A UK multicentre cohort study of clinical outcomes of distal femoral replacement for nononcological conditions : the EndoProsthetic Replacement for nonOncological conditions (EPRO) study.

Abstract

Aims: This study aims to determine the outcomes of distal femoral replacements (DFRs) for nononcological conditions.

Methods: This was a multicentre retrospective cohort study across five UK centres between 1 August 2009 and 1 April 2023. The primary outcome was the local complication rate. Secondary outcomes assessed were blood transfusion rate, critical care requirements, return to baseline mobility and residence status, systemic complication rates, reoperation rate, and mortality rates. Implant survival analysis was performed using Kaplan-Meier methodology with local complication as the endpoint. Binary logistical regression was performed to identify risk factors for developing local complications. The study included 227 DFRs with a median age of 78.2 years (IQR 70.1 to 84.0). Indications were periprosthetic femoral fracture (PFF) (n = 74; 33%), aseptic revision arthroplasty (n = 45; 20%), acute trauma (n = 42; 19%), infected revision arthroplasty (n = 40; 18%), chronic/failed trauma (n = 14; 6%), and complex primary arthroplasty (n = 12; 5%). Median follow-up was 3.9 years (IQR 1.5 to 7.1).

Results: The local complication rate was 21% (48 cases). The most common local complications were periprosthetic joint infection (n = 22; 10%), PFF (n = 7; 3%), and aseptic loosening (n = 7; 3%). Blood transfusion was required in 57 patients (25%), while 67 (30%) required critical care facilities. A return to baseline mobility and residence was observed in 94 (50%) and 183 (83%) patients, respectively. The six-month systemic complication rate was 12% (n = 27) and the reoperation rate was 16% (n = 36). The 30-day and one-year mortality rates were 3% (n = 6) and 9% (n = 21), respectively. The two-year implant survival rate was 80.9% (SE 2.8). Binary logistic regression demonstrated surgery for infected revision arthroplasty, an increasing construct:stem ratio, and increasing operating time were associated with a higher risk of failure (p < 0.05).

Conclusion: This is the largest study of DFR for nononcological conditions. Due to high local complication and reoperation rates, it should be considered as a salvage option for complex knee reconstruction and patients should be counselled appropriately.