Wijesekera Maheshi P, Pandit Hemant, Palan Jeya, Jain Sameer, East Jamie, Chan Corey D, Hadfield James N, As-Sultany Mohammed, Abourisha Eslam, James Catherine, Neo Chryssa, Yapp Liam Z, Kassam Al-Amin M, Petheram Timothy, Wynn Jones Henry, Eastley Nicholas C, Scott Chloe E H
Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK.
Bone Joint J. 2025 Jun 1;107-B(6):625-631. doi: 10.1302/0301-620X.107B6.BJJ-2024-1304.R1.
This study aims to determine the outcomes of proximal femoral replacement (PFR) for nononcological conditions.
This was a multicentre retrospective cohort study across six UK centres. The primary outcome was the local complication rate. Secondary outcomes were blood transfusions, critical care requirements, return to baseline mobility and residence status, systemic complications, reoperations, and mortality rates. Implant survival analysis was performed using Kaplan-Meier methodology with local complication as the endpoint, and was compared by surgical indication, stem length, and construct stem ratio (CSR).
There were 230 PFRs in 226 patients with a median age of 76.0 years (IQR 66.9 to 83.7). Indications were periprosthetic femoral fracture (n = 62; 27%), infected revision arthroplasty (n = 55; 24%), chronic/failed trauma (n = 41; 18%), aseptic revision arthroplasty (n = 38; 17%), acute trauma (n = 33; 14%), and complex primary arthroplasty (n = 1; 0.5%). Median follow-up was 4.2 years (IQR 1.9 to 7.2). The local complication rate was 27% (n = 62). The most common local complications were dislocation (n = 27; 12%) and periprosthetic joint infection (n = 22; 10%). Blood transfusion was required in 86 patients (37%). Overall, 90 patients (39%) required critical care facilities. A return to baseline mobility and residence was observed in 127 (55%) and 200 (87%) patients, respectively. The six-month systemic complication rate was 9% (n = 21) and the reoperation rate was 21% (n = 48). The 30-day and one-year mortality rates were 2% (n = 4) and 8% (n = 19), respectively. The two-year implant survival rate was 78.0% (SE 2.8). Survival rates did not differ significantly by surgical indication, stem length, or CSR.
This is the largest study of PFR for nononcological conditions. Due to high local complication and reoperation rates, it should be considered a salvage option for complex hip reconstruction and patients should be counselled appropriately.
本研究旨在确定非肿瘤性疾病行股骨近端置换术（PFR）的治疗效果。
这是一项在英国六个中心开展的多中心回顾性队列研究。主要结局是局部并发症发生率。次要结局包括输血情况、重症监护需求、恢复至基线活动能力和居住状态、全身并发症、再次手术以及死亡率。采用Kaplan-Meier方法进行植入物生存分析，以局部并发症为终点，并按手术指征、柄长度和结构柄比率（CSR）进行比较。
226例患者共进行了230例PFR手术，患者中位年龄为76.0岁（四分位间距为66.9至83.7岁）。手术指征包括假体周围股骨骨折（n = 62；27%）、感染性翻修关节成形术（n = 55；24%）、慢性/陈旧性创伤（n = 41；18%）、无菌性翻修关节成形术（n = 38；17%）、急性创伤（n = 33；14%）以及复杂初次关节成形术（n = 1；0.5%）。中位随访时间为4.2年（四分位间距为1.9至7.2年）。局部并发症发生率为27%（n = 62）。最常见的局部并发症是脱位（n = 27；12%）和假体周围关节感染（n = 22；10%）。86例患者（37%）需要输血。总体而言，90例患者（39%）需要重症监护。分别有127例（55%）和200例（87%）患者恢复至基线活动能力和居住状态。六个月时全身并发症发生率为9%（n = 21），再次手术率为21%（n = 48）。30天和一年死亡率分别为2%（n = 4）和8%（n = 19）。两年植入物生存率为78.0%（标准误为2.8）。生存率在手术指征、柄长度或CSR方面无显著差异。
这是关于非肿瘤性疾病行PFR的最大规模研究。鉴于较高的局部并发症和再次手术率，应将其视为复杂髋关节重建的挽救性选择，并且应给予患者适当的咨询。
