Outcomes of Endoprosthetic Replacement for Salvage of Failed Fixation of Malignant Pathologic Proximal Femur Fractures

Internal fixation is often used to treat pathologic proximal femur fractures. However, nonunion and/or tumor progression may lead to hardware failure. In such cases, endoprosthetic replacement may be considered. The purpose of this study is to analyze the outcome of patients undergoing conversion to an endoprosthetic replacement following failed fixation of a pathological proximal femur fracture.

We identified 26 patients who underwent conversion hip arthroplasty for salvage of failed fixation of a pathologic proximal femur fracture between 2000 and 2016. Previous surgical hardware included femoral nail (n = 18), dynamic hip screw (n = 5), proximal femoral locking plate (n = 1), blade plate (n = 1), and cannulated screws (n = 1). Twenty-one patients had metastatic disease, 4 myeloma, and 1 lymphoma. All received adjuvant or neoadjuvant radiotherapy at a mean dose of 30 Gy.

There were 15 males and 11 females with mean age 63 ± 11 years. Patients underwent conversion arthroplasty at a mean of 13 ± 12 months after initial fixation. At final follow-up, 19 patients had died, with 5-year overall survival of 35%. Conversion to arthroplasty was performed due to disease progression (n = 12), hardware failure (n = 8), and nonunion (n = 6). Eight hips required reoperation, most commonly for infection (n = 4). At last follow-up, the Harris Hip Scores ( P < .001) and Musculoskeletal Tumor Society Scores ( P < .001) significantly improved from a mean of 24 and 14 preoperatively to 68 and 59 postoperatively, respectively.

Conversion hip arthroplasty reliably provides improved quality of life and immediate weight bearing, making it an effective treatment for salvage of failed fixation of pathologic proximal femur fractures.