Design: Single-centre retrospective review of a prospective database
Population: 205 patients with proximal femoral metastases, Scotland, 2008–2025
Primary outcome: Reintervention for femoral implant failure
Effect: About 1% at 2 and 5 years (death as competing risk); 8% any reoperation

This Scottish tertiary series reviewed 205 patients with symptomatic metastatic disease of the proximal femur reconstructed between 2008 and 2025 using a long modular uncemented femoral stem spanning the femur. Most (78%) were operated on for impending rather than completed fracture.

With death treated as a competing risk, the probability of reintervention for femoral implant failure was about 1% at both two and five years. The three such failures were all periprosthetic fractures; no stem was revised for loosening. Overall, 8% needed further surgery for any complication. Two-year mortality was about 51% and 68% of patients died during follow-up.

Cemented fixation has been the conventional choice in metastatic hip disease, but it brings the risk of bone cement implantation syndrome and limits stem length. A long uncemented stem protects distal metastases and avoids cement. This is a single-centre series without a comparison group, so it supports the option rather than proving superiority.

Image the whole femur before reconstruction to identify distal lesions
Consider a long stem that bypasses all femoral metastases
Weigh the risk of bone cement implantation syndrome when choosing fixation in frail patients
Plan surgery with the oncology team, given about half of patients die within two years

Why it matters

Offers an alternative to cemented fixation that avoids cement reactions in fragile patients.

The statistics, in plain English

Because many patients died before an implant could fail, the authors used a competing-risk method; a 1% reintervention probability means implant failure was rare among people who lived long enough to experience it. Without a cemented comparison group, the series cannot show one approach is better.