Total femoral replacement for severe femoral bone loss in non-oncologic patients: high complication rates but acceptable functional outcomes

The management of severe femoral bone loss is a growing challenge in prosthetic revision surgery, especially in patients who have undergone multiple previous surgeries. In these complex scenarios, total femoral replacement (TFR) has been used as a rescue technique to preserve the limb, despite its association with a high rate of complications. Evidence on functional outcomes and patient-reported outcome measures (PROMs) from patients with nononcological indications is limited. The objective of this study was to analyze the clinical and functional results of and the complications associated with TFR in a nononcology series and to identify possible prognostic factors.

In this retrospective, observational study, 13 consecutive patients who underwent TFR between 2020 and 2024 and who had a minimum follow-up of 18 months were included. Demographic, clinical and surgical variables; implant survival; and postoperative complications were analyzed. Functional evaluations included assessments of the ability to walk, the visual analog scale for pain and collection of PROMs (12-item short form survey (SF-12), Musculoskeletal Tumor Society (MSTS) scale and Western Ontario and McMaster Universities Arthritis Index (WOMAC) test).

The mean patient age was 75.3 years. The main indication for TFR was peri-/interprosthetic fracture (69.2%), followed by aseptic loosening (23.1%). The average number of previous surgeries was 4.8. Implant survival at one year was 100%; however, 61.5% of the patients required at least one reintervention, with periprosthetic infection being the most frequent complication (38.5%). A total of 92.3% of the patients maintained the ability to walk with assistance, and while the PROMs reflected moderate pain control and limited function, they were indicative of basic independence.

Despite the high rate of complications, in patients with severe femoral bone loss, TFR is a valid option for preserving the limb and allowing a faster transition from assisted ambulation in nononcology patients.