PATIENT-SPECIFIC FACTORS AND IMPLANT DESIGN CONSIDERATIONS IN PFR FOR NON-ONCOLOGIC HIP SALVAGE
Main Article Content
Keywords
.
Abstract
Introduction: Proximal femoral replacement (PFR) has long been recognized as an essential reconstructive solution for patients with extensive proximal femoral bone loss.
Objective: The study's main objective is to find the patient-specific factors and implant design considerations in PFR for non-oncologic hip salvage.
Methodology: This retrospective study was conducted at Orthopedic Department, Jinnah Postgraduate Medical Center (JPMC), Karachi from 2022-2023.data were collected from 55 patients. Data on demographics, comorbidities, surgical details, and outcomes were systematically documented and analyzed. The surgeries were performed under general anesthesia using a standardized approach
Results:Data were collected from 55 patients, comprising 32 males (58%) and 23 females (42%), with a mean age of 54.67±5.81 years. The primary indications for PFR were severe trauma (40%), failed arthroplasty (30%), periprosthetic fractures (20%), and avascular necrosis (10%). Comorbidities were prevalent, with 60% of patients having osteoporosis and 25% diagnosed with diabetes. The mean BMI was 28.4 kg/m², with 18% of patients classified as obese, reflecting a diverse and clinically challenging patient population.The overall implant survivorship was 92.7%, demonstrating the reliability of PFR in non-oncologic hip salvage. Revisions due to aseptic loosening occurred in 5.5% of cases (3 patients), while mechanical failures were rare at 1.8% (1 patient).
Conclusion:It is concluded that proximal femoral replacement (PFR) is an effective solution for non-oncologic hip salvage, offering significant improvements in functional outcomes and quality of life.
References
2. Kim YH, Park JW, Kim JS, Rastogi D. High Survivorship WithCementless Stems and Cortical Strut Allografts for Large Femoral Bone Defects in Revision THA. Clin OrthopRelat Res. 2015 Sep;473(9):2990-3000. doi: 10.1007/s11999-015-4358-y. Epub 2015 May 27. PMID: 26013152; PMCID: PMC4523544.
3. Toepfer, A., Straßer, V., Ladurner, A. et al. Different outcomes after proximal femoral replacement in oncologic and failed revision arthroplasty patients - a retrospective cohort study. BMC MusculoskeletDisord 22, 813 (2021). https://doi.org/10.1186/s12891-021-04673-z
4. Grammatopoulos G, Alvand A, Martin H, Whitwell D, Taylor A, Gibbons CLMH. Five-year outcome of proximal femoral endoprosthetic arthroplasty for non-tumour indications. Bone Joint J. 2016;98-B(11):1463–70. https://doi.org/10.1302/0301-620X.98B11.BJJ-2016-0244.R1.
5. Toepfer A, Harrasser N, Petzschner I, Pohlig F, Lenze U, Gerdesmeyer L, et al. Is total femoral replacement for non-oncologic and oncologic indications a safe procedure in limb preservation surgery? A single center experience of 22 cases. Eur J Med Res. 2018;23(1):5. https://doi.org/10.1186/s40001-018-0302-4.
6. Colman M, Choi L, Chen A, Crossett L, Tarkin I, McGough R. Proximal femoral replacement in the management of acute periprosthetic fractures of the hip: a competing risks survival analysis. J Arthroplast. 2014;29(2):422–7. https://doi.org/10.1016/j.arth.2013.06.009.
7. Toepfer A, Harrasser N, Schwarz PR, Pohlig F, Lenze U, Mühlhofer HML, et al. Distal femoral replacement with the MML system: a single center experience with an average follow-up of 86 months. BMC MusculoskeletDisord. 2017;18(1):206. https://doi.org/10.1186/s12891-017-1570-9.
8. Smith EL, Shah A, Son SJ, Niu R, Talmo CT, Abdeen A, et al. Survivorship of Megaprostheses in revision hip and knee arthroplasty for septic and aseptic indications: a retrospective, multicenter study with minimum 2-year follow-up. Arthroplast Today. 2020;6(3):475–9. https://doi.org/10.1016/j.artd.2020.05.004.
9. Toepfer A, Harrasser N, Petzschner I, Pohlig F, Lenze U, Gerdesmeyer L, et al. Short- to long-term follow-up of total femoral replacement in non-oncologic patients. BMC MusculoskeletDisord. 2016;17(1):1–9. https://doi.org/10.1186/s12891-016-1355-6.
10. Vaishya R, Thapa SS, Vaish A. Non-neoplastic indications and outcomes of the proximal and distal femur megaprosthesis: a critical review. Knee Surg Relat Res. 2020;32(1):18. https://doi.org/10.1186/s43019-020-00034-7.
11. De Martino I, D’Apolito R, Nocon AA, Sculco TP, Sculco PK, Bostrom MP. Proximal femoral replacement in non-oncologic patients undergoing revision total hip arthroplasty. Int Orthop. 2019;43(10):2227–33. https://doi.org/10.1007/s00264-018-4220-4.
12. Viste A, Perry KI, Taunton MJ, Hanssen AD, Abdel MP. Proximal femoral replacement in contemporary revision total hip arthroplasty for severe femoral bone loss. Bone Joint J. 2017;99-B(3):325–9. https://doi.org/10.1302/0301-620X.99B3.BJJ-2016-0822.R1.
13. Pennekamp PH, Wirtz DC, Dürr HR. Proximal and total femur replacement. OperOrthopTraumatol. 2012;24(3):215–26. https://doi.org/10.1007/s00064-011-0061-7.
14. Sambri, A.; Parisi, S.C.; Zunarelli, R.; Di Prinzio, L.; Morante, L.; Lonardo, G.; Bortoli, M.; Montanari, A.; De Cristofaro, R.; Fiore, M.; et al. Megaprosthesis in Non-Oncologic Settings—A Systematic Review of the Literature. J. Clin. Med. 2023, 12, 4151. https://doi.org/10.3390/jcm12124151
15. Apprich, S.R.; Nia, A.; Schreiner, M.M.; Jesch, M.; Böhler, C.; Windhager, R. Modular megaprostheses in the treatment of periprosthetic fractures of the femur. Wien. Klin. Wochenschr. 2021, 133, 550–559.
16. Vitiello, R.; Bellieni, A.; Oliva, M.S.; Di Capua, B.; Fusco, D.; Careri, S.; Colloca, G.F.; Perisano, C.; Maccauro, G.; Lillo, M. The importance of geriatric and surgical co-management of elderly in muscoloskeletal oncology: A literature review. Orthop. Rev. 2020, 12, 8662.
17. Vitiello, R.; Ziranu, A.; Oliva, M.S.; Meluzio, M.C.; Cauteruccio, M.; Maccauro, G.; Liuzza, F.; Saccomanno, M.F. The value of megaprostheses in non-oncological fractures in elderly patients: A short-term results. Injury 2022, 53, 1241–1246.
18. Page, M.J.; Moher, D.; Bossuyt, P.M.; Boutron, I.; Hoffmann, T.C.; Mulrow, C.D.; Shamseer, L.; Tetzlaff, J.M.; Akl, E.A.; Brennan, S.E.; et al. PRISMA 2020 explanation and elaboration: Updated guidance and exemplars for reporting systematic reviews. BMJ 2021, 372, n160.
19. De Marco, D.; Messina, F.; Meschini, C.; Oliva, M.S.; Rovere, G.; Maccagnano, G.; Noia, G.; Maccauro, G.; Ziranu, A. Periprosthetic knee fractures in an elderly population: Open reduction and internal fixation vs. distal femur megaprostheses. Orthop. Rev. 2022, 14, 33772.
20. Aebischer, A.S.; Hau, R.; de Steiger, R.N.; Holder, C.; Wall, C.J. Distal Femoral Replacement for Periprosthetic Fractures After TKA: Australian Orthopaedic Association National Joint Replacement Registry Review. J. Arthroplast. 2022, 37, 1354–1358.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Kashif Anwar
Senior Registrar, Orthopedic Department, Jinnah Postgraduate Medical Center (JPMC), Karachi
Tahsinullah
=Medical Officer, DHQ Teaching Hospital Timergara Lower Dir
Naveed Khan
Assistant Professor, Orthopedic Surgery Department, Medicare Cardiac and General Hospital (Jinnah Medical and Dental College), Karachi
Tahmeedah Safiullah
TMO, General Surgery Department, Lady Reading Hospital, Peshawar
Zia Ullah
Assistant Professor, Orthopaedics Department, Khalifa Gul Nawaz Hospital / Bannu Medical College, Bannu
Mumraiz Salik Naqshband
Associate Professor of Orthopedic Surgery, King Edward Medical University/ Mayo Hospital, Lahore