Five-year outcome of proximal femoral endoprosthetic arthroplasty for non-tumour indications.
OBJECTIVE
A possible solution for the management of proximal femoral bone loss is a modular femoral endoprosthesis (EPR). Although the outcome of EPRs in tumour surgery has been well described, the outcome of their use in revision hip surgery has received less attention. The aim of this study was to describe the outcome of using EPR for non-neoplastic indications.


METHODS
A retrospective review of 79 patients who underwent 80 EPRs for non-neoplastic indications was performed, including the rates of complication and survival and the mean Oxford Hip Scores (OHS), at a mean of five years post-operatively. The mean age at the time of surgery was 69 years (28 to 93) and the mean number of previous operations on the hip was 2.4 (0 to 17). The most common indications for EPR implantation were periprosthetic joint infection (PJI) (n = 40), periprosthetic fracture (n = 12) and failed osteosynthesis of a proximal femoral fracture or complex trauma (n = 11).


RESULTS
Salvage was achieved in all patients. A total of 25 patients (25 EPRs, 31.6%) had a complication, the most common being infection (n = 9) and dislocation (n = 3). Further surgery was required for 18 EPRs (22%), nine of which were revision procedures. The five year survival of the EPR was 87% (95%CI: 76% to 98%). The mean OHS was 28 (4 to 48). Inferior survival and outcomes were seen in EPRs which were performed for the treatment of infection. However, the eradication of infection was achieved in 33 of the 40 (82.5%) which were undertaken for this indication.


CONCLUSIONS
We recommend the continued use of proximal femoral EPRs for non-neoplastic indications, including PJI. Cite this article: Bone Joint J 2016;98-B:1463-70.
Nuffield Orthopaedic Centre, Windmill Road, Headington, OX3 7LD, Oxford, UK.
G
G
Grammatopoulos
University of Oxford , Nuffield Orthopaedic Centre, Windmill Road, Headington, OX3 7LD, Oxford, UK.
A
A
Alvand
Nuffield Orthopaedic Centre, Windmill Road, Headington, OX3 7LD, Oxford, UK.
H
H
Martin
Nuffield Orthopaedic Centre, Windmill Road, Headington, OX3 7LD, Oxford, UK.
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D
Whitwell
Nuffield Orthopaedic Centre, Windmill Road, Headington, OX3 7LD, Oxford, UK.
A
A
Taylor
Nuffield Orthopaedic Centre, Windmill Road, Headington, OX3 7LD, Oxford, UK.
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CL
Gibbons
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005264:Femoral Fractures / Q000601:surgery; D005269:Femur / Q000601:surgery*; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D005599:Fractures, Ununited / Q000601:surgery; D006622:Hip Prosthesis; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D057068:Periprosthetic Fractures / Q000601:surgery; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000601:surgery; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
Endo-prosthesis; Hip; Periprosthetic joint infection; Proximal femoral arthroplasty; Revision