Total femoral replacement carries high risk of failure and amputation
The increased occurrence of total femoral replacement failure reinforces that this procedure must only be undertaken once all other options have been exhausted, according to investigators of a recently published study.
“Total femoral replacement (TFR) with an endoprosthesis is an operation with few indications, primarily malignant bone tumors involving most of the femur and combined ipsilateral total hip and knee arthroplasty failure(s),” Eric R. Henderson, MD, from the department of orthopedics and the sarcoma and connective tissue oncology program in the Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center, and colleagues wrote. “Improved understanding of the outcomes following TFR performed for primary and revision indications will be valuable in guiding decision-making for patients and surgeons considering this operation, which historically is fraught with high morbidity.”
In a retrospective cohort study, researchers evaluated information on 166 patients who received total femoral endoprostheses for oncological and revision arthroplasty indications. They analyzed TFR failures and failure predictions using bivariate logistic regression and a multivariate model.
TFR failure occurred in 27% of patients, with 23% occurring in primary TFRs and 33% occurring in revision TFRs. The difference between these findings was non-significant in a bivariate analysis but was significant in a multivariate analysis.
Of patients with mechanical failure, none had reoccurrence of their original failure while eight patients from the nonmechanical failure cohort saw reoccurrence of the original failure mode. Overall failure showed significant association with TFR revision when compared to primary TFR (odds ratio 2.44), as well as a significantly greater risk of infection failure (OR, 3.73).
“Limb salvage with TFR had a high failure rate and a propensity for deep infection, especially in the setting of revision indications and prior infection ... ultimately resulting in amputation,” Henderson and colleagues concluded. “National, prospective registry data are needed to better clarify failure risk and best practice for patients who undergo resection of the entire femur followed by TFR with an endoprosthesis.”
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