Outcomes of a long modular uncemented femoral stem for reconstruction in metastatic femoral disease

Aims Cemented arthroplasty has previously been recommended for treating metastatic bone disease (MBD) around the hip. However, cementing has disadvantages, including restricted femoral component length, loosening due to disease progression, and bone cement implantation syndrome (BCIS). A long uncemented implant spanning the whole femur could negate these disadvantages; however, there is a paucity of data regarding their use. Our aim was to assess the outcomes of a long uncemented femoral component in MBD. Methods A total of 205 patients with MBD underwent femoral reconstruction using the Restoration Modular Revision Hip System Plasma stem between January 2008 and December 2025. They were identified from the prospectively collected database of a tertiary MBD service. Any patient with symptomatic bone metastases involving the acetabulum or femur, with completed or impending pathological fracture, were included. The primary endpoint was reintervention for femoral implant failure, with exclusion of reintervention for deep infection and/or instability. Results Indications for surgery included pathological fracture (46 of 205; 22%) or lesions at risk of fracture (78%; n = 159). The mean follow-up was 45 months (12 to 131). A total of 140 patients (68%) died during the study period (mean 20 months (0.1 to 128) postoperatively). The mean distance from the centre of the femoral head to the most distal femoral metastasis was 126 mm (5 to 369). Using death as a competing risk, two-year probability of reintervention was 0.010 (95% CI 0.000 to 0.025) and probability of death was 0.507 (95% CI 0.436 to 0.577). At five years, probability of reintervention was 0.010 (95% CI 0.000 to 0.025) and the risk of death was 0.703 (95% CI 0.629 to 0.776). Overall complication rate requiring further surgery was 8% (16 out of 205) with three reinterventions for femoral implant failure (all periprosthetic femoral fractures). Conclusion This implant demonstrates promising short- to mid-term survivorship, with no patient requiring femoral revision for loosening and a comparatively low complication rate. A long uncemented femoral component may be an appropriate option in selected patients presenting with symptomatic bone metastases around the hip. Cite this article: Bone Joint J 2026;108-B(11):1344–1353.