Clinical Orthopaedics and Related Research®

, Volume 470, Issue 3, pp 920–926

Endoprosthetic Treatment is More Durable for Pathologic Proximal Femur Fractures

  • Matthew Steensma
  • Patrick J. Boland
  • Carol D. Morris
  • Edward Athanasian
  • John H. Healey
Clinical Research

DOI: 10.1007/s11999-011-2047-z

Cite this article as:
Steensma, M., Boland, P.J., Morris, C.D. et al. Clin Orthop Relat Res (2012) 470: 920. doi:10.1007/s11999-011-2047-z

Abstract

Background

Pathologic proximal femur fractures result in substantial morbidity for patients with skeletal metastases. Surgical treatment is widely regarded as effective; however, failure rates associated with the most commonly used operative treatments are not well defined.

Questions/purposes

We therefore compared surgical treatment failure rates among intramedullary nailing, endoprosthetic reconstruction, and open reduction-internal fixation when applied to impending or displaced pathologic proximal femur fractures.

Patients and Methods

We retrospectively compared the clinical course of 298 patients who underwent intramedullary nailing (n = 82), endoprosthetic reconstruction (n = 197), or open reduction-internal fixation (n = 19) from 1993 to 2008. Primary outcome was treatment failure, which was defined as reoperation for any reason. Treatment groups were compared for differences in demographic and clinical parameters.

Results

The number of treatment failures in the endoprosthetic reconstruction group (3.1%) was significantly lower than in the intramedullary nailing (6.1%) and open reduction-internal fixation (42.1%) groups. The number of revisions requiring implant exchange also was significantly lower for endoprosthetic reconstruction (0.5%), compared with intramedullary nailing (6.1%) and open reduction-internal fixation (42.1%).

Conclusions

Endoprosthetic reconstruction is associated with fewer treatment failures and greater implant durability. Prospective studies are needed to determine the impact of operative strategy on function and quality of life.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  • Matthew Steensma
    • 1
    • 2
  • Patrick J. Boland
    • 2
  • Carol D. Morris
    • 2
  • Edward Athanasian
    • 2
  • John H. Healey
    • 2
  1. 1.Department of SurgeryMichigan State University College of Human MedicineGrand RapidsUSA
  2. 2.Department of Surgery, Orthopaedic Surgery ServiceMemorial Sloan-Kettering Cancer Center (affiliated with Weill Cornell Medical College)New YorkUSA