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Abstract：
BACKGROUND: Total femur replacement (TFR) has become increasingly significant as a salvage procedure for both oncologic reconstruction and complex nononcologic conditions such as revision arthroplasty. Despite its effectiveness in limb salvage, TFR is associated with high complication and failure rates, which vary depending on the underlying indication.
METHODS: This systematic review and meta-analysis adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of MEDLINE, EMBASE, Web of Science, and Cumulative Index to Nursing and Allied Health Literature databases was conducted, focusing on studies that reported outcomes of TFR in oncologic and nononcologic cases. Primary outcomes included failure mode and rates according to the Henderson classification, functional outcomes scores, and mobility status. Data were analyzed using random-effects models and generalized linear mixed models.
RESULTS: A total of 35 studies involving 1,002 patients were included. The majority of TFRs were performed for oncologic reasons (63.7%). The mean Musculoskeletal Tumor Society (MSTS) score was 66%, with a limb salvage rate of 89%. The meta-analysis revealed a combined failure rate of 34%. For type 4 failures (infection), nononcologic patients exhibited a significantly higher rate at 18% (95% confidence interval [CI], 12%-26%, I2 = 46%, p < 0.01) compared with 8% in oncologic patients (95% CI, 6%-12%, I2 = 0%). Regarding combined types 1 to 4 failures, oncologic patients had a rate of 20% (95% CI, 25%-52%, I2 = 60%), whereas nononcologic patients faced a higher rate of 37% (95% CI, 12%-26%, I2 = 63%) (p < 0.05), indicating a significant difference. There were no significant differences in the MSTS score. In addition, there were no notable differences when comparing failure modes 1, 2, and 3 independently. Mobility analysis showed that approximately 70% of patients required walking aids after surgery.
CONCLUSIONS: TFR offers a valuable limb salvage option in both oncologic and nononcologic scenarios, despite its high failure rates. Although functional outcomes were similar between groups, the higher failure rate in nononcologic cases and the poor overall quality of evidence warrant further comprehensive assessments into predictors of outcomes to optimize results.
METHODS: Level III. See Instructions for Authors for a complete description of levels of evidence.
METHODS: This systematic review and meta-analysis adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of MEDLINE, EMBASE, Web of Science, and Cumulative Index to Nursing and Allied Health Literature databases was conducted, focusing on studies that reported outcomes of TFR in oncologic and nononcologic cases. Primary outcomes included failure mode and rates according to the Henderson classification, functional outcomes scores, and mobility status. Data were analyzed using random-effects models and generalized linear mixed models.
RESULTS: A total of 35 studies involving 1,002 patients were included. The majority of TFRs were performed for oncologic reasons (63.7%). The mean Musculoskeletal Tumor Society (MSTS) score was 66%, with a limb salvage rate of 89%. The meta-analysis revealed a combined failure rate of 34%. For type 4 failures (infection), nononcologic patients exhibited a significantly higher rate at 18% (95% confidence interval [CI], 12%-26%, I2 = 46%, p < 0.01) compared with 8% in oncologic patients (95% CI, 6%-12%, I2 = 0%). Regarding combined types 1 to 4 failures, oncologic patients had a rate of 20% (95% CI, 25%-52%, I2 = 60%), whereas nononcologic patients faced a higher rate of 37% (95% CI, 12%-26%, I2 = 63%) (p < 0.05), indicating a significant difference. There were no significant differences in the MSTS score. In addition, there were no notable differences when comparing failure modes 1, 2, and 3 independently. Mobility analysis showed that approximately 70% of patients required walking aids after surgery.
CONCLUSIONS: TFR offers a valuable limb salvage option in both oncologic and nononcologic scenarios, despite its high failure rates. Although functional outcomes were similar between groups, the higher failure rate in nononcologic cases and the poor overall quality of evidence warrant further comprehensive assessments into predictors of outcomes to optimize results.
METHODS: Level III. See Instructions for Authors for a complete description of levels of evidence.
摘要：
背景：全股骨置换（TFR）作为肿瘤重建和复杂的非肿瘤疾病（如关节翻修术）的抢救程序已变得越来越重要。尽管它在挽救肢体方面很有效，TFR与高并发症和失败率相关，这取决于潜在的指示。
方法：本系统评价和荟萃分析遵循系统评价和荟萃分析指南的首选报告项目。全面搜索MEDLINE,EMBASE,WebofScience,并对护理和相关健康文献数据库进行了累积索引，专注于报告肿瘤和非肿瘤病例TFR结局的研究。主要结果包括根据亨德森分类的故障模式和发生率，功能结果评分，和移动性状态。使用随机效应模型和广义线性混合模型对数据进行分析。
结果：共纳入35项研究，涉及1,002名患者。大多数TFR是出于肿瘤原因(63.7%)。肌肉骨骼肿瘤协会（MSTS）的平均得分为66％，保肢率为89%。荟萃分析显示综合失败率为34%。对于类型4故障（感染），非肿瘤患者的比率显著高于18%(95%置信区间[CI]，12%-26%，I2=46%，p<0.01）与肿瘤患者的8%相比（95%CI，6%-12%，I2=0%)。关于组合类型1至4的故障，肿瘤患者的比率为20%(95%CI，25%-52%，I2=60%)，而非肿瘤患者的发病率更高，为37%(95%CI，12%-26%，I2=63%)(p<0.05)，表明存在显著差异。MSTS评分无显著差异。此外,当独立比较故障模式1,2和3时,没有显著差异.流动性分析显示，大约70％的患者在手术后需要助行器。
结论：TFR在肿瘤和非肿瘤情况下都提供了有价值的保肢选择，尽管它的故障率很高。尽管两组之间的功能结果相似，非肿瘤病例的失败率较高且总体证据质量较差,因此需要进一步全面评估结局预测因子,以优化结果.
方法：三级。有关证据级别的完整描述，请参阅作者说明。
方法：本系统评价和荟萃分析遵循系统评价和荟萃分析指南的首选报告项目。全面搜索MEDLINE,EMBASE,WebofScience,并对护理和相关健康文献数据库进行了累积索引，专注于报告肿瘤和非肿瘤病例TFR结局的研究。主要结果包括根据亨德森分类的故障模式和发生率，功能结果评分，和移动性状态。使用随机效应模型和广义线性混合模型对数据进行分析。
结果：共纳入35项研究，涉及1,002名患者。大多数TFR是出于肿瘤原因(63.7%)。肌肉骨骼肿瘤协会（MSTS）的平均得分为66％，保肢率为89%。荟萃分析显示综合失败率为34%。对于类型4故障（感染），非肿瘤患者的比率显著高于18%(95%置信区间[CI]，12%-26%，I2=46%，p<0.01）与肿瘤患者的8%相比（95%CI，6%-12%，I2=0%)。关于组合类型1至4的故障，肿瘤患者的比率为20%(95%CI，25%-52%，I2=60%)，而非肿瘤患者的发病率更高，为37%(95%CI，12%-26%，I2=63%)(p<0.05)，表明存在显著差异。MSTS评分无显著差异。此外,当独立比较故障模式1,2和3时,没有显著差异.流动性分析显示，大约70％的患者在手术后需要助行器。
结论：TFR在肿瘤和非肿瘤情况下都提供了有价值的保肢选择，尽管它的故障率很高。尽管两组之间的功能结果相似，非肿瘤病例的失败率较高且总体证据质量较差,因此需要进一步全面评估结局预测因子,以优化结果.
方法：三级。有关证据级别的完整描述，请参阅作者说明。
