Surgical management of metastatic lesions of the proximal femur with pathological fractures using intramedullary nailing or endoprosthetic replacement

Yu, Zeping; Xiong, Yan; Shi, Rui; Li, Min; Zhang, Wenli; Liu, Hongyuan; Fang, Xiang; Duan, Hong

doi:10.3892/mco.2017.1503

Cited by 14 publications

(9 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As of 2017, IMN was used just as frequently as HA for PPFFs in our study population (41.8% for both). The rapid rise in rates of IMN is noteworthy given it coincides with several recent studies demonstrating endoprosthetic replacement may be the preferred treatment modality for PPFFs, especially for patients with longer expected survivals . Moreover, orthopedic oncologists most experienced in treating PPFFs favor endoprosthetic reconstruction for most patients.…”

Section: Discussionmentioning

confidence: 61%

Trends in the surgical treatment of pathological proximal femur fractures in the United States

Varady

Ameen

Schwab

et al. 2019

Journal of Surgical Oncology

View full text Add to dashboard Cite

Background and objectives Large scale data on the treatment of pathologic proximal femur fractures (PPFFs) are lacking. The purpose of this study was to evaluate trends in patient demographics, complication rates, and relative utilization rates of various techniques associated with PPFFs. Methods The American College of Surgeons‐National Surgical Quality Improvement Program (NSQIP) database was queried for PPFFs from 2009 to 2017. Patient demographics, 30‐day complications, and utilization rates were recorded. Trends in these variables were determined over the study period. Results Most patient demographics did not change during the study period. There were no trends toward decreasing rates of major complications (P = .82), reoperations (P = .65), non‐home discharges (P = .17), readmissions (P = .07), or deaths (P = .75); transfusion rates significantly decreased (P < .001). Rates of hemiarthroplasty decreased (P = .03) and rates of intramedullary nailing increased (P = .001). Discussion Despite advances in cancer therapeutics, the average PPFF patient has not significantly changed over the past decade. Similarly, most short‐term outcomes after PPFF surgery have not improved, demonstrating a need for improved perioperative protocols. Finally, rates of IMN fixation are increasing while rates of HA are falling at NSQIP hospitals. Given that orthopedic oncologists favor endoprosthetic reconstruction in most cases, there may be a need for increased communication between orthopedic oncologists and other members of the orthopedic community treating PPFFs.

show abstract

Section: Discussionmentioning

confidence: 61%

Trends in the surgical treatment of pathological proximal femur fractures in the United States

Varady

Ameen

Schwab

et al. 2019

Journal of Surgical Oncology

View full text Add to dashboard Cite

show abstract

“…In another study, Yu et al (13) . reported higher functional score for endoprosthesis group compared to IM nailing group at postoperative 6 months while longer survival, operative , and hospitalization times (10mo vs 7.5 mo, 142 min vs 98 min, 8 days vs 5 days),but lower complication rates (10% vs 29%) were observed in the prosthesis group.…”

Section: Discussionmentioning

confidence: 90%

“…reported higher functional score for endoprosthesis group compared to IM nailing group at postoperative 6 months while longer survival, operative , and hospitalization times (10mo vs 7.5 mo, 142 min vs 98 min, 8 days vs 5 days),but lower complication rates (10% vs 29%) were observed in the prosthesis group. Mostly medical complications were seen like thrombosis, infection with only one implant-related dislocation, while in the IMN group most complications were nail breakage or nonunion related to placement of implants (13) .…”

Section: Discussionmentioning

confidence: 95%

Proximal Femur Metastasis Treatment With Fixation or Hip Replacement. Results of 47 Patients

Aydemir¹,

Türemiş²,

Havıtçıoğlu³

et al. 2021

HIP

View full text Add to dashboard Cite

Objective: Purpose of the present study was to compare patients with proximal femur metastasis with actual or impending fractures who were treated by fixation or prosthetic hip replacement. Method: Twenty-seven patients underwent fixation treatment (IM nail, DHS), and 20 patients prosthetic (endoprosthesis or total hip arthroplasty) replacement. Data were analyzed regarding patient demographics, cancer type, localization and type of metastasis, actual or impending fracture, number of bone metastasis, presence of spinal or visceral metastasis and treatment data (ASA class, length of hospital stay or surgery or survival, cement usage, adjuvant treatment, postoperative walking status). Results: Fixation group (63 years) was younger than prosthesis group (70 years) (p: 0.03). Fixation was more preferred at subtrochanteric area (p˂0.001). Cementation of the lesion was more preferred and surgery time was longer at fixation group (p: 0.01). Greater number of complications (mostly medical) were more likely to be seen in the fixation group (6 ‘1 loosening’ vs 3 ‘1 dislocation’). Conclusion: It is not still clear whether one implant is clearly superior to other one, however it was revealed again that nailing was mostly preferred for the subtrochanteric area and tended to have more complications although mostly medical and unrelated to implant placement as previously reported

show abstract

“…The surgical treatment of proximal femur metastases is a hot topic for oncological surgeons still quite discussed. The recent literature shows different article in favor of hip replacement [ 2 , 36 ], other show similar result between the IN and the HM [ 15 , 37 , 38 ], while still others prove the safety of the IN [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Intramedullary nailing vs modular megaprosthesis in extracapsular metastases of proximal femur: clinical outcomes and complication in a retrospective study

Vitiello

Perisano

Greco

et al. 2022

BMC Musculoskelet Disord

View full text Add to dashboard Cite

Background Extracapsular proximal femur metastasis could be treated by synthesis or resection and megaprosthesis. No universal accepted guidelines are present in the literature. The aim of our study is to analyze of patients with metastases in the trochanteric region of the femur treated by a single type of intramedullary nailing or hip megaprosthesis. Methods We retrospectively reviewed all patients affected by extracapsular metastases of proximal femur. Anthropometric and anamnestic data, routine blood exams and complications were collected. VAS score and MSTS score was administered before the surgery, ad 1–6-12 months after surgery. An un-paired T test and Chi-square were used. Multiple linear regression and logistic regression was performed. Significance was set for p < 0.05. Result Twenty patients were assigned in intramedullary Group, twenty-five in megaprostheses Group. The mean operative time is shorter in intramedullary group. Differential shows a higher anemization in megaprostheses group (2 ± 2 vs 3.6 ± 1.3; p = 0.02). The patients of intramedullary group showed malnutrition (Albumin: 30.5 ± 6.5 vs 37.6 ± 6 g/L; p = 0.03) and pro-inflammatory state (NLR: 7.1 ± 6.7 vs 3.8 ± 2.4; p = 0.05) (PLR: 312 ± 203 vs 194 ± 99; p = 0.04) greater than megaprostheses group. The patients in intramedullary groups shows a higher functional performance score than megaprostheses group at 1 month follow-up (MSTS: 16.4 ± 6.3 vs 12.2 ± 3.7; p = 0.004). A multivariate analysis confirms the role of type of surgery (p = 0.001), surgery duration (p = 0.005) and NLR (p = 0.02) in affecting the MSTS. Globally eight complications were recorded, no statistical difference was noticed between the two groups (p = 0.7), no predictor was found at logistic analysis. Conclusion Intramedullary nailing guarantees a rapid functional recovery, compared to patients undergoing hip megaprosthesis who instead improve gradually over time. The selection of patients with poor prognosis allows the correct surgical indication of nailing, while in the case of a more favorable prognosis, the intervention of hip megaprosthesis is to be preferred.

show abstract

Surgical management of metastatic lesions of the proximal femur with pathological fractures using intramedullary nailing or endoprosthetic replacement

Cited by 14 publications

References 30 publications

Trends in the surgical treatment of pathological proximal femur fractures in the United States

Trends in the surgical treatment of pathological proximal femur fractures in the United States

Proximal Femur Metastasis Treatment With Fixation or Hip Replacement. Results of 47 Patients

Intramedullary nailing vs modular megaprosthesis in extracapsular metastases of proximal femur: clinical outcomes and complication in a retrospective study

Contact Info

Product

Resources

About