A UK multicentre cohort study of clinical outcomes of proximal femoral replacement for nononcological conditions the EndoProsthetic Replacement for nonOncological conditions (EPRO) study

Aims

This study aims to determine the outcomes of proximal femoral replacement (PFR) for nononcological conditions.

Methods

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).

Results

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.

Conclusion

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.