When is hemiarthroplasty preferable to intramedullary prophylactic fixation of malignant lesions of the proximal femur?

Abstract

There is no difference in survival or likelihood of unassisted ambulation after prophylactic femoral fixation with IM nails versus hemiarthroplasty in patients with metastatic disease of proximal femur.

When is hemiarthroplasty preferable to intramedullary prophylactic fixation of metastatic disease of the proximal femur?

“…First, though use of an extended Cox model is an excellent suggestion for handling time to event data when the proportional hazards assumption is not met, we would like to clarify that the proportional hazards assumption was in fact met in our survival analyses. As you have pointed out, in Figure of our study, the survival curves do cross at several points; however, the overall rate of failure is similar between groups, and a cross‐over in survival curves does not necessarily mean the proportional hazards assumption has been violated. We routinely check the proportional hazards assumption when building Cox models.…”

“…Log‐log plot to assess proportional‐hazards assumption for survival following hemiarthroplasty or IM nail fixation for impending pathologic fractures of the proximal femur due to metastatic disease. The data represented in this plot corresponds to the data presented in Figure 1 by Lin et al In this example, the proportional hazards assumption is not violated as the curves for the IM Nail (shown in black) and Hemiarthroplasty (shown in white) groups are parallel…”

“…As part of the descriptive data analyses, we routinely check for normal distribution of continuous data both by visual inspection of a histogram plot and statistically with the Shapiro‐Wilk goodness of fit test for normal distribution. If you examine the data as presented in Table 2 of our manuscript, you can appreciate that all continuous variables (with the exception of survival time) are presented with means and standard deviations as is appropriate for normally distributed data.…”

Comments on “When is hemiarthroplasty preferable to intramedullary prophylactic fixation of malignant lesions of the proximal femur?”

“…We were interested to read the paper authored by Lin et al that was published in Journal of Surgical Oncology . The authors purposed to determine if there are advantages of intramedullary (IM) fixation versus hemiarthroplasty in patients with impending fracture of the hip with metastatic disease in terms of postoperative survival, treatment failure, pain relief, and ability to ambulate without gait.…”

“…Otherwise, only variables with large effect would be remained in the model and Testimation bias may be yielded . So, the results of study conducted by Lin et al may be biased.…”