Prophylactic Stabilization for Bone Metastases, Myeloma, or Lymphoma: Do We Need to Protect the Entire Bone?

Alvi, Hasham M.; Damron, Timothy A.

doi:10.1007/s11999-012-2656-1

Cited by 79 publications

(83 citation statements)

References 9 publications

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“…Alternative treatments have been associated with dislocation, infection, nonunion, and disease progression, often requiring reoperation. Intraoperative complications such as hypotension, oxygen desaturation, embolization, and cardiac arrest have also been reported [2,9,12,22,24,[26][27][28]. Of note, Barwood et al [4] reported acute oxygen desaturation and hypertension in 11 of 45 patients treated with intramedullary nail fixation for metastatic tumors of the femur with actual or impending fractures.…”

Section: Discussionmentioning

confidence: 99%

“…The procedure also enables the surgeon to remove all gross disease, minimize recurrence and hardware failure, and protect the rest of the femur against progressing disease [2]. Disadvantages of endoprosthetic reconstruction include hip dislocation, leg length discrepancy, blood loss during the procedure, and intraoperative hypotension.…”

Section: Introductionmentioning

confidence: 99%

“…Results Ten patients died of disease within the followup period. Before surgery, the median total MSTS score for the entire group of patients (n = 22) was 4.5 (range, 0-23), the median ECOG score was 3.5 (range, [1][2][3][4], and the median KPS score was 40 (range, . Postoperatively, the median total MSTS score (measured at most recent followup) for the entire group of patients was 21 (range, , the median ECOG score was 2 (range, 0-3, 68% B 2), and the median KPS score was 60 (range, 40-100).…”

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confidence: 99%

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

Peterson

Decilveo

O'Connor

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Traditional treatments for pathological fractures of the proximal femur resulting from metastatic bone disease include fixation with intramedullary nailing supplemented with polymethylmethacrylate, osteosynthesis with a plate-screw construct and polymethylmethacrylate, or endoprosthetic reconstruction. Despite the frequent practice of these treatments, treatment outcomes have not been rigorously compared. In addition, very few studies examine specific approaches to endoprosthetic reconstruction such as long stem hemiarthroplasty.Questions/purposes This study examines survival, functional outcomes, and complications associated with long stem hemiarthroplasty in a small group of patients treated for impending and actual pathologic fractures of the proximal femur resulting from metastatic bone disease. Methods Between 2012 and 2015, 21 patients were treated with long stem cemented hemiarthroplasty in 22 limbs. During that time, indications for this approach included lesions from metastases, myeloma, or lymphoma involving the proximal femur that resulted in an impending or actual pathological fracture. An impending fracture was classified as a painful lesion with at least 50% cortical erosion. During the study period, six patients with proximal femoral metastases not deemed to meet these indications were treated with other surgical approaches such as intramedullary nailing supplemented with polymethylmethacrylate and osteosynthesis with a plate-screw construct and polymethylmethacrylate. Mortality was tracked through medical records and phone calls to the patients and their families. Followup for the entire group of patients (n = 22) ranged from 1 to 27 months with a mean duration of 11 months. For patients with at least 1 year of followup (n = 11), the mean duration was 18 months (range, 12-27 months) and for patients with less than 1 year of followup (n = 11), the mean duration was 3 months (range, 1-11 months). Functional outcomes were evaluated according to the Musculoskeletal Tumor Society (MSTS) scoring system for lower extremities, the Eastern Cooperative Oncology Group (ECOG) Scale of Performance Status, and the Karnofsky Performance Scale (KPS) Index. Scores and complications were determined by direct patient examination, retrospective chart review, review of a longitudinally maintained institutional database, and followup phone calls. Results Ten patients died of disease within the followup period. Before surgery, the median total MSTS score for the entire group of patients (n = 22) was 4.5 (range, 0-23), Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research1 editors and board members are on file with the publication and can be viewed on request. Clinical O...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Peterson

Decilveo

O'Connor

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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“…Intramedullary nailing traditionally has been an accepted form of palliative treatment for patients with metastatic carcinoma, but we could find no studies that report specifically on intramedullary nailing of metastatic sarcoma lesions. Questions/purposes We asked: (1) What is the survival of patients with an impending or pathologic fracture from a sarcoma metastasis? (2) What proportion of patients treated with intramedullary nailing subsequently underwent a revision procedure or nail removal during their lifetimes?…”

Section: Introductionmentioning

confidence: 99%

Is It Appropriate to Treat Sarcoma Metastases With Intramedullary Nailing?

Moon

Dunbar

Lin

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Patients with primary bone and soft tissue sarcoma are at risk for skeletal metastases. Although uncommon, these metastases can result in impending or pathologic fractures. Intramedullary nailing traditionally has been an accepted form of palliative treatment for patients with metastatic carcinoma, but we could find no studies that report specifically on intramedullary nailing of metastatic sarcoma lesions. Questions/purposes We asked: (1) What is the survival of patients with an impending or pathologic fracture from a sarcoma metastasis? (2) What proportion of patients treated with intramedullary nailing subsequently underwent a revision procedure or nail removal during their lifetimes? Methods Between 1996 and 2014, we performed 40 intramedullary nailing procedures in 34 patients with multifocal metastases from sarcomas who showed signs or symptoms of impending fracture or who presented with a pathologic fracture. All of these patients are accounted for, either through the time of death or to the present, and all are included at a mean of 13 months (range, 0.3-86 months) in this retrospective study. During the study period, we generally applied the same surgical indications for patients with nailing of metastatic sarcoma lesions as we did for patients with metastatic carcinoma; in general, we used intramedullary nailing (with or without cement) rather than resection for diaphyseal lesions with less cortical destruction and no substantial soft tissue mass or metadiaphyseal lesions that could be adequately supplemented with cementation. The goal was to use this approach when it would allow immediate weightbearing, or in patients whose medical conditions were such that a more-extensive procedure seemed unsafe. During the same period, an additional 58 patients underwent resection procedures for metastatic sarcomas to long bones because they either did not meet the above indications, had a solitary resectable metastasis, or because of surgeon preference; these patients were excluded from this study. The median age of the patients was 52 years (range, 27-81 years). Eleven patients with 11 impending or pathologic fractures were documented to have received either preoperative or postoperative radiation therapy and 29 patients received some form of chemotherapy.

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“…In the current study, Price and colleagues reported transient cardiopulmonary derangements, but concluded that long-stem femoral implants are an appropriate surgical option, and remain their preference. However, another recent CORR 1 publication [1] found a lack of disease progression in patients with tumors other than myeloma and renal cell carcinoma, along with a similar rate of physiologic nonfatal complications. This led the senior author to state in the Editor's Spotlight/Take 5 interview [2], ''I have been less aggressive with putting in long-stem cemented femoral components that protect the entire femur.''…”

mentioning

confidence: 98%

CORR Insights®: Complications of Cemented Long-stem Hip Arthroplasties in Metastatic Bone Disease Revisited

Terek

2013

Clinical Orthopaedics &Amp; Related Research

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Prophylactic Stabilization for Bone Metastases, Myeloma, or Lymphoma: Do We Need to Protect the Entire Bone?

Abstract: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Cited by 79 publications

References 9 publications

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

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

Is It Appropriate to Treat Sarcoma Metastases With Intramedullary Nailing?

CORR Insights®: Complications of Cemented Long-stem Hip Arthroplasties in Metastatic Bone Disease Revisited

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