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. 2021 Nov 8;22(Suppl 2):933.
doi: 10.1186/s12891-021-04711-w.

Survivorship and clinical outcomes of proximal femoral replacement in non-neoplastic primary and revision total hip arthroplasty: a systematic review

Fabio Mancino  1   2   3 , Vincenzo Di Matteo  4   5 , Fabrizio Mocini  4   5 , Giorgio Cacciola  6 , Giuseppe Malerba  4 , Carlo Perisano  4 , Ivan De Martino  4
Affiliations

Survivorship and clinical outcomes of proximal femoral replacement in non-neoplastic primary and revision total hip arthroplasty: a systematic review

Fabio Mancino et al. BMC Musculoskelet Disord. .

Abstract

Background: 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; 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.

Methods: A 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.

Results: In 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.

Conclusion: PFR 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.

Keywords: Bone defect; Femoral bone loss; Femoral reconstruction; Femoral revision; Proximal femoral arthroplasty; Proximal femoral replacement; Revision hip arthroplasty; Total hip arthroplasty.

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Conflict of interest statement

The authors have no conflicts of interest to declare that are relevant to the content of this article. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Figures

Fig. 1
Fig. 1
Modified Coleman Methodology Score
Fig. 2
Fig. 2
Flow chart of study selection according to PRISMA guidelines for reporting systematic reviews and meta-analyses
See this image and copyright information in PMC

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