Proximal Femur Endoprosthesis (Indications for Oncologic Pathology) Systematic Literature Review

Introduction: The proximal femur is a very common location for primary malignant tumors, aggressive benign tumors, and one of the most frequent sites in the appendicular skeleton for the presentation of metastatic disease. Thanks to advances in oncology, which have achieved better local and global control of the disease, new pathways have opened for alternatives such as limb preservation and reconstruction. There are various reconstruction alternatives, among which endoprostheses stand out. Current studies have consistently demonstrated that these implants effectively treat local disease, offer good survival rates and patient acceptance, provide reproducible functional results, and present complication rates similar to those of conventional prostheses used for other causes. Objective: To conduct a review of the literature available over the last 20 years regarding the use of endoprostheses at the proximal femur level for oncologic pathology. Materials and Methods: A systematic search was conducted using the electronic databases Cochrane, Lilacs, Scielo, Pubmed, Science Direct, and the Timbó portal. The search yielded a total of 6,837 articles, of which 22 were selected based on inclusion and exclusion criteria for this review. Results: It is noted that the majority of the articles are of evidence level IV. The primary indications for their use in tumor pathology include aggressive primary tumors and metastatic disease, applicable in various scenarios such as pathological or impending fractures, salvage procedures following failed osteosynthesis or pseudarthrosis. Different options exist for repairing the abductor mechanism and capsular closure; however, the studies are heterogeneous regarding techniques, making it difficult to recommend a gold standard. Key factors to prevent instability and dislocation include the use of bipolar hemiarthroplasties and, surgically, preserving as much tissue as possible (greater trochanter, gluteus medius, fascia lata, vastus lateralis, and capsule) with the use of sutures or non-absorbable materials for repair. The most frequent complications include dislocation (5.8%), infection (5.2%), local recurrence (4.7%), and periprosthetic fracture (0.6%). The survival rate of these prostheses ranges between 80%-90% at 5 years, while limb survival in multiple series is around 90%. The most commonly used functional score is the MSTS. Conclusion: We consider endoprostheses to be an excellent option within our therapeutic arsenal for proximal femur reconstruction, as they are durable, allow local treatment of the disease, relieve pain, and provide quality of life and function to patients, with a low complication rate comparable to the use of conventional prostheses for other causes..