There is a paucity of data available for the use of Total Femoral Arthroplasty (TFA) for joint reconstruction in the non-oncological setting. The aim of this study was to evaluate TFA outcomes with minimum 5-year follow-up.

This was a retrospective database study of TFAs performed at a UK tertiary referral revision arthroplasty unit. Inclusion criteria were patients undergoing TFA for non-oncological indications. We report demographics, indications for TFA, implant survivorship, clinical outcomes, and indications for re-operation.

A total of 39 TFAs were performed in 38 patients between 2015–2018 (median age 68 years, IQR 17, range 46–86), with 5.3 years’ (IQR 1.2, 4.1–18.8) follow-up; 3 patients had died. The most common indication (30/39, 77%) for TFA was periprosthetic joint infection (PJI) or fracture-related infection (FRI); and 23/39 (59%) had a prior periprosthetic fracture (PPF). TFA was performed with dual-mobility or constrained cups in 31/39 (79%) patients. Within the cohort, 12 TFAs (31%) required subsequent revision surgery: infection (7 TFAs, 18%) and instability (5 TFAs, 13%) were the most common indications. 90% of patients were ambulatory post-TFA; 2 patients required disarticulation due to recurrent PJI. While 31/39 (79%) were infection free at last follow-up, the remainder required long-term suppressive antibiotics.

This is the largest series of TFA for non-oncological indications. Though TFA has inherent risks of instability and infection, most patients are ambulant after surgery. Patients should be counselled on the risk of life-long antibiotics, or disarticulation when TFA fails.

The management of proximal femoral bone loss is a significant challenge in revision hip arthroplasty. A possible solution is the use of a modular proximal femur endoprosthesis (EPR). Although the survivorship and functional outcome of megaprostheses used in tumour surgery has been well described, outcome of EPRs used in revision hip surgery has received less attention. The aim of this study was to determine the 5-year outcome following proximal femur EPR and determine factors that influence it.

This was a retrospective consecutive case series of all EPRs (n=80) performed for non-neoplastic indications, by 6 surgeons, in our tertiary referral centre, between 2005–2014. Patient demographics and relevant clinical details were determined from notes. The most common indications for the use of EPRs included infection (n=40), peri-prosthetic fracture (n=12) and failed osteosynthesis of proximal femoral fractures/complex trauma (n=11). Outcome measures included complication and re-operation rates, implant survival and assessment of functional outcome using the Oxford-Hip-Score (OHS).

The mean age at surgery was 69 years and mean follow-up was 4 (0 – 11) years. The mean number of previous hip operations was 2.4 (range: 0 – 17). Twenty-five patients sustained a complication (31%), the most common being infection (n=9) and dislocation (n=4). By follow-up, further surgery was required in 18 (22%) hips, 9 of which were EPR revisions. 5-yr implant survivorship was 87% (95%CI: 76 – 98%). Mean OHS was 28 (range: 4 – 48). Inferior survival and outcome were seen in EPRs performed for the treatment of infection. Infection eradication was achieved in 34/41 with the index EPR procedure and in 40/41 hips by follow-up.

Limb salvage was achieved in all cases and acceptable complication- and re-operation rates were seen. EPRs for periprosthetic fractures and failed osteosynthesis had best outcome. We recommend the continued use of proximal femur EPR in complex revision surgery.