Cemented Proximal Femoral Replacement for the Management of Non-Neoplastic Conditions: A Versatile Implant but Not Without Its Risks

Background: The demand for revision arthroplasty continues to grow. Proximal femoral bone loss poses a significant challenge to surgeons and proximal femoral replacements (PFRs) are one option to address this problem. The aim of our study is to assess the reoperation, complication, and mortality rates following PFR for treatment of non-neoplastic conditions. Methods: A retrospective observational study was conducted of a consecutive group of patients treated with a PFR for non-neoplastic conditions between 2010 and 2018. Mortality was confirmed using the Irish national death events publication service. Results: Over the 8-year study period, 79 PFRs in 78 patients were performed. Mean age of patients was 78.3 years (standard deviation 11.9), of which 37.2% were male. Periprosthetic fracture was the most common indication for PFR (63.3%). The 30-day mortality rate was 7.6% (6 patients), of which bone cement implantation syndrome occurred in 4 patients. One-year mortality was 12.7%. Complications occurred in 22.8%. Conclusion: A cemented PFR is a versatile prosthesis in the armamentarium of a revision arthroplasty surgeon that allows immediate full weight-bearing. However, it may appropriately be considered a last resort procedure that poses specific risks that must be explained to patients and family. We present the short-term outcomes on one of the largest series of PFR to date.