BACKGROUND: Proximal femoral fractures resulting from metastatic disease often require surgical management. Few studies have compared surgical techniques, and physicians' preferred strategies vary. This study compared revision and complication rates among surgical strategies. METHODS: The study consisted of a retrospective review of electronic medical records of 417 consecutive patients with proximal femoral metastasis or multiple myeloma who underwent intramedullary nailing (n = 302), endoprosthetic reconstruction (n = 70), and open reduction and internal fixation (n = 45) between 1999 and 2014 at two orthopaedic oncology centers. Primary outcome measures were revisions and 30-day systemic complications. Secondary outcome measures were total estimated blood loss, anesthesia time, duration of hospital admission, and 30-day survival. RESULTS: Revision rates did not differ between strategies (5.3% after intramedullary nailing, 11% after endoprosthetic reconstruction, and 13% after open reduction and internal fixation; P = 0.134). When reasons for revision were assessed separately, fixation failure was most common after open reduction and internal fixation (13% versus 3.0% after intramedullary nailing and none after endoprosthetic reconstruction; P < 0.001), whereas deep infection was most common after endoprosthetic reconstruction (8.6% versus 2.0% after intramedullary nailing and none after open reduction and internal fixation; P = 0.010). Overall systemic complication rates did not differ between strategies (8.3% after intramedullary nailing, 14% after endoprosthetic reconstruction, and 11% after open reduction and internal fixation; P = 0.268). CONCLUSION: Implant-specific complications and their timing should be considered in the choice of surgical strategy. Analysis of secondary outcomes and risk factors for systemic complications could aid in surgical decision making. LEVEL OF EVIDENCE: Therapeutic Level III.
BACKGROUND: Proximal femoral fractures resulting from metastatic disease often require surgical management. Few studies have compared surgical techniques, and physicians' preferred strategies vary. This study compared revision and complication rates among surgical strategies. METHODS: The study consisted of a retrospective review of electronic medical records of 417 consecutive patients with proximal femoral metastasis or multiple myeloma who underwent intramedullary nailing (n = 302), endoprosthetic reconstruction (n = 70), and open reduction and internal fixation (n = 45) between 1999 and 2014 at two orthopaedic oncology centers. Primary outcome measures were revisions and 30-day systemic complications. Secondary outcome measures were total estimated blood loss, anesthesia time, duration of hospital admission, and 30-day survival. RESULTS: Revision rates did not differ between strategies (5.3% after intramedullary nailing, 11% after endoprosthetic reconstruction, and 13% after open reduction and internal fixation; P = 0.134). When reasons for revision were assessed separately, fixation failure was most common after open reduction and internal fixation (13% versus 3.0% after intramedullary nailing and none after endoprosthetic reconstruction; P < 0.001), whereas deep infection was most common after endoprosthetic reconstruction (8.6% versus 2.0% after intramedullary nailing and none after open reduction and internal fixation; P = 0.010). Overall systemic complication rates did not differ between strategies (8.3% after intramedullary nailing, 14% after endoprosthetic reconstruction, and 11% after open reduction and internal fixation; P = 0.268). CONCLUSION: Implant-specific complications and their timing should be considered in the choice of surgical strategy. Analysis of secondary outcomes and risk factors for systemic complications could aid in surgical decision making. LEVEL OF EVIDENCE: Therapeutic Level III.
Authors: Julie J Willeumier; Mustafa Kaynak; Peer van der Zwaal; Sven A G Meylaerts; Nina M C Mathijssen; Paul C Jutte; Panagiotis Tsagozis; Rikard Wedin; Michiel A J van de Sande; Marta Fiocco; P D Sander Dijkstra Journal: Clin Orthop Relat Res Date: 2018-09 Impact factor: 4.176
Authors: Franz Liska; Philipp Schmitz; Norbert Harrasser; Peter Prodinger; Hans Rechl; Rüdiger von Eisenhart-Rothe Journal: Unfallchirurg Date: 2018-01 Impact factor: 1.000
Authors: Olivier Q Groot; Michiel E R Bongers; Colleen G Buckless; Peter K Twining; Neal D Kapoor; Stein J Janssen; Joseph H Schwab; Martin Torriani; Miriam A Bredella Journal: J Surg Oncol Date: 2022-01-13 Impact factor: 2.885
Authors: Taylor J Reif; Patrick K Strotman; Stephanie A Kliethermes; Benjamin J Miller; Lukas M Nystrom Journal: J Bone Oncol Date: 2018-02-27 Impact factor: 4.072
Authors: Peter K Twining; Olivier Q Groot; Colleen G Buckless; Neal D Kapoor; Michiel E R Bongers; Stein J Janssen; Joseph H Schwab; Martin Torriani; Miriam A Bredella Journal: J Am Acad Orthop Surg Glob Res Rev Date: 2022-03-09
Authors: Bas J J Bindels; Quirina C B S Thio; Kevin A Raskin; Marco L Ferrone; Santiago A Lozano Calderón; Joseph H Schwab Journal: Clin Orthop Relat Res Date: 2020-02 Impact factor: 4.755