Total hip/knee arthroplasty in the treatment of tumor-induced osteomalacia patients: More than 1 year follow-up

Abstract

BackgroundTumor-induced osteomalacia (TIO) may result in a better prognosis after complete resection of the causative neoplasm. However, tumors located proximal to the articular surface of the metaphysis remain largely uninvestigated.MethodsA retrospective study of sixteen patients was undertaken to evaluate treatment of tumors with joint arthroplasty and tumor resection. The bone metabolism index, hip/knee joint function, arthroplasty complications and symptoms were followed up for at least 12 months in each patient.ResultsAll patients presented with neoplasms situated in the articular surface of the metaphysis, with 13 cases undergoing hip arthroplasty and 3 undergoing knee arthroplasty. Treatment of the tumors with joint arthroplasty and tumor resection significantly and rapidly ameliorate bone metabolism indexes in patients with TIO (p<0.01), with no identified tumor recurrence. The joint function evaluation score was improved in 15 patients (93.75%). Complications in these patients included post-operative pain, joint squeaking and secondary hyperparathyroidism.ConclusionsJoint arthroplasty that includes tumor-expanding resection appears to be a safe and appropriate method for the treatment of TIO patients with a neoplasm located in the metaphysis proximal to the articular surface.Level of evidenceTherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Hemiarthroplasty for tumor-induced osteomalacia caused by tumor localized in femoral head: a case report

“…Considering the residual seeding of the tumor, we chose hemiarthroplasty, as we decided that a total hip arthroplasty with manipulation on the acetabular side would be risky. However, given that a report of total hip and knee replacements for TIO showed good results in all the cases, and if the concerns of seeding and invasiveness could be dispelled, it might have been considered as an option [ 8 ]. In the present case, the surgical outcome proved to be effective, and the patient remained in biochemical remission, albeit for a short period of time.…”

Preoperative evaluation and orthopedic surgical strategies for tumor-induced osteomalacia

“…Further results showed that joint replacement and tumor resection can significantly and quickly improve bone metabolism indicators in TIO patients, without tumor recurrence during short-term follow-up [57] . Also, the postoperative joint function score of the patients was significantly improved [57] . The major postoperative complications in these patients mainly included postoperative pain, joint clicking, and secondary hyperparathyroidism [57] .…”

“…Moreover, joint replacement surgery is suitable for patients whose tumor cannot be completely removed since it may result in persistent symptoms [57] . Zhu et al [57] conducted a retrospective study with 16 TIO patients to evaluate the surgical treatment effect of joint replacement and tumor resection on PMTs and found that causative tumors were located on the metaphyseal joint surface after a one-year postoperative follow-up of bone metabolism index, hip/knee joint function, joint replacement complications, and symptoms. Thirteen cases were undergoing hip joint replacement, and three cases were undergoing knee joint replacement [57] .…”

“…Zhu et al [57] conducted a retrospective study with 16 TIO patients to evaluate the surgical treatment effect of joint replacement and tumor resection on PMTs and found that causative tumors were located on the metaphyseal joint surface after a one-year postoperative follow-up of bone metabolism index, hip/knee joint function, joint replacement complications, and symptoms. Thirteen cases were undergoing hip joint replacement, and three cases were undergoing knee joint replacement [57] . Further results showed that joint replacement and tumor resection can significantly and quickly improve bone metabolism indicators in TIO patients, without tumor recurrence during short-term follow-up [57] .…”

“…Thirteen cases were undergoing hip joint replacement, and three cases were undergoing knee joint replacement [57] . Further results showed that joint replacement and tumor resection can significantly and quickly improve bone metabolism indicators in TIO patients, without tumor recurrence during short-term follow-up [57] . Also, the postoperative joint function score of the patients was significantly improved [57] .…”