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Proximal femur replacement (PFR) or Proximal femur reconstruction is a way of salvaging excess bone loss in proximal femur and yet providing a total hip replacement

The article aims to highlight the technical difficulties and comorbidities associated with this complex procedure of proximal femur replacement. We retrospectively evaluated eight complex typical PFR cases performed under the care of same team of two surgeons, from 2013 to 2021, to highlight the various technical difficulties and complications that may be incurred during such a major salvage surgery. This was intended to help prepare the fellows, colleagues and future surgeons to have a plan of action and holistic approach towards the process. Average age of 87.4 years makes it a challenge both pre-operatively and post operatively in view of comorbidities existing in this age, apart from the technical difficulties of PFR. Complications observed were difficult rehabilitation, infection, pulmonary embolism deep vein thrombosis, dislocation, limb-length discrepancies and death. This is a level IV evidence case series with individual case description along with respective radiographs.