الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Background: Metastatic tumors are the most common malignant lesion of the proximal femur, with carcinomas being the most frequent. The proximal femur and mid-femur are common sites for primary bone sarcomas; approximately16% of Ewing’s sarcomas, 13% chondrosarcomas and 10% of osteosarcomas develop at these locations. The major aim in the management of patients who have bone malignancies is prolonging their survival. Primary bone sarcomas that require surgical resection can be treated by either amputation or limb salvage. Most studies which compared both approaches reported that limb salvage had no adverse effect on patients’ survival on long-term.
Objective: This is a systematic review of literature with meta-analysis study that compare the functional outcomes and complications of the methods; proximal femoral hemi versus total arthroplasty after proximal femur resection followed by endoprosthetic reconstruction and provide recommendations by the best available evidence.
Methods: We included Randomized control trails (RCTs), including cluster RCTs, controlled (non-randomized) clinical trials or cluster trials, prospective and retrospective comparative cohort studies, and case-control or nested case-control studies and controlled clinical trials. We excluded cross-sectional studies, case reports, review articles, letters to the editor, meeting abstracts, and technique papers. Search results conducted to systematic review management software and manually screened for eligibility were included. Critical appraisal checklist was used to assess the search results based on the inclusion/exclusion criteria.
Results: Twenty-three studies are included. Quality appraisal demonstrated that all but one study is retrospective. The pooled results from the meta-analysis showed that the rate of aseptic loosening was only 2% when reconstruction occurs with endoprosthetic proximal femoral hemiarthroplasty. There was unimportant heterogeneity in the included studies. The rate of conversion to total hip arthroplasty (THA) is 4.6% to 8% of oncological patients. The rate of periprosthetic fracture was only 1%
Conclusion: Proximal femoral endoprosthesis has definitive benefits in the treatment of primary or metastatic tumors affecting the proximal femur. The implants tend to improve the function and quality of life of patients with metastatic disease and high-grade localized disease. It also provides them with a relatively pain-free limb with good functional capacity. With continuing advances in the surgical and oncological fields, there is a great potential for curative limb salvage surgery in the long term. Reconstruction with endoprosthetic Proximal femoral hemiarthroplasty after proximal femoral resection in young adults can confer additional stability with a reduced dislocation rates and systemic complications as compared to total hip arthroplasty.