Abstract
PURPOSE: This study compared internal fixation (IF) to proximal femur replacement (PFR) for proximal femoral metastasis. METHODS: Between 2005 and 2019, 113 lesions underwent IF (n = 94) or PFR (n = 19). Revision risk was calculated with mortality as a competing event. RESULTS: The 5-year revision risk after IF was 17.6% (95% CI, 9.8%-27.3%) compared to 7.6% (95% CI, 0.3%-28.9%) after PFR (p = 0.59). PFR had longer operative times (p < 0.001), hospital stay (p = 0.039), and higher blood loss (p < 0.001) than IF, respectively. CONCLUSIONS: IF may be considered for patients with poor health and a limited prognosis given the less-invasive procedure and shorter hospital stay. LEVEL OF EVIDENCE: III. Retrospective Study.