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Background <p>Proximal femoral replacement (PFR) is a critical limb-salvage strategy for managing massive proximal femoral bone loss due to oncologic and non-oncologic conditions. Although oncologic outcomes are well described, evidence surrounding PFR for infection, periprosthetic fracture, and mechanical failure remains limited. This study evaluates short- to mid-term outcomes following PFR for multiple indications and compares primary with revision procedures.</p> Methods <p>We retrospectively reviewed all patients undergoing PFR at a Level I trauma center from 2009 to 2023. Cases were categorized by procedure type (primary vs. revision) and indication (tumor, infection, other causes). Outcomes included operative time, complications according to the Henderson classification, reoperation rates, and functional outcomes.</p> Results <p>A total of 81 patients (84 procedures) were included with a median follow-up of 7 months (IQR 0–31); 57.1% were lost to follow-up. The overall complication rate was 42.9%, significantly higher in revision procedures than in primary PFRs. Infection (Henderson Type IV) was the most frequent complication and occurred predominantly in revision surgeries. No cases of aseptic loosening (Type II) were identified. Reoperation was required in 29% of all procedures, with the highest rates observed in infection cases.</p> Conclusions <p>PFR remains a reliable limb-salvage option for extensive proximal femoral deficiency. Revision procedures, especially infection-related cases, carry substantially higher risks of complications and reoperation. In contrast, primary oncologic PFRs showed comparatively favorable outcomes. Infection remains the principal barrier to durable results, underscoring the need for optimized perioperative strategies.</p> Level of evidence <p>Therapeutic Level III (retrospective cohort study).</p>

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Proximal femoral replacement for oncologic and non-oncologic indications: a retrospective study over a 13-year period

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月31日

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  • Ricardo Ramón,
  • Aktas Gökmen,
  • Jorge Mayor,
  • Hür Özbek,
  • Adrian Niemann,
  • Luis Marín,
  • Tarek Omar Pacha,
  • Mohamed Omar,
  • Marco Ezechieli,
  • Tilman Graulich

摘要

Background

Proximal femoral replacement (PFR) is a critical limb-salvage strategy for managing massive proximal femoral bone loss due to oncologic and non-oncologic conditions. Although oncologic outcomes are well described, evidence surrounding PFR for infection, periprosthetic fracture, and mechanical failure remains limited. This study evaluates short- to mid-term outcomes following PFR for multiple indications and compares primary with revision procedures.

Methods

We retrospectively reviewed all patients undergoing PFR at a Level I trauma center from 2009 to 2023. Cases were categorized by procedure type (primary vs. revision) and indication (tumor, infection, other causes). Outcomes included operative time, complications according to the Henderson classification, reoperation rates, and functional outcomes.

Results

A total of 81 patients (84 procedures) were included with a median follow-up of 7 months (IQR 0–31); 57.1% were lost to follow-up. The overall complication rate was 42.9%, significantly higher in revision procedures than in primary PFRs. Infection (Henderson Type IV) was the most frequent complication and occurred predominantly in revision surgeries. No cases of aseptic loosening (Type II) were identified. Reoperation was required in 29% of all procedures, with the highest rates observed in infection cases.

Conclusions

PFR remains a reliable limb-salvage option for extensive proximal femoral deficiency. Revision procedures, especially infection-related cases, carry substantially higher risks of complications and reoperation. In contrast, primary oncologic PFRs showed comparatively favorable outcomes. Infection remains the principal barrier to durable results, underscoring the need for optimized perioperative strategies.

Level of evidence

Therapeutic Level III (retrospective cohort study).