Alberto Di Martino1, Nicolò Martinelli2, Mattia Loppini3, Andrea Piccioli4, Vincenzo Denaro5. 1. Department of Orthopaedics and Trauma Surgery, Campus Bio-medico University of Rome, Via Alvaro del Portillo 200, 00128 Rome, Italy. Electronic address: dimartino.cbm@gmail.com. 2. Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20100 Milan, Italy. 3. Department of Orthopaedics and Trauma Surgery, Hip Diseases and Joint Replacement Surgery Unit, Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089 Rozzano (Milan), Italy. 4. Centro Oncologico di Palazzo Baleani, Policlinico Umberto I, 00186 Rome, Italy. 5. Department of Orthopaedics and Trauma Surgery, Campus Bio-medico University of Rome, Via Alvaro del Portillo 200, 00128 Rome, Italy.
Abstract
INTRODUCTION: Metastases to the proximal femur are usually managed surgically by tumor resection and reconstruction with an endoprosthesis, or by fixation with osteosynthesis. Still controversy remains regarding the most appropriate surgical treatment. We posed the following questions: (1) Is the frequency of surgical revision greater in patients treated with internal fixation than endoprosthetic reconstruction, and (2) Do complications that do not require surgery occur more frequently in patients treated with internal fixation rather than in those with endoprosthetic reconstruction? MATERIALS AND METHODS: A systematic review was performed of those studies reporting on surgical revision and complication rates comparing the two surgical methods. Ten studies including 1107 patients met the inclusion criteria, three with high methodological quality, three intermediate, and four with lowquality, according to the STROBE guidelines. RESULTS: At present, prosthetic dislocation is the most common complication observed in patients managed by prosthesis replacement of the proximal femur, while loosening was the main cause of reoperation in the fixation group. Time to reintervention ranged from 3 to 11.6 months for the prosthetic replacement and from 7.8 to 22.3 months for the fixation group. Non surgical complications, (mainly dislocations and infections) were more commonly observed in patients operated on by prosthetic replacement. CONCLUSIONS: Implant related complications and surgery-related morbidity should be taken into account in the decision-making process for the surgical management of these patients. These data can improve the surgeon-patient communication and guide further studies on patients' survival and complications with respect to surgery.
INTRODUCTION:Metastases to the proximal femur are usually managed surgically by tumor resection and reconstruction with an endoprosthesis, or by fixation with osteosynthesis. Still controversy remains regarding the most appropriate surgical treatment. We posed the following questions: (1) Is the frequency of surgical revision greater in patients treated with internal fixation than endoprosthetic reconstruction, and (2) Do complications that do not require surgery occur more frequently in patients treated with internal fixation rather than in those with endoprosthetic reconstruction? MATERIALS AND METHODS: A systematic review was performed of those studies reporting on surgical revision and complication rates comparing the two surgical methods. Ten studies including 1107 patients met the inclusion criteria, three with high methodological quality, three intermediate, and four with lowquality, according to the STROBE guidelines. RESULTS: At present, prosthetic dislocation is the most common complication observed in patients managed by prosthesis replacement of the proximal femur, while loosening was the main cause of reoperation in the fixation group. Time to reintervention ranged from 3 to 11.6 months for the prosthetic replacement and from 7.8 to 22.3 months for the fixation group. Non surgical complications, (mainly dislocations and infections) were more commonly observed in patients operated on by prosthetic replacement. CONCLUSIONS: Implant related complications and surgery-related morbidity should be taken into account in the decision-making process for the surgical management of these patients. These data can improve the surgeon-patient communication and guide further studies on patients' survival and complications with respect to surgery.
Authors: Charles A Gusho; Bishir Clayton; Nabil Mehta; Wassim Hmeidan; Matthew W Colman; Steven Gitelis; Alan T Blank Journal: J Orthop Date: 2021-11-08
Authors: Alberto Di Martino; Davide Pederiva; Barbara Bordini; Gabriele Di Carlo; Alessandro Panciera; Giuseppe Geraci; Niccolò Stefanini; Cesare Faldini Journal: J Orthop Traumatol Date: 2022-03-29