Abstract
BackgroundSeveral studies have evaluated the survivorship and clinical outcomes of proximal femoral replacement (PFR) in complex primary and revision total hip arthroplasty with severe proximal femoral bone loss; however, there remains no consensus on the overall performance of this implant. We therefore performed a systematic review of the literature in order to examine survivorship and complication rates of PFR usage.MethodsA systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. A comprehensive search of PubMed, MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews was conducted for English articles using various combinations of keywords.ResultsIn all, 18 articles met the inclusion criteria. A total of 578 PFR were implanted. The all-cause reoperation-free survivorship was 76.6%. The overall complication rate was 27.2%. Dislocation was the most common complication observed and the most frequent reason for reoperation with an incidence of 12.8 and 7.6%, respectively. Infection after PFR had an incidence of 7.6% and a reoperation rate of 6.4%. The reoperation rate for aseptic loosening of the implant was 5.9%. Overall, patients had improved outcomes as documented by postoperative hip scores.ConclusionPFR usage have a relatively high complication rate, however, it remains an efficacious treatment option in elderly patients with osteoporotic bone affected by severe proximal femoral bone loss. Modular designs have shown reduced dislocations rate and higher survivorship free from dislocation. However, PFR should only be used as salvage procedure when no other reconstruction options are available.
Highlights
Several studies have evaluated the survivorship and clinical outcomes of proximal femoral replacement (PFR) in complex primary and revision total hip arthroplasty with severe proximal femoral bone loss; there remains no consensus on the overall performance of this implant
We aimed to examine (1) what is the survivorship from reoperation when PFRs are used? (2) what complications are most common in PFRs? (3) what is the cumulative incidence of hip dislocation with PFRs? (4) do PFRs provide adequate implant survivorship in line with alternative treatment methods in the management of severe femoral bone loss? and (5) what are their clinical outcomes?
Study selection The search query resulted in 2473 abstracts that were examined to determine if they met the inclusion criteria related to the outcome of PFR for primary and revision Total hip arthroplasty (THA) in non-oncologic patients (Fig. 2)
Summary
Several studies have evaluated the survivorship and clinical outcomes of proximal femoral replacement (PFR) in complex primary and revision total hip arthroplasty with severe proximal femoral bone loss; there remains no consensus on the overall performance of this implant. Despite the overall success, revision THA remains a costly and challenging procedure to manage for the surgeon, especially in case of severe femoral and/or acetabular bone loss [1]. In case of severe proximal femoral bone loss multiple treatment options have been described in the literature, including structural allograft-prosthesis composite, impaction allografting, long revision stems, resection arthroplasty, and proximal femoral replacement (PFR) [3, 4, 8]. Known as “megaprosthesis”, is a wellestablished limb salvage procedure for reconstruction of bone defects after the oncological resections of malignant bone neoplasms [9] and the encouraging outcomes have broadened the indications to the treatment of severe bone loss in non-oncologic conditions [10, 11]
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