Total femur replacement: function, quality of life, and gait: a multicentric EMSOS study

Background: Total femur replacements (TFRs) involve the replacement of the whole femoral bone, reconstruction of the hip and knee joints, and soft tissue reconstruction for function and joint stability. The aim of this multicentric European Musculo-Skeletal Oncology Society (EMSOS) study is to report on the functional outcome, quality of life, as well as gait analysis in patients with TFR. Materials and methods: Retrospective data from 12 international participating centers were collected. In total, 65 patients [median (IQR) age at surgery 40 (18–56) years, 60% male] who received a TFR owing to oncologic or nononcologic indications between 1 January 1990 and 31 March 2024 were included. Patient-related outcome measures (PROMs), range of motion (ROM) of the hip and knee, and gait videos were collected. Results: At a median (IQR) follow-up of 28 (14–126) months, the median (IQR) percentage Musculoskeletal Tumor Society (MSTS) score was 63% (43–73%), 12-Item Short-Form Health Survey (SF-12) was 70% (55–79%), Harris Hip Score (HHS) was 63% (52–77%), and Oxford Knee Score (OKS) was 63% (52–79%); the median (IQR) extension-to-flexion ROM were 80° (70–97.5°, hip) and 70° (40–90°, knee). Gait videos were available for 24/65 patients (37%). The median (IQR) total Edinburgh Visual Gait Score of the operated side was 8.5 (6–13), with deviations from norm in all patients (24/24). Compensational gait pathology on the contralateral side was detected in 23/24 patients (96%). Better outcome measures significantly correlated with younger age (all PROMs), oncologic indications (MSTS and OKS), and primary TFR implantations (MSTS). Conclusions: Moderate-to-good PROM scores are to be expected after TFR, with better outcomes in younger patients undergoing primary implantations for oncologic indications. The reported results must be appraised as best-case estimates. The recurrent gait deviations observed and the compensational gait pathology on the contralateral side should be considered in TFR aftercare, remobilization, and patient counseling. Level of evidence: Level III, therapeutic study.