全股骨置换术（TFR）作为肿瘤重建和复杂非肿瘤疾病（例如翻修关节置换术）的挽救手术变得越来越重要。尽管 TFR 在保肢方面有效，但它与高并发症和失败率相关，具体取决于潜在的适应症。这项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。对 MEDLINE、EMBASE、Web of Science 以及护理和联合健康文献累积索引数据库进行了全面检索，重点关注报告肿瘤和非肿瘤病例 TFR 结果的研究。主要结局包括根据亨德森分类的失败模式和比率、功能结果评分和活动状态。使用随机效应模型和广义线性混合模型对数据进行分析。共纳入 35 项研究，涉及 1,002 名患者。大多数 TFR 是出于肿瘤原因进行的（63.7%）。肌肉骨骼肿瘤协会 (MSTS) 平均评分为 66%，保肢率为 89%。荟萃分析显示综合失败率为 34%。对于 4 型失败（感染），非肿瘤患者的失败率显着较高，为 18%（95% 置信区间 [CI]，12%-26%，I2 = 46%，p < 0.01），而肿瘤患者的失败率为 8%（ 95% CI，6%-12%，I2 = 0%）。对于 1 至 4 类联合失败，肿瘤患者的失败率为 20%（95% CI，25%-52%，I2 = 60%），而非肿瘤患者的失败率为 37%（95% CI，12%）。 -26%，I2 = 63%）（p < 0.05），表明存在显着差异。 MSTS 评分没有显着差异。此外，独立比较故障模式 1、2 和 3 时没有显着差异。活动能力分析显示，大约 70% 的患者在手术后需要助行器。尽管 TFR 的失败率很高，但它在肿瘤和非肿瘤情况下都提供了宝贵的保肢选择。尽管各组之间的功能结果相似，但非肿瘤病例的较高失败率和证据的整体质量较差，需要对结果的预测因素进行进一步的综合评估，以优化结果。III级。有关证据级别的完整说明，请参阅作者须知。版权所有 © 2024 作者。由《骨与关节外科杂志》公司出版。版权所有。

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.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.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.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.Level III. See Instructions for Authors for a complete description of levels of evidence.Copyright © 2024 The Authors. Published by The Journal of Bone and Joint Surgery, Incorporated. All rights reserved.