Five-year outcome of proximal femoral endoprosthetic arthroplasty for non-tumour indications.

Journal article

Aims

A possible solution for the management of proximal femoral bone loss is a modular proximal femur endoprosthesis (EPR). Although the outcome of EPRs in tumour surgery has been well described, the outcome of EPR use in revision hip surgery has received less attention. The aim of this study was to describe the outcome of EPR in the arthroplasty setting.

Materials and Methods

We retrospectively reviewed 80 EPRs (79 patients) performed for non-neoplastic indications, in our tertiary referral centre, and defined 5-year outcome (complications, 5-year survival, Oxford-Hip-Score [OHS]). The mean age at surgery was 69 years old (range: 28–93) and the mean number of previous hip operations was 2.4 (range: 0–17). The most common indications for the use of EPRs included peri-prosthetic joint infection (PJI) (n=40), peri-prosthetic fracture (n=12) and failed osteosynthesis of proximal femoral fractures/complex trauma (n=11).

Results

Joint salvage was achieved in all cases. Twenty-five patients sustained a complication (31%), the most common being infection (n=9) and dislocation (n=3). By follow-up, further surgery was required in 18 (22%) hips, 9 of which were EPR revisions. 5-yr implant survivorship was 87% (95%CI: 76–98%). Mean OHS was 28 (with 48 as the maximum possible score). Inferior survival and outcome were seen in EPRs performed for the treatment of infection. However, Infection eradication was achieved in 33/40 with the index EPR procedure and in 36/40 hips by follow-up.

Conclusions

We recommend the continued use of proximal femur EPR in non-tumour conditions, including PJI, and suggest that modular endoprosthesis should be part of the armomatorium of revision hip arthroplasty surgeons.

Authors: Grammatopoulos, G; Alvand, A; Martin, H; Whitwell, D; Taylor, A

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: British Editorial Society of Bone & Joint Surgery
• Journal: Bone & Joint Journal
• Volume: 98-B
• Pages: 1463–70
• Publication date: 2016-11-01
• Acceptance date: 2016-06-14
• DOI: 10.1302/0301-620x.98b11.bjj-2016-0244.r1
• EISSN: 2049-4408
• ISSN: 2049-4394
• Pmid: 27803221
• Language: English
• Keywords: Retrospective Studies; Humans; Young Adult; Treatment Outcome; Adult; Middle Aged; Aged; Prosthesis-Related Infections; Female; Prosthesis Failure; Periprosthetic Fractures; Fractures, Ununited; Aged, 80 and over; Femoral Fractures; Kaplan-Meier Estimate; Femur; Follow-Up Studies; Fracture Fixation, Internal; Arthroplasty, Replacement, Hip; Male; Reoperation; Hip Prosthesis