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

Christian Marx; Tim Cheok; Allan Villadsen; Luis Munoz; Ruurd L Jaarsma; Jakub Jagiello; Luke Johnson

doi:10.1186/s12891-025-09411-3

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

Christian Marx, Tim Cheok^*, Allan Villadsen, Luis Munoz, Ruurd L Jaarsma, Jakub Jagiello, Luke Johnson

^*Corresponding author af dette arbejde

Afdeling for Led- og Knoglekirurgi HOC

Abstract

BACKGROUND: 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.

METHODS: 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).

RESULTS: 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).

CONCLUSION: 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.

LEVEL OF EVIDENCE: Therapeutic III.

Originalsprog	Engelsk
Artikelnummer	54
Tidsskrift	BMC Musculoskeletal Disorders
Vol/bind	27
Udgave nummer	1
Sider (fra-til)	54
ISSN	1471-2474
DOI	https://doi.org/10.1186/s12891-025-09411-3
Status	Udgivet - 18 dec. 2025

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10.1186/s12891-025-09411-3Licens: CC BY

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title = "Carbon fibre PEEK versus titanium cephalomedullary nails for management of oncological lesions of the femur: a retrospective cohort study",

abstract = "BACKGROUND: 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.METHODS: 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).RESULTS: 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).CONCLUSION: 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.LEVEL OF EVIDENCE: Therapeutic III.",

keywords = "Adult, Aged, Benzophenones, Bone Nails/adverse effects, Carbon, Carbon Fiber, Cohort Studies, Female, Femoral Neoplasms/surgery, Fracture Fixation, Intramedullary/instrumentation, Humans, Ketones, Male, Middle Aged, Polyethylene Glycols, Polymers, Postoperative Complications/epidemiology, Retrospective Studies, Titanium, Treatment Outcome, Femur, Intramedullary device, Carbon fibre",

author = "Christian Marx and Tim Cheok and Allan Villadsen and Luis Munoz and Jaarsma, {Ruurd L} and Jakub Jagiello and Luke Johnson",

note = "{\textcopyright} 2025. Crown.",

year = "2025",

month = dec,

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doi = "10.1186/s12891-025-09411-3",

language = "English",

volume = "27",

pages = "54",

journal = "BMC Musculoskeletal Disorders",

issn = "1471-2474",

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T1 - Carbon fibre PEEK versus titanium cephalomedullary nails for management of oncological lesions of the femur

T2 - a retrospective cohort study

AU - Marx, Christian

AU - Cheok, Tim

AU - Villadsen, Allan

AU - Munoz, Luis

AU - Jaarsma, Ruurd L

AU - Jagiello, Jakub

AU - Johnson, Luke

PY - 2025/12/18

Y1 - 2025/12/18

N2 - BACKGROUND: 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.METHODS: 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).RESULTS: 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).CONCLUSION: 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.LEVEL OF EVIDENCE: Therapeutic III.

AB - BACKGROUND: 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.METHODS: 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).RESULTS: 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).CONCLUSION: 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.LEVEL OF EVIDENCE: Therapeutic III.

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KW - Aged

KW - Benzophenones

KW - Bone Nails/adverse effects

KW - Carbon

KW - Carbon Fiber

KW - Cohort Studies

KW - Female

KW - Femoral Neoplasms/surgery

KW - Fracture Fixation, Intramedullary/instrumentation

KW - Humans

KW - Ketones

KW - Male

KW - Middle Aged

KW - Polyethylene Glycols

KW - Polymers

KW - Postoperative Complications/epidemiology

KW - Retrospective Studies

KW - Titanium

KW - Treatment Outcome

KW - Femur

KW - Intramedullary device

KW - Carbon fibre

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U2 - 10.1186/s12891-025-09411-3

DO - 10.1186/s12891-025-09411-3

M3 - Journal article

C2 - 41408220

SN - 1471-2474

VL - 27

SP - 54

JO - BMC Musculoskeletal Disorders

JF - BMC Musculoskeletal Disorders

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ER -

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

Abstract

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