Uncemented Arthroplasty After Hip Metastatic Disease and Multiple Myeloma

Abstract

Objective: To describe a case series using a combination of narrative, graphical exploratory analysis and Bayesian Network modeling. Methods: Case series with 34 patients undergoing uncemented and hybrid arthroplasty procedures secondary to hip pain or fracture secondary to metastatic disease or multiple myeloma. Results:The most common tumors included gastrointestinal, multiple myeloma and breast cancer. Most devices were total arthroplasty (n = 16, 84.2%) rather than partial and uncemented arthroplasty (n = 12, 63.2%) rather than hybrid. The average time between surgery and deambulation was 20 days, the average length of hospital stay was 13 days, and the average patient survival was 589 days. Only one infection was reported. Uncemented and hybrid arthroplasty devices did not differ regarding time to walk, as well as the length of hospital stay in this sample. Conclusion: Our model may be used as a prior for the addition of subsequent patient samples, personalizing, thus, its recommendations to other patient populations. Level of Evidence IV, Case series.

Total Hip Arthroplasty With Prophylactic Fixation of Greater Trochanter and Distal Femur in a Patient With a History of Multiple Myeloma and Breast Cancer

“…Given this patient's younger age and the presence of high bone quality throughout the femur, an uncemented, porous-coated stem was used. Although the data surrounding the use of cemented versus press-fit stems in oncologic patients are mostly neutral [10][11][12], this case demonstrates the successful use of an uncemented stem in a patient with adequate bone stock. In medically compromised patients, the use of an uncemented stem theoretically reduces surgical time, avoids risks associated with cement pressurization (hypotension, hypoxia, arrhythmias, etc.…”

Outcomes of press-fit uncemented versus cemented hip arthroplasty in the oncologic patient

“…Prior retrospective studies by Thein et al and Baptista et al have provided some support for the use of uncemented press-fit implants in the management of metastatic disease of the proximal femur. 3,23 Thein et al performed both uncemented THA and hemiarthroplasty on 60 proximal femurs for pathologic disease causing pathologic fracture or impending fracture and reported positive results with minimal complications and no apparent cases of periprosthetic fracture. 3 Baptista et al reported on 34 cases of arthroplasty procedures of the proximal femur performed with uncemented stems for multiple myeloma and again showed good outcomes, however their main conclusion was that cementing the cup for a THA did not have an impact on the length of hospitalization or time to ambulation.…”

“…3 Baptista et al reported on 34 cases of arthroplasty procedures of the proximal femur performed with uncemented stems for multiple myeloma and again showed good outcomes, however their main conclusion was that cementing the cup for a THA did not have an impact on the length of hospitalization or time to ambulation. 23 Neither of these studies included comparison groups of hip arthroplasty with cemented stems, so it is difficult to make any conclusions based off these limited studies.…”

“…21 While there are many studies comparing cemented and uncemented arthroplasty for the general population, there is a relative paucity of data regarding patients undergoing arthroplasty of the proximal femur for oncologic indications. [3][4][5][6][7][8][9][10][11][12][13]20,22,23 Thein et al retrospectively reviewed the outcomes of uncemented arthroplasty for metastatic disease of the hip and found comparable results with cemented arthroplasty when considering the following factors: prosthesis longevity, patient survival, postoperative function, and overall complication rate. 3 Similarly, a study of patients with metastatic disease of the proximal femur due to multiple myeloma showed favorable outcomes for patients undergoing uncemented arthroplasty.…”

“…3 Similarly, a study of patients with metastatic disease of the proximal femur due to multiple myeloma showed favorable outcomes for patients undergoing uncemented arthroplasty. 23 A 2018 Musculoskeletal Tumor Society (MSTS) survey by Reif et al supports no clear consensus on implant choice for treating pathologic disease of the proximal femur, but did note that when hemiarthroplasty was performed, 86.4% of respondents favored cemented hemiarthroplasty over uncemented hemiarthroplasty. 24 This study seeks to expand on the limited literature regarding cemented versus uncemented arthroplasty for patients with metastatic disease of the proximal femur.…”