Factors Associated With Failure Following Proximal Femoral Replacement for Salvage Hip Surgery for Nononcologic Indications

Proximal femoral replacement (PFR) is used when extensive proximal femoral bone loss is encountered during revision total hip arthroplasty. However, further data on 5-to-10–year survivorship and predictors of failure are needed. Our aim was to assess the survivorship of contemporary PFRs used for nononcologic indications and determine factors associated with failure. A single-institution retrospective observational study was conducted between June 1, 2010 and August 31, 2021 for patients undergoing PFR for non-neoplastic indications. Patients were followed for a minimum of 6 months. Demographic, operative, clinical, and radiographic data were collected. Implant survivorship was determined via Kaplan-Meier analysis of 56 consecutive cemented PFRs in 50 patients. At a mean follow-up of 4 years, the mean Oxford Hip Score was 36.2 and patient satisfaction was rated at an average of 4.7 of 5 on the Likert scale. Radiographic evidence of femoral-sided aseptic loosening was determined in 2 PFRs at a median of 9.6 years. The 5-year survivorship with all-cause reoperation and revision as end points was 83.2% (95% Confidence Interval [CI]: 70.1% to 91.0%) and 84.9% (95% CI: 72.0% to 92.2%), respectively. The 5-year survivorship was 92.3% (95% CI: 78.0% to 97.5%) for stem length > 90 mm compared to 68.4% (95% CI: 39.5% to 85.7%) for stem length ≤ 90 mm. A construct-to-stem length ratio (CSR) ≤ 1 was associated with a 91.7% (95% CI: 76.4% to 97.2%) survival, while a CSR > 1 was associated with a 73.6% (95% CI: 47.4% to 88.1%) survival. A PFR stem length ≤ 90 mm and CSR > 1 were associated with increased rates of failure.