Gilber Kask1, Jyrki Nieminen2, Michael C Parry3, Vincent van Iterson4, Toni-Karri Pakarinen5, Maire Ratasvuori6, Minna K Laitinen7. 1. Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland. Electronic address: gilber.kask@pshp.fi. 2. Coxa Hospital for Joint Replacement, Tampere, Finland. Electronic address: jyrki.nieminen@coxa.fi. 3. Royal Orthopaedic Hospital, Birmingham, UK. Electronic address: michael.parry3@nhs.net. 4. Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland; University of Helsinki, Helsinki, Finland. Electronic address: vincent.iterson-van@hus.fi. 5. Coxa Hospital for Joint Replacement, Tampere, Finland. Electronic address: tkpakarinen@me.com. 6. Department of Hand Surgery, Helsinki University Hospital, Helsinki, Finland. Electronic address: maire.ratasvuori@hus.fi. 7. Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland; University of Helsinki, Helsinki, Finland. Electronic address: minna.laitinen@hus.fi.
Abstract
INTRODUCTION: Skeletal metastases can weaken the bone, necessitating surgery, and surgical treatment options vary. The aim of this study was to investigate the revision rate of reconstructions in surgically treated diaphyseal skeletal metastases. MATERIALS AND METHODS: Between 2000 and 2018 at Helsinki and Tampere university hospitals in Finland, a total of 164 cases with diaphyseal skeletal metastases were identified from a prospectively maintained database. Tumor location was humerus, femur, and tibia in 106 (65%), 53 (32%), and 5 (3.0%) cases, respectively. A total of 82 (50%) cases were treated with intramedullary nailing (IMN), 73 (45%) with IMN and cementation, and 9 (5%) with another technique. RESULTS: In the upper extremity, implant survival (IS) was 96.4% at 1, 2, and 5 years; in the lower extremity, it was 83.8%, 69.1%, and 57.6% at 1, 2, and 5 years, respectively. Lower extremity IS for impending lesions was 100% at 1, 2, and 5 years, and in cases operated for true pathologic fracture, it was 71.6%, 42.9%, and 21.5% at 1, 2, and 5 years, respectively. In IMN cases without cement, the complication rate was 16% (13/82) when compared to 6% (4/73) in IMN cases with cementation. DISCUSSION: We would advocate for early intervention in patients with metastatic bone disease affecting the femur rather that watchful waiting with the risk for fracture and the need for urgent intervention. However, this choice must be balanced against the underlying risk of surgical intervention in a potentially fragile population with often limited prognoses.
INTRODUCTION: Skeletal metastases can weaken the bone, necessitating surgery, and surgical treatment options vary. The aim of this study was to investigate the revision rate of reconstructions in surgically treated diaphyseal skeletal metastases. MATERIALS AND METHODS: Between 2000 and 2018 at Helsinki and Tampere university hospitals in Finland, a total of 164 cases with diaphyseal skeletal metastases were identified from a prospectively maintained database. Tumor location was humerus, femur, and tibia in 106 (65%), 53 (32%), and 5 (3.0%) cases, respectively. A total of 82 (50%) cases were treated with intramedullary nailing (IMN), 73 (45%) with IMN and cementation, and 9 (5%) with another technique. RESULTS: In the upper extremity, implant survival (IS) was 96.4% at 1, 2, and 5 years; in the lower extremity, it was 83.8%, 69.1%, and 57.6% at 1, 2, and 5 years, respectively. Lower extremity IS for impending lesions was 100% at 1, 2, and 5 years, and in cases operated for true pathologic fracture, it was 71.6%, 42.9%, and 21.5% at 1, 2, and 5 years, respectively. In IMN cases without cement, the complication rate was 16% (13/82) when compared to 6% (4/73) in IMN cases with cementation. DISCUSSION: We would advocate for early intervention in patients with metastatic bone disease affecting the femur rather that watchful waiting with the risk for fracture and the need for urgent intervention. However, this choice must be balanced against the underlying risk of surgical intervention in a potentially fragile population with often limited prognoses.