Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA.
Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA; Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
J Arthroplasty. 2022 Mar;37(3):559-564. doi: 10.1016/j.arth.2021.11.008. Epub 2021 Nov 9.
Proximal femoral replacements (PFRs) are often used in the setting of severe bone loss. As osteolysis has become less common, PFR may be used to address other causes of bone loss such as infection or periprosthetic fracture. The aim of this study is to investigate the clinical outcomes of PFR for non-neoplastic conditions.
A retrospective review of 46 patients undergoing PFR at a single institution was performed. The electronic records were reviewed to extract relevant information including the reason for use of PFR, surgical variables, follow-up, and complications. Survivorship curves were generated and differences in survivorship were evaluated using the log-rank test. Radiographic evaluation was also performed.
Using revision as an endpoint, the Kaplan-Meier analysis of the entire cohort demonstrated a survival rate of 74% at 1 year and 67% at 5 years. Patients with a preoperative diagnosis of periprosthetic joint infection demonstrated the lowest survivorship with a failure rate of 47%. Furthermore, a high dislocation rate at 17.4% (n = 8) was observed. The use of dual-mobility articulation was effective in reducing dislocation.
PFR is a valuable reconstructive option for patients with massive proximal femoral bone loss. This study demonstrates that patients with periprosthetic joint infection who undergo PFR reconstruction are at very high risk of subsequent failure, most commonly from reinfection and instability. The use of a dual-mobility articulation in association with PFR appears to help mitigate risk of subsequent dislocation.
股骨近端置换（PFR）常用于严重骨丢失的情况。随着骨溶解的减少，PFR 可能用于解决感染或假体周围骨折等其他原因引起的骨丢失。本研究旨在探讨 PFR 治疗非肿瘤性疾病的临床疗效。
对一家医疗机构的 46 例接受 PFR 的患者进行回顾性研究。对电子病历进行回顾，以提取相关信息，包括使用 PFR 的原因、手术变量、随访和并发症。生成生存曲线，并使用对数秩检验评估生存曲线的差异。还进行了影像学评估。
以翻修为终点，对整个队列进行 Kaplan-Meier 分析显示，1 年生存率为 74%，5 年生存率为 67%。术前诊断为假体周围关节感染的患者生存率最低，失败率为 47%。此外，还观察到 17.4%（n=8）的高脱位率。使用双动关节可有效降低脱位率。
PFR 是治疗股骨近端严重骨丢失患者的一种有价值的重建选择。本研究表明，接受 PFR 重建的假体周围关节感染患者随后发生失败的风险非常高，最常见的原因是再感染和不稳定。在 PFR 中使用双动关节似乎有助于降低随后发生脱位的风险。
