed procedures in orthopaedic oncology and revision arthroplasty surgery. These procedures are associated with a high proportion of complications and revisions, most frequently because of infection. Revision risk and associated parameters in a high-risk population remain to be determined. Therefore, this study asked: (1) What is the cumulative incidence of implant revision and hip disarticulation after TFR at 2 and 5 years after the index procedure? (2) Which patient-related and procedure-related parameters associate with implant revision and hip disarticulation? (3) What are the overall mortality, oncologic outcome, minor complications, and reoperations in this study population?Material and methods: This was a retrospective, multicenter European Musculo-Skeletal Oncology Society (EMSOS) study reporting data from 14 international participating centers. The study included 143 patients who received a TFR between January 1, 1990, and March 31, 2024. The mean ± SD age at index operation was 44 ± 24 years, and 52% (74 of 143) of the participants were men. Most patients underwent TFR for oncologic indications (76% [108 of 143]; 12% [13 of 108] extendable growth prostheses). Complications, revisions, amputations, as well as clinical and surgical data were documented. We investigated major complications and hip disarticulation in a competing risk framework with death as the competing event.Results: The cumulative incidence of implant revision at 2 and 5 years was 24% (95% confidence interval [CI] 16% to 31%) and 35% (95% CI 26% to 44%). The cumulative incidence of hip disarticulation at 2 and 5 years was 4% (95% CI 1% to 7%) and 10% (95% CI 4% to 16%). We found that advanced patient age was associated with an increased risk for major complications (subdistribution HR 1.01 [95% CI 0.98 to 1.02]; p = 0.17; cause-specific HR 1.01 [95% CI 1.00 to 1.03]; p = 0.023). Furthermore, advanced patient age (subdistribution HR 1.03 [95% CI 1.01 to 1.05]; p < 0.001; cause-specific HR 1.05 [95% CI 1.02 to 1.07]; p < 0.001) and no mesh graft (subdistribution HR 0.30 [95% CI 0.10 to 0.92]; p = 0.035; cause-specific HR 0.46 [95% CI 0.15 to 1.42]; p = 0.18) were associated with higher risk for hip disarticulations. No other risk factor was associated with altered risk for implant revision or hip disarticulation.Discussion and conclusions: Patients should be informed about the high incidence of revision associated with TFR and the secondary hip disarticulation risk. The identified risk factors may be considered upon patient counseling, as well as for surgical decision-making. Our findings confirm the beneficial effects of mesh grafts. As technical solutions for patients undergoing amputations advance, the indications for these complex reconstructions should be chosen carefully, especially in older patients. 0 0 0 0