JOA - 2026-09-09 - Journal Article; Review
Proximal Femoral Replacement Outcomes for Oncologic Versus Non-Oncologic Indications: A Systematic Review and Meta-Analysis.
Kurapatti M, Shah A, Tao B, Henriquez A, Parsons K, Wu K, Eward WC
Topics
Key Takeaway
Non-oncologic proximal femoral replacement carries more than double the revision rate of oncologic PFR (13% vs 6%, P=0.03) and higher dislocation rates (9% vs 5%, P=0.04), despite similar overall complication rates of 27%.
Summary Depth
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Summary
This systematic review and meta-analysis compared complications, revision rates, implant survivorship, and patient survival between oncologic and non-oncologic PFR across 42 studies and 2,804 cases. Non-oncologic PFR had higher dislocation (9% vs 5%) and revision rates (13% vs 6%), while oncologic PFR had higher amputation rates (1% vs 0%) and dramatically lower 5-year patient survival (46% vs 67%). Overall implant survivorship was 90.8%, 89.4%, and 77.1% at 1, 5, and 10 years across both groups.
Key Limitation
The non-oncologic cohort is less than one-third the size of the oncologic cohort (723 vs 2,081 cases), and the mean age difference of 18 years between groups (72 vs 54) confounds direct complication rate comparisons without individual patient-level data adjustment.
Original Abstract
BACKGROUND
Proximal femoral replacement (PFR) is a modular endoprosthetic reconstruction technique traditionally used for oncologic resections, but increasingly applied to non-oncologic conditions. This systematic review and meta-analysis aimed to compare complications, revision and amputation rates, implant survivorship, and patient survival between oncologic and non-oncologic PFR cases.
METHODS
A systematic search of PubMed, Embase, and Scopus was conducted through September 2025. Studies were included if they reported clinical outcomes of PFR with separate data for oncologic and non-oncologic indications. Outcomes such as overall complication rate, dislocation, periprosthetic fracture, and infection rate were collected. Data were pooled using random-effects models, and heterogeneity was quantified with the I 2 statistic. There were 42 studies that met inclusion criteria, encompassing 2,804 PFR cases (2,081 oncologic and 723 non-oncologic). Patient mean age was higher in non-oncologic cohorts (72 versus 54 years, P < 0.001).
RESULTS
The pooled overall complication rate was 27% (95% confidence interval (CI) [0.21 to 0.32]), without significant difference between groups (P = 0.93). Dislocation or instability occurred more frequently in non-oncologic PFR (9 versus 5%; P = 0.04), while rates of infection, aseptic loosening, and periprosthetic fracture were similar. Revision rates were significantly higher in non-oncologic cases (13% [0.08 to 0.18]) than oncologic (6% [0.04 to 0.09]; P = 0.03). Amputation was rare overall, but more common in oncologic series (1 versus 0%; P = 0.02). Overall implant survivorship was 90.8, 89.4, and 77.1% at one, five, and 10 years, respectively. The five-year patient survival was markedly lower in oncologic cohorts (46 versus 67%; P < 0.001).
CONCLUSION
The PFR demonstrates acceptable complication and survivorship rates across indications. While oncologic patients experience higher mortality, non-oncologic cases have greater revision risk. However, given the substantial heterogeneity across included studies, results should be interpreted with caution and underscore the need for future standardized, prospective investigations.