Ouillette Ryan, Chen Kevin, Dipane Matthew, Christ Alexander, McPherson Edward, Stavrakis Alexandra
Department of Orthopedic Surgery, University of California, Los Angeles, Santa Monica, CA, USA.
Arthroplast Today. 2025 Jan 2;31:101607. doi: 10.1016/j.artd.2024.101607. eCollection 2025 Feb.
Revision hip and knee arthroplasty volume continues to rise, and total femur replacement (TFR) remains a key salvage option in patients with extensive bone loss. Prior research has demonstrated mixed results of this procedure, and this study aimed to characterize the outcomes of nononcologic TFR in one of the largest single-center modern series.
A retrospective analysis was conducted on 23 nononcologic TFR procedures performed on 22 patients between 2012 and 2021. Primary outcomes included TFR revision rate and indication for revision, while secondary outcomes included overall reoperation rate, complications, patient ambulatory status, and assistive device requirements.
The average age at time of TFR was 65.7 years, with periprosthetic fracture (65.2%) and periprosthetic joint infection (34.8%) as predominant indications. More than half of patients (52.2%) required TFR revision, primarily due to periprosthetic joint infection (75.0%). Despite a high complication profile, only 1 patient underwent limb amputation and there was only 1 mortality during the study period. Overall, 63.6% of patients were ambulating (assisted or unassisted) at final follow-up.
Nononcologic TFR remains a viable limb-salvage option for patients undergoing revision arthroplasty with extensive bone loss. Despite a notable revision rate and infection risk, the majority of patients maintain or regain ambulatory function, emphasizing the procedure's role in preserving limb function. Clinicians should weigh potential complications when considering TFR, emphasizing patient counseling and risk mitigation strategies.
髋关节和膝关节翻修置换手术量持续上升，全股骨置换术（TFR）仍是骨量大量丢失患者的关键挽救性选择。既往研究表明该手术结果不一，本研究旨在描述最大的单中心现代系列之一的非肿瘤性TFR的结果。
对2012年至2021年间22例患者进行的23例非肿瘤性TFR手术进行回顾性分析。主要结局包括TFR翻修率和翻修指征，次要结局包括总体再手术率、并发症、患者行走状态和辅助器械需求。
TFR时的平均年龄为65.7岁，主要指征为假体周围骨折（65.2%）和假体周围关节感染（34.8%）。超过一半的患者（52.2%）需要TFR翻修，主要原因是假体周围关节感染（75.0%）。尽管并发症发生率较高，但在研究期间只有1例患者接受了截肢，只有1例死亡。总体而言，63.6%的患者在末次随访时能够行走（借助或不借助辅助器械）。
对于接受翻修置换术且骨量大量丢失的患者，非肿瘤性TFR仍然是一种可行的保肢选择。尽管翻修率和感染风险显著，但大多数患者维持或恢复了行走功能，强调了该手术在保留肢体功能方面的作用。临床医生在考虑TFR时应权衡潜在并发症，强调患者咨询和风险缓解策略。
