Metastatic bone disease in proximal femur. Outcome of surgical treatments. − Do we know what to do?

IF 3.5 2区医学 Q2 Medicine

Journal of Bone Oncology Pub Date : 2025-09-06 DOI:10.1016/j.jbo.2025.100711

K. Kilk , G. Kask , J. Nieminen , M.K. Laitinen

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引用次数: 0

Abstract

Background

Skeletal metastases related pathological fracture reconstruction methods in proximal femur range from osteosynthesis to tumor prostheses with acetabular reconstruction, depending on lesion size and location. This retrospective study, of 299 patients surgically treated for proximal femur metastases, investigates implant survival, complications, and functional outcomes of various surgical strategies for treating pathological fractures of the proximal femur.

Patients and methods

This retrospective study of 299 patients surgically treated for proximal femur metastases, investigates implant survival (Kaplan–Meier), complications, and functional outcomes of different surgical strategies. The chi-test and Mann-Witney U test were used for analysis between groups. The subdistribution Hazard Ratio (SHR) of the role of factors affecting implant survival was calculated using competing risk analysis.

Results

Reconstruction methods comprised osteosynthesis (n = 59), hemiarthroplasty (n = 72), total hip replacement (THA) (n = 43), and endoprosthetic replacement (EPR) either with or without acetabular component (n = 125). The precise location and size of the metastases was evaluated. The mean implant survival was 17 months (SD 21.2). Complications occurred in 33 patients, 20 required revision surgery. In prosthesis patients, infections and dislocations were the main complications, while mechanical failure predominated in the osteosynthesis group. Mean implant failure time was 11 months, shortest in THA and osteosynthesis. Functional outcomes in 38 patients showed a mean Oxford Hip Score (OHS) of 33, with no significant differences across methods.

Interpretation

Patient survival is a critical factor in selecting the appropriate reconstruction method for trochanteric metastatic lesions. Osteosynthesis is suitable for patients with a limited life expectancy. In cases of metastases involving the head-neck anatomical region, arthroplasty with acetabular reconstruction offers no advantage over hemiarthroplasty. With our data there was no statistical difference in functional outcome between different surgical methods.

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股骨近端转移性骨病。手术治疗的结果。−我们知道该怎么做吗？

背景：股骨近端骨转移相关的病理性骨折重建方法，根据病变的大小和位置，从骨融合术到髋臼重建的肿瘤假体不等。本回顾性研究纳入299例手术治疗股骨近端转移的患者，调查了治疗病理性股骨近端骨折的各种手术策略的植入物存活、并发症和功能结果。患者和方法本研究对299例股骨近端转移手术患者进行回顾性研究，调查不同手术策略的植入物存活（Kaplan-Meier）、并发症和功能结果。组间分析采用chi检验和Mann-Witney U检验。采用竞争风险分析计算影响种植体存活因素作用的亚分布风险比（SHR）。结果重建方法包括骨融合术（n = 59），半关节置换术（n = 72），全髋关节置换术（n = 43）和假体内置换术（n = 125），有或无髋臼假体（n = 125）。评估转移的精确位置和大小。种植体平均存活17个月（SD 21.2）。33例出现并发症，20例需要翻修手术。在假体患者中，感染和脱位是主要的并发症，而骨融合术组以机械故障为主。平均植入失败时间为11个月，THA和骨融合术最短。38例患者的功能结果显示牛津髋关节评分（OHS）平均为33，不同方法间无显著差异。解释：在选择合适的粗隆转移性病变重建方法时，患者的生存是一个关键因素。骨融合术适用于寿命有限的患者。在涉及头颈解剖区域的转移病例中，髋臼重建的关节置换术与半关节置换术相比没有优势。根据我们的数据，不同手术方式在功能结局上没有统计学差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Bone Oncology ONCOLOGY-

CiteScore

7.20

自引率

2.90%

发文量

审稿时长

34 days

期刊介绍： The Journal of Bone Oncology is a peer-reviewed international journal aimed at presenting basic, translational and clinical high-quality research related to bone and cancer. As the first journal dedicated to cancer induced bone diseases, JBO welcomes original research articles, review articles, editorials and opinion pieces. Case reports will only be considered in exceptional circumstances and only when accompanied by a comprehensive review of the subject. The areas covered by the journal include: Bone metastases (pathophysiology, epidemiology, diagnostics, clinical features, prevention, treatment) Preclinical models of metastasis Bone microenvironment in cancer (stem cell, bone cell and cancer interactions) Bone targeted therapy (pharmacology, therapeutic targets, drug development, clinical trials, side-effects, outcome research, health economics) Cancer treatment induced bone loss (epidemiology, pathophysiology, prevention and management) Bone imaging (clinical and animal, skeletal interventional radiology) Bone biomarkers (clinical and translational applications) Radiotherapy and radio-isotopes Skeletal complications Bone pain (mechanisms and management) Orthopaedic cancer surgery Primary bone tumours Clinical guidelines Multidisciplinary care Keywords: bisphosphonate, bone, breast cancer, cancer, CTIBL, denosumab, metastasis, myeloma, osteoblast, osteoclast, osteooncology, osteo-oncology, prostate cancer, skeleton, tumour.