J Korean Bone Joint Tumor Soc.  2011 Jun;17(1):44-50. 10.5292/jkbjts.2011.17.1.44.

Surgical Treatment for Pathologic Fracture of Skeletal Metastatic Lesion of the Proximal Femur: Comparison of Clinical Outcomes for Prosthetic Joint Replacement and Osteosynthetic Fixation

• Shin DS
• Kim US
• Kwak HJ
• Ko YJ

• KMID: 2137043
• DOI: http://doi.org/10.5292/jkbjts.2011.17.1.44

Abstract

PURPOSE
To compare clinical outcomes of the tumor prosthetic replacement and osteosynthetic fixation for pathologic fracture of skeletal metastatic lesion of the proximal femur.
MATERIALS AND METHODS
From 1994 May to 2009 May, medical records of 22 patients who underwent tumor prosthetic replacement with tumor resection (group 1) and 15 others (16 hips) who underwent osteosynthetic fixation without tumor resection (group 2) were reviewed. The mean age of overall patients were 59 (group 1) and 60 (group 2). Mean follow up periods were 23 and 11 months. The oncological and functional results were evaluated with Kaplan-Meier methods and Musculoskeletal Tumor Society (MSTS) scoring system, 1993. The statistical evaluation was assessed with Log rank test and t-test.
RESULTS
The mean survival periods were 24 months in group 1 and 11months in group 2. The 1 year survival rates were 86% in group 1 and 50 % in group 2, and 2 year survival rates were 29.7% in group 1 and 9.4% in group 2. The mean MSTS functional score were 26.4 (19-30), 87.9% in group 1 and 15.3 (10-23), 51.0% in group 2.
CONCLUSION
The results of tumor resection and prosthetic replacement in selected cases was better than osteosynthetic fixation without tumor resection for metastatic bone tumors around proximal femur in oncological and functional aspects.

Keyword

proximal femur; metastatic bone tumor; tumor prosthetic replacement; osteosynthetic fixation

MeSH Terms

Femur
Follow-Up Studies
Fractures, Spontaneous
Humans
Joints
Medical Records
Survival Rate

Figure

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  Figure 1. Kaplan-Meier life table curves of group 1 and group 2.

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  Figure 2. (A) Pre-operative radiograph of subtrochanteric pathologic fracture of the right femur. (B) Immediate postoperative radiograph after osteosynthetic fixation without tumor resection. (C) Loss of fixation due to increased osteolysis with metastasis progression.

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  Figure 3. (A) Pre-operative radiograph of trochanteric pathologic fracture of the right femur. (B) Two months postoperative radiograph after proximal femur resection and tumor prosthetic replacement.

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  Figure 4. (A) Pre-operative radiograph of wide spreaded peritrochanteric pathologic fracture of the left femur (arrow: tumor extent). (B) Immediate postoperaive radiograph after bipolar hip replacement using long femoral stem.

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  Figure 5. (A) Pre-operative radiograph of right femoral neck fracture and shaft skip lesion with impending fracture (arrow: tumor site (femoral neck and skip metastasis)). (B) Two months postoperative radiograph after proximal femur resection and tumor prosthetic replacement using long femoral stem.

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