Roustemis Anastasios G, Gavriil Panayiotis, Goumenos Stavros, Trikoupis Ioannis, Karampikas Vasileios, Koulouvaris Panagiotis, Kontogeorgakos Vasileios, Savvidou Olga, Mavrogenis Andreas F, Papagelopoulos Panayiotis J
First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Rimini Street, Chaidari 124 62, Athens, Greece.
Department of Orthopaedics, Charité - Universitätsmedizin Berlin, 20 Schumannstraße, 10117 Berlin, Germany.
SICOT J. 2025;11:50. doi: 10.1051/sicotj/2025031. Epub 2025 Aug 26.
Proximal femoral megaprosthetic reconstruction is a well-established solution for extensive bone loss in the hip region. Despite its utility in limb salvage, it carries notable complication rates, reported between 30% and 40%, along with increased morbidity and mortality. This study evaluated implant and patient survival, failure modes, and associated risk factors.
We retrospectively reviewed 165 patients who underwent proximal femoral megaprosthetic reconstruction between 2003 and 2023. Indications included primary bone tumors (n = 67), metastatic bone disease (n = 60), and non-oncologic conditions (n = 38). A total of 57 METS (Stanmore) and 108 MUTARS (Implantcast) implants were used. Median follow-up was 5 years (range: 0.25-17 years).
Mean implant survival was 5.13 years (range: 0.2-17 years), with an overall complication rate of 30.9%. The most common failure modes were type 1 (11.5%) and type 4 (13.3%) per Henderson classification. Five-year implant survival ranged from 60% to 70% across indications. Independent risk factors for type 4 failure included prolonged hospitalization (OR = 1.07, p = 0.020) and longer operative time (OR = 1.01, p = 0.023). Silver-coated implants showed a trend toward reduced infection (OR = 0.18, p = 0.29), though not statistically significant. METS implants were associated with lower type 1 failure risk (OR = 0.09, p = 0.020), with a soft-tissue failure rate of 3.5% versus 15.7% for MUTARS.
Proximal femoral megaprostheses remain effective for limb salvage but are linked to a substantial complication burden. Recognition of modifiable and patient-specific risk factors may improve surgical outcomes and reduce failure rates.
股骨近端大型假体重建是治疗髋部广泛骨质流失的一种成熟方法。尽管其在保肢治疗中具有实用性，但并发症发生率较高，报道的发生率在30%至40%之间，同时发病率和死亡率也有所增加。本研究评估了植入物和患者的生存率、失败模式及相关危险因素。
我们回顾性分析了2003年至2023年间接受股骨近端大型假体重建的165例患者。适应证包括原发性骨肿瘤（n = 67）、转移性骨病（n = 60）和非肿瘤性疾病（n = 38）。共使用了57枚METS（斯坦莫尔）和108枚MUTARS（英普朗卡特）植入物。中位随访时间为5年（范围：0.25 - 17年）。
植入物平均生存时间为5.13年（范围：0.2 - 17年），总体并发症发生率为30.9%。根据亨德森分类，最常见的失败模式为1型（11.5%）和4型（13.3%）。各适应证的5年植入物生存率在60%至70%之间。4型失败的独立危险因素包括住院时间延长（OR = 1.07，p = 0.020）和手术时间延长（OR = 1.01，p = 0.023）。镀银植入物有感染率降低的趋势（OR = 0.18，p = 0.29），但无统计学意义。METS植入物与较低的1型失败风险相关（OR = 0.09，p = 0.020），MUTARS的软组织失败率为15.7%，而METS为3.5%。
股骨近端大型假体在保肢方面仍然有效，但与相当大的并发症负担相关。识别可改变的和患者特异性的危险因素可能会改善手术效果并降低失败率。
