Trauma Salvage With Femoral Endoprosthetic Arthroplasty for Failed Internal Fixation Following Femoral Fragility Fracture Surgery.

Abstract

Despite major advances in femoral fragility fracture fixation techniques and implants, fixation failures still occur. To restore function, conversion to an endoprosthesis may be preferable to repeated attempts at fixation. The aim of this study was to explore the outcomes of femoral endoprostheses when performed specifically for trauma salvage. We identified 35 patients who underwent femoral endoprosthesis for trauma salvage between January 2012 and December 2022 through review of our prospectively collected institutional implant database, electronic notes, and national Picture Archiving and Communication System. Demographics, comorbidities, surgical details, and outcomes were collated and analyzed. The primary outcome measure was reoperation-free survivorship after 3 years. Secondary outcomes included readmission, length of hospital stay, blood transfusion rate, mobility status, and morbidity, and mortality at 90 days and 1 year. Of the 35 endoprostheses performed, 26 were proximal femoral replacements (PFRs) and nine were distal femoral replacements (DFRs). The mean age was 71 years (range, 42 to 86) and 25 of 35 (71.4%) were women. A median of one trauma surgery (range, one to seven) had been performed before endoprosthesis. Modes of failure requiring conversion to endoprostheses included nonunion (n = 19), fixation failure (n = 6), lag screw cut-out (n = 4), refracture (n = 2), and infection (n = 4). Patients undergoing PFR were older and less mobile prefracture and postendoprosthesis than those requiring DFR. Reoperations were required in four of 35 cases, all PFRs, due to infection (n = 2) and instability (n = 2). At 3 years, survival free from reoperation was 82.0% for PFRs and 100% for DFRs. Length of hospital stay was longer following PFR (25 versus 7 days, P = 0.037). There were six patients who required readmission (17%), all after PFR. There was one patient who died before 90 days. Endoprostheses for trauma salvage were associated with significant, but acceptable, complication rates. Infection and instability remain the most important complications. Reoperation and readmission were limited to patients who had undergone PFRs who were older and less mobile.