Endoprostheses Last Longer Than Intramedullary Devices in Proximal Femur Metastases

Abstract

Background The proximal femur is the most common site of surgery for bone metastases, and stabilization may be achieved through intramedullary fixation (IMN) or endoprosthetic reconstruction (EPR). Intramedullary devices are less expensive, less invasive, and may yield improved function over endoprostheses. However, it is unclear which, if either, has any advantages. Questions/purposes We determined whether function, complications, and survivorship differed between the two approaches. Methods We retrospectively reviewed 158 patients with 159 proximal femur metastatic lesions treated with surgical stabilization. Forty-six were stabilized with IMN and 113 were treated with EPR. The minimum followup was 0.25 months (mean, 16 months; median, 17 months; range, 0.25-86 months). Results The mean Musculoskeletal Tumor Society score was 24 of 30 (80%) after IMN and 21 of 30 (70%) after EPR. There were 12 complications (26%) in the IMN group, including 10 nonunions, six of which went on to mechanical failure. There were complications in 20 of 113 (18%) of the EPR group, which consisted of 10 dislocations (9%) and 10 infections (9%). There were no mechanical failures with EPR. Both implants remained functional for the limited lifespan of these patients in each group at all time intervals. EPRs were associated with increased implant longevity compared with IMNs (100% versus 85% 5-year survival, respectively) and a decreased rate of mechanical failure (0% versus 11%, respectively) when compared with the intramedullary devices. Conclusions Patients with metastatic disease to the proximal femur may live for long periods of time, and these patients may undergo stabilization with either IMN or EPR with comparable functional scores and the implant survivorship exceeding patient survivorship at all time intervals. Endoprostheses demonstrate a lower mechanical failure rate and a higher rate of implant survivorship without mechanical failure than IMN devices.

What Are the Functional Results and Complications With Long Stem Hemiarthroplasty in Patients With Metastases to the Proximal Femur?

“…Not surprisingly then, nearly half of the patients in this series (10 of 21) died within 1 year of the hip reconstruction. This is comparable to the survivorship reported by Harvey et al [10], in which overall patient survival at 1 year after undergoing endoprosthetic reconstruction or intramedullary nail fixation for proximal femur metastases was 51%. Hattori et al [11] reported a 1-year survival rate of 69%, although this represents only eight patients who underwent endoprosthetic reconstruction.…”

Trends in the Surgical Treatment of Pathologic Proximal Femur Fractures Among Musculoskeletal Tumor Society Members

“…We reviewed the peer-reviewed literature from 1980 through 2011 and found 14 articles describing outcomes for IMN, PFRR, LSCH/CH, and ORIF in patients treated for femoral metastases. Notably, few studies examined proximal femur fractures specifically, and 14 of 15 studies were retrospective, citing either a retrospective cohort (Level of Evidence IV) or retrospective comparison design (Level of Evidence III) (Table 5) [2,4,5,[7][8][9][10][11][12][13][14][15][18][19][20]. A single, prospective study (Level I) was found that showed functional improvement in patients undergoing surgery for nonspinal bone metastases [17], but outcomes specific to the proximal femur were not reported.…”

Pathological femoral shaft fracture in a patient with a history of lobular carcinoma treated with bisphosphonates. A surgical approach

“…Istnieje wiele sposobów zaopatrzenia tego typu złamania: protezoplastyka resekcyjna, repozycja złamania i stabilizacja przy pomocy gwoździowania śródszpikowego lub płyty ze śrubami stabilnymi kątowo [4][5][6][7][8][9][10][11][12][13][14][15]. Najważniejsze w leczeniu chorego ze złamaniem patologicznym kości udowej jest wczesne rozpoznanie i minimalnie inwazyjna operacja pozwalająca na wczesną bezbolesną pionizację poprawiającą jakość życia [16,17,18].…”

“…There is a number of surgical approaches to such trauma: resection arthroplasty or fracture reposition, intramedullary nailing fixation or plate fixation using angular stable screws [4][5][6][7][8][9][10][11][12][13][14][15]. First of all, a patient with pathological femoral shaft fracture should be early recognized and treated with a minimally invasive surgery, which facilitates early and painless rehabilitation focused on bringing patient to the erect, life-quality improving, position.…”

“…This type of fracture may be treated operatively using plate [4][5][6][7][8] intramedullary nailing [9][10][11][12][13] or hip resection arthroplasty [14,15,8].…”