# Carbon fibre PEEK versus titanium cephalomedullary nails for management of oncological lesions of the femur: a retrospective cohort study

## TL;DR

This study compares carbon fiber PEEK and titanium nails for treating femur tumors, finding no significant differences in safety or effectiveness.

## Contribution

The study provides a novel comparison of carbon fiber PEEK versus titanium nails in orthopedic oncology for femoral lesions.

## Key findings

- No significant difference in revision risk between CF-PEEK and titanium nails.
- Titanium nails showed a trend toward fewer complications and less blood loss, but results were not statistically significant.
- No difference in mortality between the two groups.

## Abstract

Carbon fibre reinforced polyetheretherketone (CF-PEEK) intramedullary devices have been gaining traction in the field of orthopaedic oncology. We aim to investigate the safety and efficacy of this device.

A retrospective cohort study was performed. Our primary objectives were to compare all-cause revision and the incidence of postoperative complications between CF-PEEK nails (Group 1) to titanium alloy nails (Group 2) for management of oncological lesions of the femur. Secondary objectives were to compare estimated blood loss and all-cause mortality between the two groups. Each outcome was adjusted for age, sex, American Society of Anaesthesiologist score and surgical indication (pathological fracture versus prophylactic fixation).

Eighty-two patients with 85 hips (Group 1 = 50; Group 2 = 35) were identified. Our competing risk analysis found no significant difference in the revision risk between groups (subdistribution hazard ratio = 1.14, p = 0.931). There was an 85% increase in odds of complication in Group 2 which was not statistically significant (p = 0.249). Furthermore, those in Group 2 experienced 306.35 mL less blood loss than Group 1, which was also not statistically significant (p = 0.086). There was no difference in all-cause mortality between groups (HR = 1.11, p = 0.702).

Our study demonstrates no difference in the safety and efficacy profile of CF-PEEK nails as compared to titanium alloy nails in the management of oncological lesions of the femur. This needs to be interpreted with caution given the underpowered nature of this study. Furthermore, the current implant cost of CF-PEEK nails is prohibitive. Adequately powered randomised controlled trials or multinational registry-based studies incorporating economic assessment and patient reported outcome measures are required to further investigate this new technology prior to its adoption.

Therapeutic III.

The online version contains supplementary material available at 10.1186/s12891-025-09411-3.