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Is endoprosthetic replacement of the proximal femur appropriate in the comorbid patient?

Abstract

Introduction

Patients with failed hip arthroplasty requiring extensive femoral reconstruction often present with a multitude of comorbidities. Many treatment options limit initial mobilisation relying on bone graft incorporation. The use of endoprosthetic replacement (EPR), despite often being a “last resort”, offers an expeditious solution with early mobilisation that is crucial in the comorbid individual. Many perceive that the surgical insult of EPR is associated with an increased mortality. The aim of this study was to report our experience of proximal femoral EPR as the treatment for failed arthroplasty or fracture fixation. Primary outcomes included mortality, complications, revision and function.

Methods

Retrospective review of proximal femoral EPR undertaken at our institution for non-oncological indications between 2007 and 2015 identified 37 patients with a mean follow-up of 33 months. Patient case notes, demographics and radiographs were studied.

Results

The 90-day mortality following proximal femoral EPR was 2.7%. 9 patients had died at the time of final follow-up (mean time to death was 33 months). The mean preoperative and postoperative Oxford Hip Score improved from 8 to 31 respectively (p<0.05). When considering revision for any cause, 5-year survival was 94.6%. 2 patients suffered periprosthetic joint infection and 1 patient required revision for prosthesis dislocation.

Conclusions

We report a relatively low incidence of perioperative complications, with a mortality rate similar to other revision options in this high-risk cohort. Whilst further revision may not always be possible, this “last resort” technique is safe in the comorbid population presenting with significant proximal femoral bone deficiency.

Post author correction

Article Type: ORIGINAL RESEARCH ARTICLE

Article Subject: Arthroplasty

DOI:10.5301/hipint.5000520

Authors

Arun Khajuria, Jonathon Ward, George Cooper, Jonathon Stevenson, Michael Parry, Lee Jeys

Article History

Disclosures

Financial support: none.
Conflict of interest: none.

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Authors

Affiliations

  • Royal Orthopaedic Hospital, Birmingham - UK

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