Carbon fibre PEEK versus titanium cephalomedullary nails for management of oncological lesions of the femur: a retrospective cohort study

Abstract Background Carbon fibre reinforced polyetheretherketone (CF-PEEK) intramedullary devices have been gaining traction in the field of orthopaedic oncology. We aim to investigate the safety and efficacy of this device. Methods A retrospective cohort study was performed. Our primary objectives were to compare all-cause revision and the incidence of postoperative complications between CF-PEEK nails (Group 1) to titanium alloy nails (Group 2) for management of oncological lesions of the femur. Secondary objectives were to compare estimated blood loss and all-cause mortality between the two groups. Each outcome was adjusted for age, sex, American Society of Anaesthesiologist score and surgical indication (pathological fracture versus prophylactic fixation). Results Eighty-two patients with 85 hips (Group 1 = 50; Group 2 = 35) were identified. Our competing risk analysis found no significant difference in the revision risk between groups (subdistribution hazard ratio = 1.14, p = 0.931). There was an 85% increase in odds of complication in Group 2 which was not statistically significant (p = 0.249). Furthermore, those in Group 2 experienced 306.35 mL less blood loss than Group 1, which was also not statistically significant (p = 0.086). There was no difference in all-cause mortality between groups (HR = 1.11, p = 0.702). Conclusion Our study demonstrates no difference in the safety and efficacy profile of CF-PEEK nails as compared to titanium alloy nails in the management of oncological lesions of the femur. This needs to be interpreted with caution given the underpowered nature of this study. Furthermore, the current implant cost of CF-PEEK nails is prohibitive. Adequately powered randomised controlled trials or multinational registry-based studies incorporating economic assessment and patient reported outcome measures are required to further investigate this new technology prior to its adoption. Level of evidence Therapeutic III.