Di Martino Alberto, Pederiva Davide, Bordini Barbara, Di Carlo Gabriele, Panciera Alessandro, Geraci Giuseppe, Stefanini Niccolò, Faldini Cesare
Department of Biomedical and Neurimotor Sciences - University of Bologna, Piazza di Porta S. Donato, 2, 40127, Bologna, Italy.
Ist Orthopaedic Department, IRCCS - Istituto Ortopedico Rizzoli, via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy.
J Orthop Traumatol. 2022 Mar 29;23(1):18. doi: 10.1186/s10195-022-00632-z.
Proximal femoral replacement (PFR) is a well-established treatment for neoplasia of the proximal femur. The use of this surgical technique for non-neoplastic conditions has increased over the years. We carried out a systematic review of the literature to study the indications, complications, and functional results when PFR is used for non-neoplastic conditions. Twenty-seven studies were included in the review with a total of 828 PFRs with a mean follow-up of 50 months (range 1-225 months). The main indications were infection (28%), periprosthetic fracture (27%), aseptic loosening (22%), and fracture (16%). The rate of reoperation was 20.3% overall. The overall revision rate was 15.4%. The main complications were dislocation (10.2%) and infection (7.3%). After 2010, the rates of reoperation (25.5% versus 18.2%), loosening (9.4% versus 3.2%), and dislocation (15.7% versus 7.9%) were lower than before 2010. The 30-day mortality ranged from 0% to 9%. The hip function scores improved post-surgery. In conclusion, the use of PFR in non-neoplastic conditions remains a marginal tool, associated with low direct mortality and high complication rates, but we expect its use to increase in the near future.
股骨近端置换术（PFR）是治疗股骨近端肿瘤的一种成熟疗法。多年来，这种手术技术在非肿瘤性疾病中的应用有所增加。我们对文献进行了系统回顾，以研究PFR用于非肿瘤性疾病时的适应证、并发症及功能结果。该回顾纳入了27项研究，共828例PFR，平均随访50个月（范围1 - 225个月）。主要适应证为感染（28%）、假体周围骨折（27%）、无菌性松动（22%）和骨折（16%）。总体再手术率为20.3%。总体翻修率为15.4%。主要并发症为脱位（10.2%）和感染（7.3%）。2010年后，再手术率（25.5%对18.2%）、松动率（9.4%对3.2%）和脱位率（15.7%对7.9%）均低于2010年前。30天死亡率在0%至9%之间。术后髋关节功能评分有所改善。总之，PFR在非肿瘤性疾病中的应用仍然是一种边缘手段，直接死亡率低但并发症发生率高，不过我们预计其在不久的将来应用会增加。
