Proximal femoral replacement for oncologic and non-oncologic indications: a retrospective study over a 13-year period

Proximal femoral replacement (PFR) is a critical limb-salvage strategy for managing massive proximal femoral bone loss due to oncologic and non-oncologic conditions. Although oncologic outcomes are well described, evidence surrounding PFR for infection, periprosthetic fracture, and mechanical failure remains limited. This study evaluates short- to mid-term outcomes following PFR for multiple indications and compares primary with revision procedures. We retrospectively reviewed all patients undergoing PFR at a Level I trauma center from 2009 to 2023. Cases were categorized by procedure type (primary vs. revision) and indication (tumor, infection, other causes). Outcomes included operative time, complications according to the Henderson classification, reoperation rates, and functional outcomes. A total of 81 patients (84 procedures) were included with a median follow-up of 7 months (IQR 0–31); 57.1% were lost to follow-up. The overall complication rate was 42.9%, significantly higher in revision procedures than in primary PFRs. Infection (Henderson Type IV) was the most frequent complication and occurred predominantly in revision surgeries. No cases of aseptic loosening (Type II) were identified. Reoperation was required in 29% of all procedures, with the highest rates observed in infection cases. PFR remains a reliable limb-salvage option for extensive proximal femoral deficiency. Revision procedures, especially infection-related cases, carry substantially higher risks of complications and reoperation. In contrast, primary oncologic PFRs showed comparatively favorable outcomes. Infection remains the principal barrier to durable results, underscoring the need for optimized perioperative strategies. Therapeutic Level III (retrospective cohort study).