title: Total femoral replacement for salvage of periprosthetic fractures.
abstract: Patients with complex periprosthetic fracture patterns of the femur may ultimately require amputation. Some authors have described the use of mega-endoprostheses as a salvage procedure. This study reports functional outcome, complications, and implant and patient survival after total femoral replacement (TFR) for salvage of periprosthetic fracture of the femur. A prospective database of 20 consecutive patients who underwent TFR for salvage of a periprosthetic fracture was compiled. Patient demographics, mobility information, and preoperative and postoperative Short Form 12-item Survey (SF-12) and 1-year Toronto Extremity Salvage Score (TESS) data were recorded. Postoperative complications were obtained from the hospital database and patient medical notes. One patient was lost to follow-up and was excluded from analysis. The study included 8 men and 11 women, with a mean age of 68.4 years. No significant difference was noted in the prefracture physical (4.4; P=.13) or mental (0.3; P=.78) component scores of the SF-12 compared with 1-year scores. The TESS at 1 year was 69%. However, patients were more likely to require a walking aid postoperatively (P<.0001). One-fourth of the patients had a postoperative medical complication. In addition, 1 patient had a dislocation and 2 patients had a periprosthetic infection. The implant survival rate was 86% at 10 years; however, the 10-year mortality rate was 58%. Although TFR for salvage of a periprosthetic fracture of the femur offers good functional outcome and implant survival, it is at the expense of postoperative complications, and TFR is associated with a high long-term mortality rate.
authors.forename: Nicholas D
authors.initials: ND
authors.lastname: Clement
authors.forename: Deborah
authors.initials: D
authors.lastname: MacDonald
authors.forename: Issaq
authors.initials: I
authors.lastname: Ahmed
authors.forename: James T
authors.initials: JT
authors.lastname: Patton
authors.forename: Colin R
authors.initials: CR
authors.lastname: Howie
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000009:adverse effects*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D016208:Databases, Factual; D005260:Female; D005264:Femoral Fractures / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery*; D015207:Osteoarthritis, Hip / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000601:surgery; D057068:Periprosthetic Fractures / Q000209:etiology / Q000601:surgery*; D011475:Prosthesis Failure; D019919:Prosthesis Implantation / Q000009:adverse effects*; D020127:Recovery of Function; D016879:Salvage Therapy; D016019:Survival Analysis