Surgical Treatment for Pathologic Fracture of Skeletal Metastatic Lesion of the Proximal Femur: Comparison of Clinical Outcomes for Prosthetic Joint Replacement and Osteosynthetic Fixation

Duk-Seop Shin; Ui-Sik Kim; Hae-jun Kwak; Young-Jin Ko

doi:10.5292/jkbjts.2011.17.1.44

Journal List > J Korean Bone Joint Tumor Soc > v.17(1) > 1051991

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Shin, Kim, Kwak, and Ko: Surgical Treatment for Pathologic Fracture of Skeletal Metastatic Lesion of the Proximal Femur: Comparison of Clinical Outcomes for Prosthetic Joint Replacement and Osteosynthetic Fixation

Original Article

J Korean Bone Joint Tumor Soc 2011;17(1):44-50.

Published online: 7 January 2011

DOI: https://doi.org/10.5292/jkbjts.2011.17.1.44

Surgical Treatment for Pathologic Fracture of Skeletal Metastatic Lesion of the Proximal Femur: Comparison of Clinical Outcomes for Prosthetic Joint Replacement and Osteosynthetic Fixation

Duk-Seop Shin, Ui-Sik Kim, Hae-jun Kwak, Young-Jin Ko

Department of Orthopedic Surgery, Yeungnam University College of Medicine, Daegu, Korea

Correspondence to: Duk-Seop Shin, M.D. Department of Orthopaedic Surgery, Yeungnam University Hospital, Daemyong-dong, Nam-gu, Daegu 705-717, Korea TEL: +82-53-620-3640 FAX: +82-53-628-4020 E-mail: shinds@med.yu.ac.kr

Received 21 March 201113 May 2011 Accepted 30 May 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare clinical outcomes of the tumor prosthetic replacement and osteosynthetic fixation for pathologic fracture of skeletal metastatic lesion of the proximal femur.

Materials and Methods

From 1994 May to 2009 May, medical records of 22 patients who underwent tumor prosthetic replacement with tumor resection (group 1) and 15 others (16 hips) who underwent osteosynthetic fixation without tumor resection (group 2) were reviewed. The mean age of overall patients were 59 (group 1) and 60 (group 2). Mean follow up periods were 23 and 11 months. The oncological and functional results were evaluated with Kaplan-Meier methods and Musculoskeletal Tumor Society (MSTS) scoring system, 1993. The statistical evaluation was assessed with Log rank test and t-test.

Results

The mean survival periods were 24 months in group 1 and 11months in group 2. The 1 year survival rates were 86% in group 1 and 50 % in group 2, and 2 year survival rates were 29.7% in group 1 and 9.4% in group 2. The mean MSTS functional score were 26.4 (19-30), 87.9% in group 1 and 15.3 (10-23), 51.0% in group 2.

Conclusion

The results of tumor resection and prosthetic replacement in selected cases was better than osteosynthetic fixation without tumor resection for metastatic bone tumors around proximal femur in oncological and functional aspects.

Keywords: proximal femur, metastatic bone tumor, tumor prosthetic replacement, osteosynthetic fixation

REFERENCES

1. Damron TA, Sim FH. Surgical treatment for metastatic disease of the pelvis and the proximal end of the femur. Instr Course Lect. 2000; 49:461–70.

2. Swanson KC, Pritchard DJ, Sim FH. Surgical treatment of metastatic disease of the femur. J Am Acad Orthop Surg. 2000; 8:56–65.

3. Lee SH, Kim HS, Kim SR, Park YB, Yoo KH, Lee HK. Functional outcome following surgical treatment of metastatic tumors involving the femur. Orthopedics. 2000; 23:1075–9.

4. Capanna R, Campanacci DA. Indications for the surgical treatment of long bone metastases. Jasmin C, Capanna R, Coia L, Coleman R, Saillant G, editors. Textbook of bone metastases. Chantilly: Wiley;2005. p. 135–46.

5. Jacofsky DJ, Haidukewych GJ. Management of pathologic fractures of the proximal femur: state of the art. J Orthop Trauma. 2004; 18:459–69.

6. Eckardt JJ, Kabo JM, Kelly CM, Ward WG Sr, Cannon CP. Endoprosthetic reconstructions for bone metastases. Clin Orthop Relat Res. 2003; 415(Suppl):S254–62.

7. Swanson KC, Pritchard DJ, Sim FH. Surgical treatment of metastatic disease of the femur. J Am Acad Orthop Surg. 2000; 8:56–65.

8. Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 1993; 286:241–6.

9. Talbot M, Turcotte RE, Isler M, Normandin D, Iannuzzi D, Downer P. Function and health status in surgically treated bone metastases. Clin Orthop Relat Res. 2005; 438:215–20.

10. Harrington K. Management of lower extremity metastases. Harrington K, editor. Orthopaedic management of metastatic bone disease. St. louis: CV Mosby;1998. p. 141–214.

11. Harrington K. Prophylactic management of impending fractures. Harrington K, editor. Orthopaedic management of metastatic bone disease. St. louis: CV Mosby;1988. p. 283–307.

12. Vincent T, Devita Jr. Principles & practice of oncology. 4th ed.Rosenberg: Steven A;1993. 160-1.

13. Harrington KD. New trends in the management of lower extremity metastases. Clin Orthop. 1982; 169:53–61.

14. Kim JD, Park PJ, Kwon YH, Jang JH, Lee YG. Surgical treatment of metastatic tumor in proximal femur with recycling autograft prosthetic composite after wide excision. J of Korean Bone & Joint Tumor Soc. 2005; 11:71–80.

15. Sim FH. Metastatic bone disease of the pelvis and femur. Instr Course Lect. 1992; 41:317–27.

16. Harrington KD, Sim FH, Enis JE, et al. Methylmethacrylate as an adjunct in internal fixation of pathologic fractures: experience with 375 cases. J Bone Joint Surg Am. 1976; 58A:1047–55.

17. Karachalios T, Atkins RM, Sarangi PP, Crichlow TP, Solomon L. Reconstruction nailing for pathological subtrochanteric fractures with coexisting femoral shaft metastases. J Bone Joint Surg Br. 1993; 75:119–22.

18. Van der Hulst RR, van den Wildenberg FA, Vroemen JP, Greve JW. Intramedullary nailing of (impending) pathologic fractures. J Trauma. 1994; 36:211–5.

19. Weikert DR, Schwartz HS. Intramedullary nailing for impending pathological subtrochanteric fractures. J Bone Joint Surg Br. 1991; 73:668–70.

20. Algan SM, Horowitz SM. Surgical treatment of pathologic hip lesions in patients with metastatic disease. Clin Orthop Rel Res. 1996; 332:223–31.

21. Sim FH, Frassica FJ, Chao EY. Orthopaedic management using new devices and prostheses. Clin Orthop Relat Res. 1995; 312:160–72.

22. Habermann ET, Sachs R, Stern RE, Hirsh DM, Anderson WJ Jr. The pathology and treatment of metastatic disease of the femur. Clin Orthop. 1982; 169:70–82.

23. Keating JF, Burke T, Macauley P. Proximal femoral replacement for pathological fracture. Injury. 1990; 21:231–3.

24. Hattori H, J Mibe, Matsuoka H, Nagai S, Yamamoto K. Surgical management of metastatic disease of the proximal femur. Journal of Orthopaedic Surgery. 2007; 15:295–8.

Figure 1.

Kaplan-Meier life table curves of group 1 and group 2.

Figure 2.

(A) Pre-operative radiograph of subtrochanteric pathologic fracture of the right femur. (B) Immediate postoperative radiograph after osteosynthetic fixation without tumor resection. (C) Loss of fixation due to increased osteolysis with metastasis progression.

Figure 3.

(A) Pre-operative radiograph of trochanteric pathologic fracture of the right femur. (B) Two months postoperative radiograph after proximal femur resection and tumor prosthetic replacement.

Figure 4.

(A) Pre-operative radiograph of wide spreaded peritrochanteric pathologic fracture of the left femur (arrow: tumor extent). (B) Immediate postoperaive radiograph after bipolar hip replacement using long femoral stem.

Figure 5.

(A) Pre-operative radiograph of right femoral neck fracture and shaft skip lesion with impending fracture (arrow: tumor site (femoral neck and skip metastasis)). (B) Two months postoperative radiograph after proximal femur resection and tumor prosthetic replacement using long femoral stem.

Table 1.

Patients Details

	Group 1 (n=22)	Group 2 (n=15, 16 hips)
Gender (M/F)	11/11	7/8
Mean age (yrs)	58.5 (23-80)	59.7 (55-75)
Mean F/U (month)	22.6 (3-108)	10.7 (1-33)

Table 2.

Primary Cancer and Location

	Group 1 (n=22)	Group 2 (n=15)
Primary cancer
Breast	6 (27%)	5 (33%)
Kidney	4 (18%)	4 (27%)
Lung	3 (14%)	3 (20%)
Others	9 (41%)	3 (20%)
Location
Head	2 (9%)	1 (7%)
Neck	3 (14%)	2 (13%)
Trochanter	12 (55%)	8 (53%)
Subtrochanter	5 (22%)	4 (27%)

Table 3.

Functional results (Musculoskeletal Tumor Society Scores)

Patient	Pain	Function	Emotional accept	Support	Walking ablity	Gait	Sum	Score (%)
No.	5	5	5	5	5	5	30	100
Group 1 (Endoprosthetic replacement with tumor resection)
1	5	3	5	5	4	4	26	86.67
2	5	5	5	5	4	4	28	93.34
3	5	3	5	4	3	3	23	76.67
4	3	3	4	3	3	3	19	63.33
5	5	5	5	5	5	4	29	96.67
6	5	5	5	5	4	4	28	93.34
7	5	4	4	5	4	4	26	86.67
8	4	4	5	4	4	4	25	83.33
9	5	4	5	4	4	3	25	83.33
10	4	5	5	4	4	4	26	86.67
11	4	5	5	4	4	4	26	86.67
12	5	5	5	5	5	5	30	100.00
13	4	4	4	4	3	4	23	76.67
14	4	4	4	4	3	3	22	73.33
15	5	5	5	5	5	5	30	100.00
16	4	4	5	5	5	4	27	90.00
17	5	5	5	5	5	4	29	96.67
18	5	5	5	5	5	4	29	96.67
19	4	4	4	5	4	4	25	83.33
20	5	5	5	5	4	4	28	93.34
21	5	5	5	5	4	4	28	93.34
22	5	5	5	5	4	4	28	93.34
Subtotal mean score	4.59	4.41	4.77	4.59	4.09	3.91	26.36	87.88
(%)	91.81	88.18	95.45	91.81	81.81	78.2	87.86	87.94
Group 2 (Internal fixation without tumor resection)
1	3	3	3	4	3	3	19	63.33
2	2	2	3	2	3	3	15	50.00
3	2	3	3	2	3	2	15	50.00
4	1	2	2	3	1	1	10	33.33
5	1	2	2	2	2	2	11	36.67
6	3	4	4	4	4	3	22	73.33
7	2	2	3	2	1	2	12	40.00
8	3	3	3	3	3	2	17	56.67
9	4	4	5	4	3	3	23	76.67
10	2	2	2	2	2	2	12	40.00
11	3	2	3	2	2	2	14	46.67
12	2	2	3	2	2	2	13	43.33
13	1	2	3	2	1	2	11	36.67
14	2	2	3	2	2	2	13	43.33
15	3	3	4	3	3	3	19	63.33
16	3	3	4	3	3	3	19	63.33
Subtotal mean score	2.31	2.56	3.13	2.63	2.38	2.31	15.31	50.22
(%)	46.25	51.25	62.5	52.5	47.5	74	51.04	51.04

TOOLS

Similar articles