Tran Guillaume, Waast Denis, Nich Christophe, Pere Morgane, Berchoud Juliane, Gouin Francois, Crenn Vincent
CHU de Nantes, Nantes University, CHU Nantes, Clinique Chirurgicale Orthopédique et Traumatologique, 1 Place Alexis Ricordeau, 44000, Nantes, France.
CRCI2NA (Centre de Recherche en Cancérologie et Immunologie Nantes-Angers), INSERM UMR 1307, CNRS UMR 6075-Team 9 CHILD (CHromatin and Transcriptional Deregulation in Pediatric Bone Sarcoma), Nantes Université, Nantes, France.
Int Orthop. 2025 Feb;49(2):495-502. doi: 10.1007/s00264-025-06408-4. Epub 2025 Jan 9.
Proximal femur megaprostheses (PFMPs) are used to manage large bone defects in both non-oncological indications (NOI) and oncological indications (OI). However, little is known about the comparative risks of reoperation and functional outcomes between these groups. This study aimed to evaluate the cumulative incidences of reoperation and functional results of PFMPs between NOI and OI.
This retrospective, monocentric cohort study included 109 implants between 2005 and 2020 (NOI, n = 42; OI, n = 67). Competing risk analysis was used to estimate and compare cumulative incidence of reoperation and complications, with death as a competing event. The Musculoskeletal Tumour Society Score (MSTS) was retrospectively assessed to compare functional outcomes.
The estimated cumulative incidence of reoperation at ten years did not statistically differ: 33.5% for NOI vs. 32.7% for OI (HR = 0.90, 95% CI (0.42-0.95), p = 0.791). The estimated cumulative incidence of complications at ten years did not statistically differ (HR = 1.50, 95%CI (0.80-2.80), p = 0.204). The MSTS score at ten years was significantly higher in the OI group (78.2% ± 19.5) compared to the NOI group (48.3% ± 10.9) (p = 0.012).
PFMPs for NOI demonstrate a comparable risk of reoperation to OI, but with lower long-term functional outcomes.
股骨近端大型假体（PFMPs）用于治疗非肿瘤性适应证（NOI）和肿瘤性适应证（OI）中的大骨缺损。然而，对于这两组之间再次手术的比较风险和功能结果知之甚少。本研究旨在评估NOI和OI之间PFMPs再次手术的累积发生率和功能结果。
这项回顾性、单中心队列研究纳入了2005年至2020年间的109例植入物（NOI，n = 42；OI，n = 67）。采用竞争风险分析来估计和比较再次手术和并发症的累积发生率，并将死亡作为竞争事件。对肌肉骨骼肿瘤学会评分（MSTS）进行回顾性评估以比较功能结果。
十年时再次手术的估计累积发生率在统计学上无差异：NOI为33.5%，OI为32.7%（HR = 0.90，95% CI（0.42 - 0.95），p = 0.791）。十年时并发症的估计累积发生率在统计学上无差异（HR = 1.50，95%CI（0.80 - 2.80），p = 0.204）。十年时，OI组的MSTS评分（78.2% ± 19.5）显著高于NOI组（48.3% ± 10.9）（p = 0.012）。
用于NOI的PFMPs显示出与OI相当的再次手术风险，但长期功能结果较低。
