Functional outcomes of displaced metastatic fractures of proximal femur: comparison between prosthetic replacement and intramedullary nailing
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20242380Keywords:
Displaced, Metastatic fracture, Proximal femur, Outcome, MSTS scoreAbstract
Background: Surgical treatments for proximal femur metastasis include prosthetic replacement (PR) and intramedullary nailing (IMN). Controversy persists regarding the most appropriate surgical option, and previous studies have mixed outcomes of patients with both displaced and impending fractures. This study aimed to assess the early functional outcomes in patients undergoing PR or IMN specifically for displaced metastatic fractures.
Methods: A retrospective cohort study was conducted on patients with displaced metastatic proximal femur fractures treated surgically between January 2013 and March 2023. Patients with metastases confined to the femoral head or neck without trochanteric extension, which is not an indication for IMN, were excluded. Patients were divided into PR and IMN groups. Functional outcomes were assessed using the Musculoskeletal Tumor Society (MSTS) score at three months postoperatively.
Results: Seventeen patients (10 females, 7 males; mean age 63.1±10.7 years) were treated with PR, and 31 patients (18 females, 13 males, mean age 61.4±11.3 years) were treated with IMN. Preoperative MSTS scores were similar between PR and IMN groups (3.8±2.6 vs. 2.9±1.6, p=0.179). Postoperatively, PR group had significantly higher MSTS scores (16.6±7.0 vs. 12.8±5.1, p=0.045), with better scores in function (p=0.028), supports (p=0.005), and walking (p=0.032). PR group had longer operative time (142 vs. 90 min) and greater blood loss (650 vs. 200 ml) compared to IMN group.
Conclusions: Patients with displaced proximal femur fractures from metastatic lesions had significantly higher MSTS scores with PR than with IMN at three months postoperatively.
References
Phanphaisarn A, Patumanond J, Settakorn J, Chaiyawat P, Klangjorhor J, Pruksakorn D. Prevalence and survival patterns of patients with bone metastasis from common cancers in Thailand. Asian Pac J Cancer Prev. 2016;17(9):4335-40.
Piccioli A, Rossi B, Scaramuzzo L, Spinelli MS, Yang Z, Maccauro G. Intramedullary nailing for treatment of pathologic femoral fractures due to metastases. Injury. 2014;45(2):412-7.
Feng H, Wang J, Xu J, Chen W, Zhang Y. The surgical management and treatment of metastatic lesions in the proximal femur: A mini review. Medicine (Baltimore). 2016;95(28):3892.
Meynard P, Seguineau A, Laumonerie P, Fabre T, Foltran D, Niglis L, et al. Surgical management of proximal femoral metastasis: Fixation or hip replacement? A 309 case series. Orthop Traumatol Surg Res. 2020;106(6):1013−23.
Steensma M, Healey JH. Trends in the surgical treatment of pathologic proximal femur fractures among Musculoskeletal Tumor Society members. Clin Orthop Relat Res. 2013;471(6):2000−6.
Yu Z, Xiong Y, Shi R, Min L, Zhang W, Liu H, et al. Surgical management of metastatic lesions of the proximal femur with pathological fractures using intramedullary nailing or endoprosthetic replacement. Mol Clin Oncol. 2018;8(1):107-14.
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.
Gao H, Liu Z, Wang B, Guo A. Clinical and functional comparison of endoprosthetic replacement with intramedullary nailing for treating proximal femur metastasis. Chin J Cancer Res. 2016;28(2):209-14.
Hindiskere S, Kim HS, Kim Y, Han I. Surgery for proximal femur metastases: endoprosthesis reconstruction or intramedullary nailing? Ann Joint. 2021;6:27.
Guzik G. Oncological and functional results after surgical treatment of bone metastases at the proximal femur. BMC Surg. 2018;18(1):5.
Gusho CA, Clayton B, Mehta N, Hmeidan W, Colman MW, Gitelis S, et al. Internal fixation versus endoprosthetic replacement of the proximal femur for metastatic bone disease: Single institutional outcomes. J Orthop. 2021;28:86-90.
Di Martino A, Martinelli N, Loppini M, Piccioli A, Denaro V. Is endoprosthesis safer than internal fixation for metastatic disease of the proximal femur? A systematic review. Injury. 2017;48(3):48-54.
Rizzo A, Paderno M, Saccomanno MF, Milano F, Milano G. The Musculoskeletal Tumor Society Scoring system is a valid subjective and objective tool to evaluate outcomes of surgical treatment of patients affected by upper and lower extremity tumors. Musculoskelet Surg. 2024;108:201-14.
